Core Needle Breast Biopsy

What is a core needle breast biopsy?

A core needle breast biopsy is a common type of breast biopsy. You may have a core needle biopsy if a healthcare provider believes changes in your breast could be breast cancer. In this procedure, a healthcare provider, usually a radiologist, uses a hollow needle to take out small cylinders (cores) of breast tissue. A medical pathologist then examines the tissue for signs of cancer or other issues.

Why would I need a core needle breast biopsy?

A healthcare provider may recommend this procedure if:

• You or they can feel a lump in your breast
• An imaging test like a mammogram, breast MRI or breast ultrasound detects abnormalities

How does a core needle breast biopsy work?

In this procedure, your radiologist inserts a tiny, hollow needle into the skin of your breast. Core needles are about 2 millimeters around or just over 1/16^th inch. You receive local anesthesia before the procedure. The anesthesia numbs your breast, so you don’t feel pain.

They may insert the needle using a spring-loaded tool that quickly moves the needle in and out of tissue. They may use a suction device that connects to the needle to help pull tissue into the needle. Your radiologist may call this a vacuum-assisted core biopsy.

What’s the difference between a core needle breast biopsy and a fine-needle aspiration?

They’re both types of needle biopsies. The difference is a fine-needle aspiration pulls out tissue and fluid. A medical pathologist will look for abnormalities, including cancer, that loose individual cells or clusters of cells may have. In a core needle breast biopsy, pathologists can examine entire blocks of tissue that provide a larger representation of the cells.

How do I prepare for a core needle breast biopsy?

Your care team will explain what you should do. In general, you should:

• Tell your team about any medication — if you take aspirin or blood thinners (anticoagulants), they may ask you to stop taking those medications a few days before your biopsy
• Wear comfortable clothes, including a soft bra that won’t irritate skin at the biopsy site
• Plan on taking it easy for a day or so after the procedure

What should I expect to happen during a core needle breast biopsy?

Most core needle biopsies are image-guided procedures. In this type of procedure, your radiologist uses different imaging machines to locate the area with suspected abnormal tissue. They also use imaging machines during the procedure to guide the core needle. Types of image-guided procedures in core needle biopsies are:

• Stereotactic breast biopsy. This procedure uses a special mammography machine.
• Ultrasound-guided biopsy. Your radiologist uses a breast ultrasound in this type of biopsy.
• MRI-guided biopsy. In this procedure, your radiologist uses a breast MRI.

Here’s what happens during an image-guided core needle biopsy:

1. Your radiologist will help you to get into the position best for the specific imaging procedure. For example, for a stereotactic breast biopsy, you’ll lay face down on an exam table that has an opening for your breast.
2. They’ll use a mammography machine, ultrasound or MRI to view the area in question.
3. Your radiologist will clean the skin in the biopsy site and inject a numbing medication into your breast.
4. They’ll make a very small cut in your skin to insert the core needle.
5. Your radiologist may take tissue samples from several sections of the area in question.
6. You may feel pressure and hear a clicking sound as your radiologist removes each sample.
7. They’ll remove the core needle from your breast and place a tiny metal clip (biopsy marker) in your breast. The marker will show up on any additional imaging tests, so providers know exactly where a specific tissue sample came from.
8. Your radiologist will put pressure on the biopsy site to help stop any bleeding and then cover the site with a sterile bandage.

How painful is a core needle breast biopsy?

You shouldn’t feel any pain from the procedure, but you may feel pressure as your radiologist removes samples. But tell your radiologist if you have any pain. They’ll inject more numbing medication into the skin of the biopsy site.

How long does a core needle biopsy take?

The actual procedure takes about 15 to 20 minutes. But you may be in the procedure room for up to 60 minutes, depending on which image-guided biopsy process your radiologist uses.

What can I expect after a core needle breast biopsy?

You’ll probably be able to go back to work or get back to your daily activities, but you should avoid strenuous activities like running for at least 48 hours after your biopsy. You may notice some bruises at the biopsy site.

What are the risks of a core needle breast biopsy?

Core needle breast biopsies are minimally invasive procedures with very few risks. Very rarely, people develop complications, including:

• Bleeding that leads to a breast hematoma, a collection of blood that accumulates in your breast tissue
• Infection
• Pneumothorax (collapsed lung)

What type of results will I get?

Medical pathologists look for signs of cancer in the breast tissue samples your radiologist provided. If there’s no sign of cancer, the pathologist will note that in their report to your provider. But if biopsy results detect a cancerous tumor, the pathologist will give your provider a report that notes:

• The tumor type. A tumor can be noninvasive or invasive. A noninvasive tumor typically won’t spread to nearby breast tissue. An invasive tumor might spread to nearby breast tissue or other part of the body.
• The tumor grade. A tumor grade shows how fast cancerous cells divide. It also shows how much cancerous cells look like normal cells. Setting a tumor grade is part of the cancer staging system.
• Hormone receptor status. You may have a test to see if the tumor is hormone-receptor positive, which means it grows in response to circulating hormones in your body.
• HER2 status: Some breast cancer cells contain the protein human epidermal growth factor receptor 2. This protein helps cancer cells grow and spread.

When should I know the biopsy results?

You may receive test results within a week to 10 days after your biopsy. But that timing may vary depending on the test process. For example, the pathologist may need time to check different samples.

Waiting for biopsy results can be stressful. Your healthcare team understands that and will be glad to answer your questions. Following your regular routine, doing things that you enjoy and sharing your feelings with others may help.

When should I call my doctor?

Core needle breast biopsies rarely cause complications. But there’s a slight risk that you’ll have an infection in the biopsy site or develop a breast hematoma. You should contact your provider if:

• You have a fever that’s greater than 101 degrees Fahrenheit or 38.4 degrees Celsius
• The skin around the biopsy site is red or darker than your skin color
• The biopsy site is painful to the touch
• You develop significant bruising that’s expanding

Can a core needle breast biopsy miss cancer?

Yes, there’s a chance that the biopsy needle will bypass the tumor and take a sample of nearby healthy tissue. Providers call this a false negative report. But research shows that false negative core needle breast biopsies are rare.