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Breast biopsy

Definition

A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders. Several different types of biopsy may be done. This article discusses open breast biopsy. An open biopsy involves making a small cut in the breast and removing breast tissue.

See also:

• Breast biopsy - stereotactic
• Breast biopsy - ultrasound
• Lumpectomy

Alternative Names

Biopsy - breast; Open breast biopsy

How the test is performed

An open biopsy may remove part (incisional biopsy) or all (excisional biopsy) of the area of interest. If the entire lump or area of interest is removed, this method may also be called a lumpectomy.

If the surgeon cannot easily feel the lump or cyst, breast ultrasound or mammography may be used before the biopsy. A needle or wire is placed in the area of interest. This will be left in to help the surgeon.

The biopsy will be done in an operating room.

• Usually, you lie on your back for the procedure. You may receive local anesthesia with medicine to make you sleepy or you may receive general anesthesia.
• A surgical cut is made in the skin. The wire and breast tissue around it are removed. Sometimes, testing is done at the time of the procedure, but a final diagnosis takes more time.
• After the tissue sample is taken, the cut is closed with sutures. A dressing and bandage are applied.

If you receive general anesthesia, your vital signs (temperature, pulse, rate of breathing, blood pressure) will be monitored for at least an hour after the procedure. Your health care provider may prescribe pain medication.

How to prepare for the test

The health care provider will ask questions about your medical history and perform a manual breast exam.

You must sign an informed consent form. If you are going to have general anesthesia, you may be asked not to eat or drink anything for 8 - 12 hours before the test.

If you take medications (including aspirin or herbal medications), ask your doctor whether you need to stop taking these before the biopsy.

Tell your doctor if you may be pregnant before having an open biopsy.

Do not wear lotion, perfume, powder, or deodorant underneath your arms or on your breasts.

How the test will feel

After the test, the breast may be sore and tender to the touch for several days. If a surgical cut is made, your doctor may prescribe pain medication.

You will probably go home the day of the procedure.

Do not do any heavy lifting for 24 hours after the biopsy. Do not take a shower for the first 24 hours.

Why the test is performed

A biopsy may be done if the doctor is concerned about breast cancer because of abnormal findings on a mammogram or breast ultrasound, or seen during a physical exam.

To determine whether someone has breast cancer, a biopsy must be done. Cells from the abnormal area are removed and examined under a microscope.

Normal Values

A normal result means there is no sign of cancer.

Your doctor or nurse will let you know when you need a follow-up mammogram or other tests.

What abnormal results mean

Biopsy may identify a number of breast conditions that are not cancer or precancer, including:

• Adenofibroma
• Fibrocystic breast disease
• Intraductal papilloma
• Mammary fat necrosis

Biopsy results may show the following precancerous breast conditions:

• Atypical ductal hyperplasia
• Atypical lobular hyperplasia

Two main types of breast cancer may be found:

• Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
• Lobular carcinoma starts in parts of the breast called lobules, which produce milk.

Depending on the biopsy results, you may need further surgery or treatment.

What the risks are

There is a slight chance of infection at the injection or incision site.

Excessive bleeding is rare, but may require draining or re-bandaging. Bruising is common.

There will be a small scar. Depending on the amount of tissue removed and how the breast heals, the appearance of the breast may be affected.

References

Abeloff MD, Wolff AC, Weber BL, et al. Cancer of the breast. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 95.

Whitman GJ. Ultrasound-guided breast biopsies. Ultrasound Clin. 2006;1:603-615.

Kim CH, Bassett LW. Imaging-guided core needle biopsy of the breast. In: Bassett LW, Jackson VP, Fu KL, Fu, YS. Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2005:chap 17.