Breast Biopsy

Test Overview

A breast biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer. A breast biopsy is usually done to check a lump found during a breast examination or a suspicious area found on a mammogram, ultrasound, or magnetic resonance imaging (MRI).

There are several ways to do a breast biopsy. The sample of breast tissue will be looked at under a microscope to check for cancer cells.

  • Fine-needle aspiration biopsy. Your doctor inserts a thin needle into a lump and removes a sample of cells or fluid.
  • Core needle biopsy. Your doctor inserts a needle with a special tip and removes a sample of breast tissue about the size of a grain of rice.
  • Vacuum-assisted core biopsy. This is done with a probe that uses a gentle vacuum to remove a small sample of breast tissue. The single small cut doesn't require stitches and leaves a very small scar.
  • Open (surgical) biopsy. Your doctor will make a small cut in the skin and breast tissue to remove part or all of a lump. This may be done as a first step to check a lump or if a needle biopsy doesn't provide enough information.

If needed, your doctor may use ultrasound or MRI to guide the biopsy needle. Or your doctor may use a computer to locate the exact spot for the biopsy sample from mammograms that have been taken from two angles (stereotactic needle biopsy). A fine wire, clip, or marker also may be used to mark the site.

Why It Is Done

A breast biopsy checks to see if a breast lump or a suspicious area seen on a mammogram is cancerous (malignant) or noncancerous (benign). Testing a biopsy sample is the only reliable way to find out if cancer cells are present.

How To Prepare

Tell your doctor if you:

  • Are taking any medicines or supplements (such as vitamins or herbal remedies).
  • Are allergic to any medicines, including anesthetics.
  • Are allergic to latex.
  • Have any bleeding problems or take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix).
  • Are or might be pregnant.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will mean. To help you understand the importance of the biopsy, fill out the medical test information formmedical test information form(What is a PDF document?).

If you take a blood thinner, you will probably need to stop taking it for a week before the biopsy.

If a breast biopsy is to be done under local anesthesia, you do not need to do anything else to prepare for the biopsy.

If the biopsy is to be done under general anesthesia, follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, do so using only a sip of water. An intravenous line (IV) will be put in your arm, and a sedative medicine will be given about an hour before the biopsy. Arrange for someone to drive you home if you will be having general anesthesia or are going to be given a sedative.

Other tests, such as blood tests, may be done before your breast biopsy.

How It Is Done

Fine-needle aspiration biopsy

A fine-needle aspiration biopsy may be done by an internist, family medicine doctor, radiologist, or a general surgeon. The biopsy may be done in your doctor's office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a needle is put through your skin into your breast tissue. Ultrasound may be used to guide the placement of the needle during the biopsy. If the lump is a cyst, the needle will take out fluid. If the lump is solid, the needle will take a sample of tissue. The biopsy sample is sent to a lab to be looked at under a microscope. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration biopsy takes about 5 to 15 minutes.

Core needle biopsy

A core needle biopsy may be done by an internist, family medicine doctor, radiologist, or general surgeon. The biopsy may be done in your doctor's office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a small cut is made in your skin. A needle with a special tip is put into the breast tissue. The doctor will take 3 to 12 samples to get the most accurate results.

The needle is removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. This may be repeated several times to make sure enough tissue samples were collected.

A core needle biopsy takes about 15 minutes.

Stereotactic biopsy

A stereotactic biopsy is done by a radiologist. The biopsy is done in a radiology department.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. You will lie on your stomach on a special table that has a hole for your breast to hang through. A mammogram or MRI is used to find the exact site for the biopsy.

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a small cut is made in the skin. With a special X-ray to guide the needle, it is put into the suspicious area. Usually, more than one sample is taken through the same cut. You must lie still while the biopsy is done.

The small cut made for the needle does not usually need stitches. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A small metal marker (clip) is usually placed in the area where the biopsy sample was taken. This is done to locate the exact spot where the tissue sample was taken.

The metal marker will stay in your breast if you do not have cancer. You will not be able to feel it, and it will not set off metal detectors. You can still have an MRI safely. When you have mammograms in the future, the radiologist will be able to see the metal marker.

This type of breast biopsy takes about 60 minutes. But most of this time is needed for the mammogram or MRI and finding the area for the biopsy.

Vacuum-assisted biopsy

A vacuum-assisted biopsy is done by a radiologist or a surgeon. This method may be used for a core needle biopsy or a stereotactic biopsy. The biopsy may be done while you sit or lie on an examination table. Or you will lie on your stomach on a special table that has an opening for your breast. A mammogram, ultrasound, or MRI is used to find the exact site for the biopsy.

Your doctor numbs your breast with a shot of local anesthetic. Once the area is numb, a small cut is made in your skin. A hollow probe with a special tip is put into the breast. Tissue is gently vacuumed into the probe. With this type of biopsy, the doctor can take more than one sample without removing the probe.

After the probe is removed, pressure is put on the site to stop any bleeding. The small cut does not need stitches and leaves only a small scar.

A vacuum-assisted core biopsy takes less than an hour.

