8 breast biopsy questions, answered

Getting a breast biopsy? You might be wondering what it is and how it works.

A breast biopsy is a diagnostic procedure in which a doctor removes a small amount of breast tissue to examine under a microscope. If the tissue sample shows cancer, the physician can have it analyzed further to provide the most accurate diagnosis — a critical first step in getting patients the best treatment possible for their particular type of breast cancer.

A biopsy may be ordered when a mammogram or other breast imaging (such as an ultrasound) reveals an abnormality or you feel a lump in your breast, or when a physician notices something suspicious (such as dimpling or a change in skin texture) during a clinical exam.

We spoke with Marion Scoggins, M.D., to learn more. Here’s what she had to say.

What are the types of breast biopsies, and how are they different?

There are two basic types of breast biopsy: surgical and needle. A breast biopsy done surgically through an incision in the skin is called a surgical breast biopsy. A breast biopsy done by inserting a needle through the skin is called a breast needle biopsy.

There are two main types of breast needle biopsy:

  • fine needle aspiration, which uses a thin, hollow needle attached to a syringe, and
  • core needle biopsy, which uses a larger needle that removes a small, tube-shaped piece of tissue with a spring-loaded device or a vacuum-assisted device.

Because it’s important to pinpoint areas of concern and pull tissue from those exact spots, doctors typically use an ultrasound — or a mammogram or MRI, in some cases — to guide a breast needle biopsy. A mammogram-guided biopsy is also called a stereotactic biopsy.

At MD Anderson, we place small metallic markers called “clips” in the breast at the time of a breast needle biopsy and leave them there. This allows our radiologists and surgeons to know the exact location of the biopsy, in case we need to remove something else from the area where a tissue sample was taken.

How painful is each kind of biopsy, and how long does it take to recover?

Local anesthesia is given for breast needle biopsies, which makes them tolerable and comfortable for most patients.

The recovery time is typically very short, but may vary depending on the amount of bleeding and/or bruising. A core needle biopsy is more likely to result in bruising than a breast fine needle biopsy. Bruising from a breast biopsy may take several weeks to completely resolve. Your doctor can discuss expected recovery times and what to do to take care of the area that’s been biopsied.

Do any breast biopsies require general anesthesia or an overnight stay in the hospital?

A breast needle biopsy is done with local anesthesia, so it does not require general anesthesia.

A surgical breast biopsy may require general anesthesia, but typically won’t require an overnight hospital stay.

How do doctors determine which biopsy is best for a particular patient?

If there’s an abnormal finding on your mammogram or breast ultrasound that we need to biopsy, a radiologist will determine the most appropriate type of biopsy, based on how much tissue is needed to get an accurate diagnosis and the question doctors seek to answer with the biopsy.

Is there ever a time when a patient should ask their doctor for a biopsy (or for a specific type)?

A biopsy is only recommended if there’s a suspicious finding on a mammogram, ultrasound or MRI, or a concerning clinical finding. If a scan is normal and there are no worrisome symptoms, there’s no need for a biopsy.

If you do need a biopsy, your doctor should discuss which type of biopsy is needed and why. Your doctor can answer any questions you have and explain the procedure and its purpose, as well as its benefits, risks and alternatives.

What are the potential risks of a breast needle biopsy?

As with any medical procedure, there are known risks and benefits with a breast needle biopsy. It is possible that patients may have pain, bleeding or infection. So, be aware of these potential complications and discuss them with your doctor before the procedure.

Some patients express concerns about whether a breast needle biopsy might cause cancer to spread. But there’s no evidence of a negative long-term effect from a breast needle biopsy. And the benefits of a breast needle biopsy — as opposed to a surgical biopsy or no biopsy at all — outweigh the risks.