What is Breast Biopsy? Types, Risks, and Results

Breast biopsy is the process of taking a tissue sample from the breast using various methods and examining it under a microscope. Biopsy, a widely used diagnostic method worldwide, helps confirm diagnoses in cases where various health issues, particularly cancer, are suspected. Breast biopsy can be performed using different methods depending on factors such as how the tissue is extracted and how specialists identify the suspicious area during the biopsy. The only way to determine whether the suspicious tissue detected in the breast contains cancer cells or benign formations such as fibrosis, cysts, or breast calcifications is through biopsy.

What is Breast Biopsy and When is it Performed?

Breast biopsy is the procedure of taking a tissue sample from a suspicious area detected during a physical examination or with the help of imaging techniques such as ultrasound or mammography, and examining it in a laboratory environment (1, 2). Not all lumps felt or detected in the breast indicate cancer. Conditions such as cysts, which are fluid-filled sacs, or masses like fibroadenomas, as well as breast calcifications, can also cause changes in breast tissue. Therefore, to diagnose breast cancer, it is essential first to determine whether the lump is cancerous.

When specialists notice any suspicious area in the breast during a physical examination, they typically examine the breast using imaging techniques such as ultrasound or mammography to be sure. If a mass is detected as a result of these imaging methods, they may decide to perform a biopsy to confirm or rule out the suspicion of breast cancer. The main situations in which a breast biopsy is performed include:

• The patient or the specialist doctor notices a lump in the breast and suspects it may be breast cancer,
• A suspicious area is detected in the breast as a result of imaging methods such as ultrasound, magnetic resonance imaging, or mammography,
• Abnormal conditions such as crusting, indentation, or discharge around the nipple or the dark ring surrounding the breast, also known as the areola.

If one or more of the above situations occur, specialists may decide to perform a breast biopsy.

How is Breast Biopsy Performed and What are its Types?

Breast biopsy, one of the frequently performed procedures to diagnose the suspicious area detected in the breast, is usually carried out under local anesthesia. However, in cases where surgical or excisional breast biopsy is performed, general anesthesia may also be used. The main types of breast biopsy are as follows, depending on how the tissue is extracted from the breast:

• Fine Needle Aspiration Biopsy (FNAB): This method is preferred for lumps that can generally be felt during a physical examination. It involves taking a sample from breast tissue using a needle and a syringe.
• Core Needle Biopsy: Similar to fine needle aspiration biopsy, this biopsy method uses a larger needle to obtain a sample. While specialists usually do not need imaging methods like ultrasound during fine needle biopsy, core needle biopsy is often performed under the guidance of imaging methods such as ultrasound, mammography, or MRI.
• Vacuum-Assisted Core Biopsy: This type of breast biopsy starts with an incision, after which the specialist places a biopsy needle into the incision area. Then, using a vacuum device, breast tissue is drawn into the needle. This procedure allows for the removal of more tissue compared to standard needle biopsy and is usually performed with the assistance of methods like mammography or ultrasonography.
• Excisional Breast Biopsy (Lumpectomy): Also known as excisional biopsy, this procedure involves surgically removing breast tissue. Excisional breast biopsy is generally performed under local anesthesia but can also be done with mild sedation depending on the patient’s overall health and preferences. During the procedure, surgeons cut the breast tissue while the patient is under anesthesia and remove the suspicious area along with a margin of surrounding breast tissue.
• Incisional Breast Biopsy: Unlike lumpectomy, during incisional biopsy, the surgeon removes only a portion of the suspicious area instead of the entire lump.

In addition to the above, breast biopsy can also be classified into different categories based on the imaging technique used by the surgeon during the biopsy. The main types of breast biopsy based on the imaging methods used are as follows:

• Stereotactic Breast Biopsy: This type of biopsy utilizes mammograms to accurately locate the suspicious breast tissue. During the procedure, specialists use a mammography machine that takes multiple X-rays of the breast to locate the suspicious tissue. The obtained images are transferred to a computer, allowing specialists to determine the area for biopsy and remove the suspicious tissue using needle aspiration or vacuum-assisted biopsy.
• Ultrasound-Guided Core Needle Biopsy: In this type of core needle biopsy, the breast tissue is visualized using an ultrasonography device that employs high-frequency sound waves to identify the suspicious area. A small incision is made to place the needle, and the suspicious tissue is removed.
• MR-Guided Breast Biopsy: This type of biopsy utilizes magnetic resonance imaging to accurately place the needle in the suspicious area.

Specialists decide on the technique to use for tissue removal based on factors such as the size and location of the suspicious tissue, the patient’s overall health, and personal preferences.

What Preparations Should the Patient Make Before Breast Biopsy?

Although breast biopsy is a simple medical procedure, the patient may need to make some preparations beforehand. First, the patient should inform the physician about all medications they regularly take. Especially medications with blood-thinning properties or various herbal products may increase the risk of bleeding during the procedure, so it may be necessary to pause these medications under the doctor’s supervision before the procedure. Additionally, patients should inform specialists about their medical history, existing health issues, known allergies, and whether they are pregnant. Specialists may advise patients undergoing sedation to refrain from eating and drinking for a while before the procedure. It is important to follow the doctor’s instructions for a smoother anesthesia experience.

What are the Risks and Complications that May Occur During and After Breast Biopsy?

Breast biopsy is generally considered a safe procedure, but like any medical procedure, there are risks and complications that may arise during and after the procedure. Pain from the breast biopsy is one of the most commonly reported complications by patients. This usually resolves on its own within a few days. In some cases, specialists may also prescribe pain relief medications. Possible complications of breast biopsy include:

• Changes in the appearance of the breast depending on the size of the tissue removed,
• Redness, bruising in the breast,
• Swelling,
• Rarely, infection at the biopsy site.

It is important to inform specialists if the above symptoms persist for a long time and are accompanied by signs such as fever.

How Long Does it Take to Get Breast Biopsy Results and How are the Results Interpreted?

Breast biopsy results typically come out within 1-2 weeks, but this duration may vary depending on factors such as the length of the procedure, whether a special dye was used during the procedure, or if a second opinion is sought from another pathology specialist. The breast biopsy report primarily indicates whether the tissue is cancerous, precancerous (precursor), or benign. If the breast biopsy is cancerous, details such as the type of tumor (e.g., ductal or lobular), size, and biological characteristics, especially hormone receptor positivity, are specified in the report. This allows specialists to determine the method to be used in the treatment of cancer. The report also includes the physical characteristics of the lesion, whether the cancer is present within or near the removed tissue (negative margin, positive margin, or close margin), and anomalies in the cellular structure. If a positive margin is detected, additional surgical intervention may be necessary to completely remove the tumor. Additionally, pathology and radiology results are expected to be consistent with each other. In cases where this consistency is not achieved, additional biopsies may be required.

Frequently Asked Questions

Do not neglect regular check-ups for your breast health. If you notice a suspicious lump or want more information about breast biopsy, you can make an appointment with our Interventional Radiology specialists at Hisar Hospital here. Early diagnosis saves lives!