Open biopsy

An open biopsy is done by a general surgeon, gynecologist, or family medicine doctor. The biopsy may be done in a surgery clinic or the hospital.

You will need to take off all or most of your clothes above the waist. You will be given a gown to use during the biopsy. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

An open biopsy can be done using local or general anesthesia. If local anesthesia is used, you may also be given a sedative.

If you have general anesthesia, an intravenous (IV) line will be put in your arm to give you medication. You will not be awake during the biopsy.

After the breast is numb (or you are unconscious), your doctor makes a cut through the skin and into the breast tissue to the lump. If a small wire was placed using mammogram to mark the biopsy site, your doctor will take a biopsy from the area at the tip of the wire.

Stitches are used to close the skin, and a bandage is put on. You will be taken to a recovery room until you are fully awake. You can usually return to your normal activities the next day.

An open biopsy takes about 60 minutes.

How It Feels

You will feel only a quick sting from the needle if you have a local anesthetic to numb the biopsy area. You may feel some pressure when the biopsy needle is put in. After a fine-needle aspiration biopsy, core needle biopsy, or stereotactic biopsy, the site may be tender for 2 to 3 days. You may also have some bruising, swelling, or slight bleeding. You can use an ice pack or take an over-the-counter pain medicine (not aspirin) to help relieve swelling and mild pain.

For 24 hours after the biopsy, do not do any heavy lifting or other activities that stretch or pull the muscles of your chest.

If you have general anesthesia for an open breast biopsy, you will not be awake during the biopsy. After you wake up, the area may be numb from a local anesthetic that was put in the biopsy site. You will also feel sleepy for several hours.

For 1 to 2 days after an open biopsy, you may feel tired. You may also have a mild sore throat if a tube was used to help you breathe during the biopsy. Using throat lozenges and gargling with warm salt water may help with the sore throat.

After an open biopsy, your breast may feel tender, firm, swollen, and bruised. You can use an ice pack or take an over-the-counter pain medicine (not aspirin) to help relieve swelling and mild pain. The tenderness should go away in about a week, and the bruising fades within 2 weeks. But the firmness and swelling may last for 6 to 8 weeks. You should wear a bra or sports bra for support for 2 to 3 days after the biopsy. Do not do any heavy lifting or other activities that stretch or pull the muscles of your chest.

Risks

The possible risks from a breast biopsy include:

  • An infection at the biopsy site. An infection can be treated with antibiotics.
  • Bleeding from the biopsy site.
  • Not getting a sample of the abnormal tissue.
  • Dizziness and fainting.

Call your doctor immediately if:

  • Your pain lasts longer than a week.
  • You have redness, a lot of swelling, bleeding, or pus from the biopsy site.
  • You have a fever.

Core needle and stereotactic breast biopsies may leave a small round scar. Open biopsies leave a small straight line scar. The scar fades over time. A fine-needle biopsy usually does not leave a scar.

Results

A breast biopsy removes a sample of breast tissue that is looked at under a microscope for breast cancer.

Breast biopsy
Normal:

No abnormal or cancer cells are present.

Abnormal:

Breast changes that are not cancer (benign) include:

  • Calcium deposits in the breast.
  • Cysts, which are lumps filled with fluid.
  • Enlarged breast lobules (adenosis), which are small round lumps that sometimes can be felt.
  • Fat necrosis, which are round, firm lumps formed by damaged fatty tissue.
  • Fibrocystic lumps and firm tumors (fibroadenomas).

Breast changes that are not cancer but may increase your risk for cancer include:

  • Abnormal cells in the breast ducts (atypical ductal hyperplasia or ADH).
  • Abnormal cells in the breast lobules (atypical lobular hyperplasia or ALH).
  • Many abnormal cells in the breast lobules (lobular carcinoma in situ or LCIS).

Cancer cells are present.

What Affects the Test

A needle biopsy takes tissue from a small area, so there is a chance that a cancer may be missed.

What To Think About

Most breast lumps are not cancer. But the chance of having a cancerous breast lump is higher after menopause than before menopause.

Some lumpiness of breast tissue is normal. The fibrous tissue in the breast often feels lumpy or bumpy, especially before your menstrual period. This lumpiness (fibrocystic change) is so common in women that doctors now think it is a normal change. These changes usually go away after menopause, but they also may be found in women who are taking hormone therapy following menopause.

Related Information

References

Other Works Consulted

  • Burstein HJ, et al. (2011). Malignant tumors of the breast. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., vol. 3, pp. 1401–1446. Philadelphia: Lippincott Williams and Wilkins.
  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer C. Dale Mercer, MD, FRCSC, FACS - General Surgery
Current as of August 16, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2014 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Decision Points

Our interactive Decision Points guide you through making key health decisions by combining medical information with your personal information.

You'll find Decision Points to help you answer questions about:

Interactive Tools

Get started learning more about your health!

Our Interactive Tools can help you make smart decisions for a healthier life. You'll find personal calculators and tools for health and fitness, lifestyle checkups, and pregnancy.

Symptom Checker

Feeling under the weather?

Use our interactive symptom checker to evaluate your symptoms and determine appropriate action or treatment.

Symptom Checker