A biopsy is a procedure in which a small portion of tissue is taken out from the organ and tested to check for cancer or other medical disease.
A breast biopsy is performed for further evaluation of an abnormal mass or other lesion detected on radiology. It is done to detect or rule out the presence of cancer or other benign conditions.
In this article, Initially, we’ll discuss various types of breast biopsies and then discuss a few of the frequently asked questions regarding breast biopsy.
Types of Breast Biopsy
Breast biopsy is crucial to differentiate cancerous growth from other lesions. we will discuss about various different ways in which a biopsy can be done.
Fine Needle Aspiration (FNA) Biopsy:
FNA biopsy involves using a thin needle to withdraw fluid or cells from a breast lump or mass. It is often used for fluid-filled cysts or to sample cells from solid masses for further analysis. This minimally invasive procedure is usually quick, with minimal discomfort and rapid recovery.
Core Needle Biopsy (CNB):
CNB involves using a larger, hollow needle to extract tissue samples (cores) from breast abnormalities. Multiple tissue samples are obtained, providing more detailed information about the tissue structure and characteristics. CNB is effective for evaluating suspicious lumps or calcifications seen on imaging tests like mammograms.
Vacuum-Assisted Breast Biopsy (VAB):
VAB uses a vacuum-powered device alongside a needle to remove multiple tissue samples through a single insertion. It allows for the removal of larger tissue samples than CNB, making it suitable for sampling larger lesions or multiple areas of concern. VAB is often guided by imaging techniques such as ultrasound or mammography for precise targeting.
Surgical (Excisional or Incisional) Biopsy:
Surgical biopsy involves surgically removing part (incisional biopsy) or the entire abnormal area (excisional biopsy) for detailed examination. It may be recommended when other biopsy methods are inconclusive or when a larger tissue sample is needed. Surgical biopsy is performed under local or general anesthesia in a hospital or surgical center setting.
Wire Localization Biopsy:
This procedure is performed before surgical biopsy to precisely locate abnormal areas identified on imaging tests. A thin wire is inserted into the breast to mark the target area for the surgeon, ensuring accurate tissue removal during the biopsy.
Ultrasound-Guided or MRI-Guided Biopsy:
Biopsies guided by ultrasound or magnetic resonance imaging (MRI) are used to target abnormalities not easily seen or felt during physical examination. Real-time imaging helps guide the needle to the precise location of the abnormal tissue for sampling.
Stereotactic Biopsy
It is performed to evaluate suspicious areas detected on mammograms, such as microcalcifications or masses. Imaging equipment, such as mammography or a specialized 3D imaging system, guides the biopsy needle to the precise location of the abnormality within the breast tissue. A core needle or Vacuum assisted biopsy is taken under the imaging guidance.
What percentage of breast biopsies are cancer?
The percentage of breast biopsies that result in a cancer diagnosis can vary depending on various factors such as the type of biopsy, the characteristics of the breast abnormality, age of the patient, type of biopsy etc. Approximately 20-30% of breast biopsies yield a cancer diagnosis, meaning that the majority (70-80%) of biopsies do not detect cancer.
The likelihood of cancer detection can vary based on the type of biopsy performed. For example, surgical biopsies (excisional or incisional) tend to have higher cancer detection rates compared to minimally invasive core needle biopsies or fine needle aspirations.
Biopsies performed on suspicious breast lesions identified through imaging tests such as mammograms, ultrasounds, or MRIs may have higher cancer detection rates compared to biopsies on palpable lumps or cysts.
It is important to note that a biopsy should have a minimal false negative result so choosing type of biopsy, and method to do so it crucial in making a diagnosis.
How long does a breast biopsy take?
Time taken for a breast tissue biopsy depends on the type of method chosen. FNAC takes from 5-15 minutes whereas a core needle biopsy usually taken about 20-30 minutes. It takes about 45 minutes for Vacuum assisted biopsy to be complete. Surgical biopsy usually done in operation theatre under local or general anesthesia and usually takes 1 to 2 hours.
Factors such as the complexity of the procedure, the need for imaging guidance, patient cooperation, and any unforeseen complications can influence the duration of a breast biopsy.
What happens after a breast biopsy is positive?
It is challenging and emotional experience to have a positive biopsy report indicating presence of cancer cells. After receiving the biopsy report, your primary care physician will refer you to an oncologist. Your oncologist will investigate further to obtain more information about the cancer. These may include imaging scans such as MRI or PET scans to determine the extent of cancer spread (staging), as well as biomarker testing to assess hormone receptor status (estrogen receptor (ER), progesterone receptor (PR)) and HER2/neu status.
The oncologist will discuss the specific type of breast cancer, its characteristics (such as grade and stage), and treatment options tailored to your individual situation. Breast cancer treatment typically involves a combination of therapies, including surgery, chemotherapy, radiation therapy, hormone therapy, targeted therapy, or immunotherapy, depending on the cancer subtype and stage.
If the cancer is localized and operable, surgical options such as lumpectomy (removal of the tumor and surrounding tissue) or mastectomy (removal of the breast) may be recommended. Sentinel lymph node biopsy or axillary lymph node dissection may also be performed to assess lymph node involvement.
Following surgery, adjuvant therapies such as chemotherapy, radiation therapy, hormone therapy, or targeted therapy may be recommended to reduce the risk of cancer recurrence and improve long-term outcomes. The sequence and duration of these therapies will be determined based on your specific treatment plan.
If breast biopsy is negative can it still be cancer?
A negative result in breast biopsy report is general reassuring and suggests that no cancer cell is present in the tissue sample provided for histopathology. A negative biopsy result may indicate the presence of benign (non-cancerous) conditions such as fibroadenomas, cysts, or fibrocystic changes, which can cause breast lumps or abnormalities. However, a few things should be considered before ruling out cancer in the patient:
Sampling Error: Biopsies target specific areas of concern identified through imaging or physical examination. It is possible that the biopsy may miss the cancerous area if it is small, located in a different part of the breast, or if the sample obtained does not contain cancer cells.
False Negative Results: In some cases, a negative biopsy result may be a false negative, meaning that cancer is present but was not detected in the sampled tissue. Factors such as the type and aggressiveness of cancer, the skill of the pathologist analyzing the sample, and the adequacy of the biopsy sample can influence the accuracy of the result.
In a few cases, additional molecular tests or genetic analysis are performed to further obtain information to detect cancer cells in the provided specimen. In case the suspicion remains high, a repeat biopsy is recommended preferable under imaging guidance and a close follow up is done with repeat imaging to detect any changes in the lesion. This is particularly important if new symptoms develop or if imaging studies continue to show suspicious changes over time.
Can a breast biopsy cause cancer to spread?
It’s a common concern among individuals undergoing a breast biopsy whether the procedure can cause cancer to spread. However, it’s important to understand that breast biopsies are generally safe procedures and do not cause cancer to spread.
Do I really need a breast biopsy?
Whether or not you need a breast biopsy depends on several factors, including your medical history, breast examination findings, imaging results, and any symptoms or concerns you may have.
Symptoms such as breast pain, nipple discharge, changes in breast size or shape, skin changes (dimpling, redness), or persistent breast abnormalities should be evaluated, and a biopsy may be recommended based on clinical assessment.
Abnormalities seen on imaging tests, such as suspicious masses, calcifications, or areas of concern that cannot be clearly identified, may warrant a biopsy to determine if they are cancerous or benign.
Finally a shared decision is made after thorough discussion between the patient and doctor after assessing the medical and imaging findings.
and then