Breast Biopsy

What is a breast biopsy?

A breast biopsy is a procedure that involves using a biopsy needle or surgery to remove a sample of your breast tissue so that a pathologist can examine it for breast cancer or other conditions.

A breast biopsy is the only diagnostic procedure that can definitively determine if a suspicious area is cancerous.

What is a breast biopsy used for?

Your healthcare provider may have you undergo a breast biopsy to confirm or rule out breast cancer or another condition. Providers usually recommend breast biopsies after other tests, such as a mammogram or a physical breast exam, when they show that there might be a chance of breast cancer.

What are the different kinds of breast biopsies?

There are many types of breast biopsy procedures. Your healthcare provider will recommend the type that’s best for you based on certain factors, including:

• The size of the suspicious area in your breast.
• The location of the suspicious area in your breast.
• How concerning the suspicious area looks.
• If they can feel the suspicious tissue with a physical exam or not.
• Your overall health and personal preferences.

The different types of breast biopsies, based on how your provider removes breast tissue, include:

• Fine-needle aspiration (FNA) biopsy: For this biopsy, your provider uses a thin needle and syringe to draw out a sample of your breast cells or fluid. This biopsy is usually for breast lumps that you can feel with a physical exam, and your provider may not need an imaging system to find the lump that’s being biopsied.
• Core needle biopsy: For this biopsy, your provider uses a larger, hollow needle to remove one sample of your breast tissue per injection. This type of biopsy usually involves imaging guidance from ultrasound, mammography or an MRI.
• Vacuum-assisted core biopsy: During this biopsy, your provider makes a small incision in your skin and inserts a special biopsy needle. They then use a vacuum-powered instrument to suction multiple, tiny samples of your breast tissue into the center of the biopsy needle. This method removes more tissue than a core biopsy performed with a regular needle and is usually performed with imaging guidance.
• Excisional breast biopsy (lumpectomy): During this breast biopsy, your surgeon performs surgery to remove a lump in your breast that might be breast cancer. Excisional breast biopsies involve removing the entire lump and usually surrounding tissue.
• Incisional breast biopsy: During this breast biopsy, your surgeon performs surgery to remove only a part of a lump in your breast or an abnormal area.

The different types of breast biopsies, based on how your provider can see the concerning area, include:

• Stereotactic breast biopsy: During this breast biopsy, your radiologist uses mammography (a mammogram) to help find the area of your breast that they need to remove for biopsy.
• Ultrasound-guided breast biopsy: During this breast biopsy, your radiologist uses an ultrasound machine to guide the needle to the area in your breast that they need to remove for biopsy.
• MRI-guided breast biopsy: During this breast biopsy, your radiologist uses an MRI (magnetic resonance imaging) machine to guide the needle to the area in your breast that they need to remove for biopsy.

When do I need a breast biopsy?

Your healthcare provider may have you undergo a breast biopsy if one or more of the following situations apply to you:

• You or your provider feels a lump or thickening inside your breast, and your provider is concerned it could be breast cancer.
• Your mammogram shows a suspicious area in your breast.
• You have a breast ultrasound scan that shows a concerning finding.
• Your breast MRI shows a suspicious finding.
• You have unusual changes in your nipple or areola, such as crusting, dimpling skin or unusual discharge.

Who performs a breast biopsy?

Depending on the type of breast biopsy you have, a radiologist or a surgeon will most likely perform your breast biopsy.

How do I prepare for a breast biopsy?

If you’re undergoing a breast biopsy, it’s important to let your healthcare provider, surgeon and/or radiologist know:

• If you’re pregnant or there’s a chance you’re pregnant.
• If you take blood-thinning medication. Your provider may adjust your medication before the biopsy to prevent excess bleeding or bruising.
• If you take aspirin or herbal supplements.
• If you have any health conditions or have recently had surgery.
• If you have any allergies, especially to anesthesia.

Questions that may be helpful to ask your healthcare provider before your breast biopsy include:

• What kind of breast biopsy am I having?
• Will I have local anesthesia or general anesthesia?
• How long will the procedure take?
• How much breast tissue will you remove?
• What will recovery from the biopsy be like?
• Will I have a scar from the procedure?
• When can I expect the results?

