Imaging studies, along with physical exams of the breast, can lead doctors to suspect that a person has breast cancer. However, the only way to know for sure is to take a sample of tissue from the suspicious area and examine it under a microscope. This is known as a biopsy and it is the only test that can tell if cancer is present. It will help us to know if surgery is required and if so, the type of surgery required.
The gold standard method for biopsy of a breast abnormality is a core needle biopsy performed under image-guidance. This procedure is performed under local anesthesia and is highly accurate for diagnosis. If a breast cancer is diagnosed, surgery for treatment of the cancer can be appropriately planned without having required a separate surgery for diagnosis alone. In certain instances, a core needle biopsy is not technically feasible, in which case a surgical biopsy may be recommended for diagnosis.
This procedure is the most invasive of the biopsy techniques so is typically reserved when a core needle biopsy is not possible. During a surgical biopsy, your surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is large, only a sample will be taken (incisional biopsy). Even though this is considered surgery, this type of biopsy is generally performed on an outpatient basis.
A biopsy is a procedure done to remove tissue from an area of concern in the body. NOTE: If your Providence Saint Johns’ surgeon feels anything suspicious in your breast, or sees something suspicious on an imaging study, we will perform a biopsy on the same day so that we can facilitate your appropriate treatment without delay.
- An ultrasound- guided core needle biopsy is a less invasive procedure conducted using an ultrasound and a biopsy device.
- Stereotactic biopsy. This technique is used to sample and evaluate areas of concern, such as clusters of microcalcifications that are seen on mammogram alone. During the procedure, a radiologist trained in doing this procedure removes a tissue sample via a core needle, using stereo mammographic images as a guide. Stereotactic biopsy procedures are minimally invasive and are performed using local anesthesia. The entire procedure takes approximately one hour.
- MRI-guided biopsy. An MRI-guided biopsy is a vacuum-assisted biopsy for an abnormality seen only on MRI and uses the MRI to locate the area of abnormality.
- Surgical biopsy is done in the hospital on an outpatient basis with a light anesthetic and local anesthesia. It is often done if the results of a needle biopsy are unclear or if it is not possible to do a needle biopsy.
The tissue specimen is examined by a pathologist to see whether or not cancer cells are present. If cancer is present, the pathologist can then look at the cancer’s characteristics. The biopsy will result in a report that lays out all of the pathologist’s findings.
Types of biopsies include:
Fine-needle aspiration biopsy
The doctor uses a thin, hollow needle to withdraw cells from the lump. He or she then analyzes the specimen under the microscope to look for abnormal cells. This type of biopsy is losing favor since a limited amount of information can be gained.
Core needle biopsy
This has largely replaced fine needle aspiration as a method for establishing a tissue diagnosis. The radiologist or surgeon uses a biopsy device to remove tissue samples from a breast abnormality. The advantage of a core needle biopsy is that it removes more tissue for analysis so it is both more accurate for diagnosis and more useful for evaluation of a cancer.
Sentinel node biopsy/sentinel lymphadenectomy
Surgeons at the Margie Petersen Breast Center pioneered an innovative technique called Sentinel Node Biopsy, now used in cancer centers worldwide. It helps to more accurately determine the stage of the patient's cancer by detecting if it has spread to nearby lymph nodes, without using radical surgery.
During this procedure, surgeons inject blue dye or radioisotope into the primary tumor and follow it to the lymph nodes under the arm. Anything that appears to be blue or shows as “radioactive” can be removed. This is the same lymph node to which the cancer would have spread if it indeed did spread. By looking at this blue or radioactive lymph node, the stage of the cancer can be determined without radical surgery.
Sentinel Node Biopsy (lymphatic mapping) identifies, with extraordinary accuracy, the lymph node most likely to contain cancer cells that have migrated from the primary tumor. If that lymph node is cancer-free, it is highly likely that the other lymph nodes are also cancer-free so there isno need to remove them. More recent data has also demonstrated that even if the sentinel node is positive, no additional lymph node surgery may be required, so the sentinel node biopsy has essentially replaced axillary dissection as the method of staging the axilla.