How Your Doctor Uses Biopsies to Make Your Diagnosis of Breast Cancer
During a biopsy, a doctor removes cells from the area of concern in your breast and then sends them to a lab to be examined under a microscope. This biopsy examination is the only way to definitely rule out or diagnose cancer. There is more than one kind of biopsy. The type that your doctor suggests depends on what has been learned so far about the lump and whether it can be located by touch alone. Here are brief descriptions of each type of biopsy:
Fine needle aspiration biopsy (FNAB). This uses a very thin needle to collect fluid or cells directly from the lump. If the lump can’t be felt easily, ultrasound or computer-guided imaging may be used to help find it. If the needle removes clear fluid, the lump is most likely a cyst and not cancer. If it finds a solid mass, it’s a tumor that may or may not be cancer. If the lump is solid, a surgeon will remove tissue and send it to a lab for examination.
Ultrasound-guided core needle biopsy. Your doctor may do this biopsy if there is doubt about the results of the FNAB. Core needle biopsy can remove one or, usually, more small cylinders of tissue from the lump for further analysis. The radiologist uses ultrasound to guide the needle. And the needle is slightly larger than the one used in FNAB. Because more tissue is removed and checked, results are often clearer than with FNAB.
Stereotactic core needle biopsy. For this procedure, you lie face down with your breast suspended through a hole on the table. The radiologist takes digital images from different angles to help find the mass. Then, the radiologist uses a small biopsy probe to remove tissue samples. The needle is slightly larger than the one used for FNAB. Again, more tissue is removed and checked, so the results are often clearer than with FNAB.
Wire needle localization surgical biopsy. This type of biopsy may be used when the lump or breast change is small and hard to find by touch. The radiologist puts a small needle containing a wire into the area that looks suspicious. With the help of mammography or ultrasound, the doctor confirms that the needle is in exactly the right place. Then, the needle is removed and the wire is left in place to guide the breast surgeon to the precise location for the biopsy.
Surgical biopsy. In some cases, surgery is required to remove part or all of the lump. There are two ways to do this. An incisional biopsy, which removes a portion of the mass. Or an excisional biopsy, which removes the entire mass.
Once the biopsy is done, the tissue is sent to a lab. There, a doctor who examines tissue samples, called a pathologist, looks at the tissue under a microscope to check for cancer cells. It usually takes several days for the results of your biopsy to come back. A biopsy is the only sure way to tell if you have cancer and what kind of cancer it is.
If your breast cells were not cancerous but were not completely normal either, you may have a condition that increases your chance of getting cancer. In this case, you would need to have clinical breast exams more often.
If the breast change is cancer, your doctor will talk with you about treatment choices.
Because some of the treatment choices depend on characteristics of the cancer, additional tests may be run on your biopsy specimen to fully analyze your cancer. This will help your doctor know what treatment to recommend.