If you’re getting general anesthesia for your breast biopsy, your healthcare provider may have you fast (not eat or drink) for several hours before your biopsy. You’ll want to have someone drive you home after your biopsy if you’re getting general anesthesia or a sedative because you may be groggy after the procedure.

In any situation, your provider will give you specific instructions before your breast biopsy appointment. Be sure to follow them.

How does a breast biopsy procedure work?

Most — but not all — breast biopsy procedures involve seven general steps, including:

• Using imaging or material guidance.
• Making the incision.
• Breast tissue removal.
• Placing biopsy markers.
• Closing the incision.
• Examining the tissue sample.

Here’s an explanation of how different types of breast biopsy procedures work.

Anesthesia

If you’re undergoing a fine needle aspiration biopsy or a core needle biopsy, your healthcare provider will most likely recommend using a local anesthetic. This means that your provider will inject an anesthetic around the area of your biopsy site to numb the area so that you won’t feel pain during the procedure. You’ll also be awake during the procedure.

If you’re undergoing a surgical biopsy (excisional breast biopsy), your healthcare provider may recommend general anesthesia (you’ll be asleep, or unconscious, during the surgery) and/or local anesthesia (injection of an anesthetic near the site of your biopsy) so you won’t feel pain. They may also have you take a type of medicine called a sedative to help you relax.

Imaging or material guidance

Most breast biopsies involve the use of an imaging machine or material guidance method to help guide your healthcare provider to the area in your breast that they need to biopsy. If you have a lump in your breast that your provider can feel with a physical exam, they may perform a fine needle aspiration biopsy or a core needle biopsy without using an imaging machine.

During any of these imaging or guidance procedures, it’s important to be as still as possible so that your provider can accurately pinpoint the correct area of your breast.

Here’s an explanation of the different kinds of imaging or material guidance for breast biopsies.

Mammogram-guided biopsy (stereotactic biopsy): During this breast biopsy, your healthcare provider uses mammogram images, which are special X-ray images, to help find the area of your breast that they need to biopsy. Here’s what’ll happen during a mammogram-guided biopsy:

• You’ll likely lie stomach-down on an exam table with your breast that your provider is going to biopsy positioned through a hole in the table.
• The mammogram equipment, which will be underneath the table, will firmly compress your breast between two plates. While this is happening, the machine will take images of your breast to help your provider pinpoint where to perform the biopsy.

Ultrasound-guided biopsy: During this breast biopsy, your provider uses ultrasound (an imaging system that uses sound waves to make images of internal body tissues and structures) to guide them to the area of your breast that they need to biopsy. Here’s what will happen during an ultrasound-guided biopsy:

• You’ll lie on an ultrasound table on your back or side.
• Your radiologist will apply water-soluble gel to your skin over the area of your breast that they are taking images of.
• Your radiologist will then move a handheld device over the gel on your breast to take images inside your breast. These images will help guide your provider when they take a biopsy sample.

MRI-guided biopsy: During this breast biopsy, your provider uses MRI (magnetic resonance imaging), which is a machine that takes multiple detailed images without using X-rays, to guide them to the area of your breast that they need to biopsy. Here’s what’ll happen during an MRI-guided biopsy:

• Some MRI exams use an injection of contrast material, which “lights up” certain areas of your breast on the MRI images, so you may undergo an injection before the MRI.
• You’ll lie stomach-down on a padded MRI table. A provider will position your breasts in a hollow area on the table. Most MRI units look like large cylinder-shaped tubes. They’re surrounded by a circular magnet, which creates images of the inside of your body with the help of a computer. The table that you’re lying on slides into the center of the magnet.
• Once your provider has located the suspicious area of your breast using the MRI image, they’ll perform the biopsy.

Wire localization (needle localization): Surgeons use wire localization for breast biopsy surgeries to help guide them to the area in your breast that they need to biopsy. Here’s what’ll happen during a wire localization procedure:

• Your provider will likely use a local anesthetic injection to numb your breast.
• With the help of an imaging machine, such as an MRI or ultrasound, they will insert a thin, hollow needle into the suspicious area of your breast.
• Once the tip of the needle is in the correct spot, your provider will insert a thin, sterile wire through the center of the needle. The wire has a small hook at the end of it to keep it in place. Your provider will then take out the needle, and the wire will stay in your breast with the other end of the wire remaining outside of your breast.
• You’ll then go to the operating room for your breast biopsy. The wire in your breast helps guide your surgeon to the suspicious area in your breast that they’ll biopsy. They’ll remove the wire during the surgery once they’ve removed the tissue.

