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What Is a Biopsy?

A lumpLump:
A mass that can be found in the breast or elsewhere in the body. This can also be called a nodule.
or other change in the breast is not necessarily a sign of cancer. There are many breast conditions that are benignBenign:
Not cancerous. This is also referred to as non-malignant.
, or noncancerous.

If a lump or other change in the breast is found, your health care provider will first order additional imaging tests, such as a diagnostic mammogramMammogram (also called mammography):
A low-dose X-ray of the breast. It is used to take images of the breasts and is an important screening tool for the earlier detection of breast cancer.
and/or an ultrasoundUltrasound:
An imaging technique that uses sound waves to take a picture of structures in the body, such as the breast.
of the breast. These are usually the first diagnostic tests to be done when investigating a breast abnormality. For most women, a diagnostic mammogram and/or ultrasound is able to confirm when a breast change is benign and rule out cancer. 

To know for sure whether a breast change is cancer, however, your health care provider may order a breast biopsyBiopsy:
A procedure in which tissue samples are removed from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
. A biopsy is the removal of a sample of breast cells or tissue to be checked in a lab for signs of cancer. This procedure may be the only way to be certain that a breast problem is breast cancer.

The experience of a having a biopsy will differ, depending on what type is required. If a biopsy is recommended for you, find out what type you will be having so you will know what to expect. The three main types are fine needle aspiration biopsy, core biopsy and surgical biopsy.

Fine-Needle Aspiration Biopsy

A fine-needle aspiration (FNA) biopsy may be done to remove some cells from a breast lump or lymph nodeLymph nodes:
Small structures that filter lymph fluid for harmful substances. They contain immune cells that can help fight infection by attacking and destroying germs. Cancer can travel through the lymphatic system spread to the lymph nodes.
. It can usually be done as an outpatient procedure, and you can go home immediately after. A thin needle is inserted to reach the affected area of your breast, and a syringe is used to draw out (aspirate) the cells that will be sent to the lab for analysis. If the lump is located deep within the breast tissue and cannot be felt easily, it may be aspiratedAspiration (biopsy):
Removing tissue or fluid from a lump or cyst with a needle into a syringe or other suction device.
by a radiologistRadiologist:
A doctor who specializes in reading tests such as ultrasounds and X-rays. A radiologist may also perform core biopsies and use imaging techniques to guide cancer treatment.
using ultrasound, mammogram, or MRIMagnetic Resonance Imaging (MRI):
An imaging technique that uses powerful magnetic fields and radio waves to create detailed, 3-dimensional images of the organs and tissues in the body, such as the breast.
to guide the needle. The actual procedure usually takes a few minutes, although it may take longer if the lump is harder to locate. A small bandage will be used to cover the area afterward. If breast cancer is diagnosed by FNA, it is not possible to say whether the type is invasiveInvasive (breast cancer):
Cancer that spreads from where it started in the breast (i.e., the breast ducts or lobules) into surrounding, healthy breast tissue.
or not. A core biopsy, which can distinguish between invasive and noninvasive breast cancers, may be required as a next step.

You may experience some temporary bleeding or soreness from the needle wound. This is a common side effect and it should go away on its own. A common myth is that needle biopsy causes cancer cells to spread (metastasizeMetastatic (metastases):
The spread of cancer from its original (primary) location to another part of the body. A tumour that is formed by cancer cells that have spread to another part of the body is called a “metastatic tumour” or a “metastasis.”
). Research shows that having a biopsy does not increase the risk of metastasis. The benefits of being diagnosed early far outweigh the risks of having a biopsy. If you have any questions or concerns about having a biopsy, ask your health care provider beforehand.

Core Biopsy

A core biopsy uses a special hollow needle to remove a small cylinder-shaped sample of affected breast cells and the tissue surrounding them. A core biopsy can be used to remove tissue from a lump, or other breast abnormality that is seen on a mammogram or other imaging test. As with FNA biopsy, the procedure can usually be done as an outpatient procedure and doesn’t take very long.