Other localizing devices: Newer methods of breast biopsy localizing devices include:

• Tiny radioactive pellets that give off a very small amount of radiation.
• Tiny magnetic pellets that create small magnetic fields.
• Tiny radiofrequency reflectors that give off a signal that your provider can see using a special device they hold over your breast.

Your provider can insert any of these devices into the suspicious area of your breast the day before your breast biopsy surgery. Unlike wire localization, these devices are fully inserted into your breast and don’t stick outside of your breast. Your surgeon can then find the suspicious area in your breast by using a handheld detector during the surgery.

The incision

Once your healthcare provider has located the area of your breast that they will biopsy, they may need to make an incision (cut) on your skin to perform the biopsy.

If you’re undergoing a core needle biopsy or a vacuum-assisted core biopsy, your provider will make a small incision (cut) on your skin that’s about one-quarter of an inch in length. They will then insert the biopsy needle and/or vacuum-powered device.

If you’re undergoing a surgical biopsy, your surgeon will make a small incision into your breast that may be 1 to 2 inches and remove part or all of the suspicious lump, depending on if it’s an incisional (partial) or excisional (total) biopsy.

Fine-needle aspiration biopsies do not need an incision. Your provider will simply inject the needle into your skin to do the biopsy.

Breast tissue removal

Next, your healthcare provider will remove a sample of or the entire suspicious tissue using one of the following methods:

• Fine-needle aspiration (FNA): Your provider uses a very thin needle with a syringe to draw out cells or fluid from the suspicious tissue.
• Hollow needle (core needle): Your provider uses a larger hollow needle to remove one sample of the suspicious tissue.
• Vacuum-powered device: Your provider uses a small, vacuum-powered device to suction multiple samples from the suspicious tissue.
• Incisional biopsy surgery: Your surgeon removes part of the suspicious tissue using surgery.
• Excisional biopsy surgery: Your surgeon removes all of the suspicious tissue — usually a lump or tumor — using surgery. They may also remove surrounding tissue for testing.

Placing biopsy markers

During your breast biopsy procedure, your healthcare provider may place a very small metal marker or clip where they took the biopsy sample. Your provider may do this so that if your biopsy shows cancer cells or precancerous cells, they can locate the biopsy area to remove more breast tissue surgically.

Even if you don’t need further treatment or surgery after your biopsy, the marker allows a radiologist to see where you had your biopsy on future mammograms.

Closing the incision

If you had a fine needle aspiration or core needle biopsy, your provider will likely use a sterile bandage to cover your biopsy site.

If you had a surgical biopsy, your surgeon will close your incision with stitches or adhesive strips. Your surgeon will give you instructions on how to care for your incision and if they will need to remove the stitches.

Examining the tissue sample

After your breast biopsy procedure, your healthcare provider will send your biopsy sample to a lab for examination and testing. A special scientist called a pathologist will process the sample and look at it under a microscope. They’ll determine a diagnosis, if applicable, and send the report to your provider.

What should I expect during a breast biopsy?

There are many types of breast biopsy procedures, and each one is slightly different. Your healthcare provider will walk you through the steps of the procedure and answer any questions you have.

In general, here are some things you can expect during your breast biopsy:

• You’ll likely experience very little discomfort or pain since you’ll have local or general anesthesia. If you have dense breast tissue or abnormalities behind your nipple, you may experience more discomfort during the procedure.
• If you’re getting a local anesthetic, general anesthetic and/or a sedative, you’ll experience a slight poke from the needle injection or the IV insertion.
• You’ll likely feel some pressure when your provider inserts the biopsy needle and during the tissue removal. This is normal.
• It’s important to be very still while your provider is performing the imaging and the biopsy.
• The total time of the procedure depends on the type of biopsy you’re having and your unique situation. In most cases, the biopsy could take 20 minutes to an hour.

How long does it take to recover from a breast biopsy?

If you’ve had a needle biopsy with local anesthesia, you may feel some discomfort in the biopsy area, but you’ll be able to return to your normal activities the next day.

If you’ve had a surgical biopsy, your recovery may take longer. Depending on how large your incision is and how much breast tissue your surgeon removed, it could take a couple of days to a week until you can return to your normal activities.

You’ll likely experience some pain in the biopsy area for a few days. Your surgeon will give you specific instructions for your recovery. Be sure to follow them closely.

What are the risks and possible complications of a breast biopsy?

Most breast biopsies are minimally invasive, and most people recover well from them. There are some common side effects of a breast biopsy procedure, including:

• Bruising.
• Bleeding.
• Swelling.
• Pain or soreness.
• Infection.

If you’re experiencing signs of an infection, such as redness, pus and/or a fever, contact your healthcare provider as soon as possible.

Very rare complications of breast biopsy procedures include:

• Collapsed lung (pneumothorax).
• Hemothorax (blood collects between your chest wall and your lungs).
• Hemopneumothorax (having a collapsed lung and blood collect between your chest wall and your lungs).

How long do breast biopsy results take?

It usually takes 1 to 2 weeks for your biopsy results to come back, but this could vary. Factors that affect how long it takes to get breast biopsy results include:

• Processing time.
• If the test requires special stains or procedures.
• If the pathologist needs to look at more samples.
• If your healthcare provider or the pathologist needs a second opinion.

Once a pathologist has examined the biopsy tissue under a microscope, they will send the findings to your healthcare provider. Your provider will then explain and go over the results with you. They’ll also discuss if you need further testing, surgery and/or treatment.

What do the results of a breast biopsy mean?

Healthcare providers and pathologists can use many different terms on a breast biopsy report. Your healthcare provider will thoroughly explain the results to you. Don’t be afraid to ask questions.

In general, the results will reveal if the sample tissue was negative or positive for abnormal cells, pre-cancer cells and/or cancer cells.

If you had a surgical biopsy to remove a lump or tumor, the results will reveal information about the type, grade and receptor status of the tumor. It will also include information about the surrounding tissue of the tumor that your surgeon removed. This surrounding tissue is called the margin.

If your results show that you have a cancerous tumor, information about the margin shows whether the cancer is contained within the removed tissue. The terms that could be on your biopsy results concerning the tumor margin include:

• Positive margin: This means that there are cancer cells in the margin of the tumor, which means the cancer may not have been fully removed and more surgery is usually recommended.
• Negative or clear margin: This means that there are no cancer cells in the margin of the tumor, which means the cancer is surrounded by normal tissue.
• Close margin: This means that there are cancer cells close to the edge of the margin but not on the edge. In this case, you may need further surgery.

When should I call my doctor?

If you’re experiencing signs of an infection at your biopsy site, such as persistent redness or pus, call your healthcare provider as soon as possible. You may need medical treatment.

What percentage of breast biopsies are cancer?

Over one million people have breast biopsies each year in the United States. Approximately 20% of the biopsies reveal a breast cancer diagnosis.

How painful is a breast biopsy?

Healthcare providers usually use a local anesthetic or general anesthetic for breast biopsies, so people who undergo a biopsy experience little discomfort.

You may feel a pinch or sting when your healthcare provider injects local anesthesia, and you’ll likely feel some pressure during the procedure, which is normal. You may have pain or discomfort after your biopsy, especially if you’ve had a surgical biopsy.

What kinds of conditions can look or feel similar to breast cancer?

It’s important to remember that many different things can appear suspicious on a mammogram or feel suspicious upon a physical breast exam — not just cancer. Just because your healthcare provider wants you to undergo a breast biopsy doesn’t necessarily mean you have cancer, but a biopsy is the only way to know for sure.

Conditions that can look or feel similar to breast cancer include:

• Benign breast tumors: Fibroadenoma is the most common type of non-cancerous (benign) breast tumor.
• Fibrosis: Fibrosis happens when your breast tissue thickens and feels firm in different areas. Hormone changes often cause fibrosis.
• Cysts: Breast cysts are fluid-filled sacs that can become painful. You can usually move them around under your skin.
• Breast calcification: Breast calcifications are small clusters of calcium deposits that form in your breast tissue.

A note from Cleveland Clinic

Undergoing a breast biopsy can be stressful. It’s important to understand that needing to have a breast biopsy doesn’t necessarily mean you have cancer. In fact, about 80% of breast biopsies reveal that there’s no cancer. But a biopsy is the only way to know for sure. If you have questions about breast cancer screening, such as mammograms or breast biopsies, don’t be afraid to talk to your healthcare provider. They’re there to help and support you.