The breast will be anesthetizedAnesthesia:
The administration of medication during a medical procedure or surgery to control pain. Anesthesia can be local or regional where a part of the body is numbed, or general where it induces unconsciousness and complete pain control.
(frozen by injection) to lessen the discomfort and the doctor will make a small cut over the area of the lump. The needle will then be inserted into the lump and a small sample of tissue will be removed and sent to a lab. An ultrasound or other imaging method may be used to help guide the needle into the lump when performing the core biopsy. A small bandage will be used to cover the area afterward.

You may experience some temporary swelling, bleeding or soreness at the biopsy site. There may also be minor bruising. These are normal side effects from the procedure and should go away on their own as the wound heals. Normal activities can usually be resumed within 24 hours.   However, if side the side effects persist or get worse, contact a health care provider. Infection at the biopsy site is rare, but if you think it has become infected, seek medical care right away.

Surgical Biopsy

A surgical biopsy is an operation to remove the breast tissue sample to be tested. Depending on the nature and location of the lump or breast change, a surgical biopsy may be the best option. In most cases, a biopsy will be done that removes all of the lump or affected area, and may also remove a small amount of the surrounding normal tissue.  For some very early stageStage:
A way of classifying breast cancer that describes how far a cancer has spread. It identifies whether breast cancer is at an early, locally advanced or metastatic stage. The stage of breast cancer can sometimes be represented as a number (e.g. between 0 and 4).
cancers, a biopsy to remove the entire lump may be the only treatment required.

A surgical biopsy is usually done under general anesthetic. The doctor will make a small cut in the area over the lump, and remove tissue to be sent to the lab. The incisionIncision:
A cut made into the skin or other body tissue as part of a medical procedure or surgery.
is closed using stitches, although staples are very occasionally used.

You may experience some temporary swelling, bleeding, minor bruising or soreness from the surgical wound. There will also be a scar at the site of the surgery that tends to fade with time. You should be able to resume normal activities within 24 hours.

What happens after my biopsy?

After the tissue sample has been taken, it is sent to a lab to be examined by a pathologistPathologist:
A doctor who specializes in the diagnosis of disease by examining cells, body fluids and tissue.
. A pathologist is a doctor who specializes in the diagnosis of disease by examining cellsCell:
The basic structural and functional unit of all organisms.
, body fluids and tissues. The pathologist will send a report to your health care provider stating whether the tissue is benign (not cancer), cancerous, or if the result is not certain. Your health care provider will discuss the results with you, including whether any further tests, procedures, treatment or follow-up care is necessary.

Waiting for a diagnosis can be a stressful time. During a biopsy, don’t be afraid to ask about when you can expect to receive results, or to take the initiative to follow up with your health care provider.

Improving Wait Times

The Working Group on the Integration of Screening and Diagnosis of the Canadian Breast Cancer Screening Initiative has set targets for the wait time between receiving an abnormal breast cancer screening result and diagnosis. These target wait times are for abnormalities that are found during screening as part of an organized screening program. If a tissue biopsy is required, the target is for at least 90% of cases to have a diagnosis within 7 weeks. Currently, median wait times for diagnosis for women who require a biopsy can range from 5 to 7 weeks, but can take longer in some parts of Canada.

 

Sources:

Canadian Cancer Society. Tests and Procedures. Accessed January 2, 2014. (pages on fine needle, core, and surgical biopsy were accessed)

Canadian Partnership Against Cancer (2012). Breast Cancer Control in Canada: A System Performance Special Report. Accessed January 2, 2014.

Peters-Engel, C., Konstantiniuk, P., Tausch, C., Haid, A., Hoffman, B., Jagoutz-Herzlinger, M., … Steinmassl, D. (2004). The impact of preoperative breast biopsy on the risk of sentinel lymph node metastasis: analysis of 2502 cases from the Austrian sentinel node biopsy study group. British Journal of Cancer, 91 (10), 1782-1786).