Breast Biopsies 101

You’ve gone through your mammogram and done all the things that were recommended to you. You did the extra views, an ultrasound, and now the radiologists inform you that they recommend a biopsy. Anxiety rushes through you with a range of thoughts and feelings. Today, we’re going to talk about the process of a breast biopsy and what the range of diagnoses can be like thereafter.

When a radiologist recommends a breast biopsy, there is something on imaging of your breast which looks abnormal (either BiRADS 4 or BiRADS 5 results – For more info on this, see our last post). Before we dive into what some of the results of a biopsy can be, let’s talk about the process you’ll go through. Of note, there are multiple different types of biopsies. For now, we’ll discuss a core needle biopsy, one of the most common techniques used in breast care.

Why do I have to have another ultrasound or mammogram before the biopsy?

Breast biopsies can be done in multiple ways. Just as breasts can be interrogated by either mammogram, ultrasound, or even MRI, biopsies can be done under the guidance of any of those imaging techniques. What does that mean, imaging guidance? Well, the radiologist most likely found the area of concern using imaging, and thus needs the imaging in order to guide the biopsy to the correct location. So, the first step in getting the biopsy is to find the area again – using either ultrasound, mammogram, or MRI in some cases.

Image courtesy of The American Cancer Society

A biopsy sounds like a needle! Is this going to hurt?

Let’s go through the steps of a biopsy. You may be seated, sitting up, lying on your back, or even lying on your stomach for this procedure. After the area of concern is found via the imaging again, the radiologist will first clean the skin, and then numb your skin as well as the deeper breast tissue. This is done with a very small needle and local numbing medication (like you would get at a dentist). It can feel like a small poke and then a burning sensation. However, this feeling should dissipate very quickly. After the area is numb, the radiologist will make a small nick in your skin (just big enough for the biopsy needle). They will then use a biopsy device which takes enough of a sample for a pathologist to look through. You should not feel sharp pain at this point, but may feel a pressure sensation. If you do feel pain, let the radiologist know so that they can give you more numbing medication. After the radiologist has taken a few samples, they will place a “clip” at the site of the biopsy inside your breast. These are very small titanium devices which you will not feel or see, and will only be visible on imaging so that in the future, the radiologist or surgeon or provider will know which areas have been biopsied in the past. The next and final step is to have another mammogram. I know, it sounds like a lot of imaging. But this final mammogram will ensure that the biopsy clip is in the correct location and has not migrated. Should a surgery be necessary, the location of the clip is important information for the surgeon to know.

What will the recovery be like?

Generally, recovery is quite quick. Soreness and bruising are expected and not uncommon after this procedure. Sometimes, you may even feel a lump where there was none before. This is also likely bruising on the inside and not to be concerned about. Your doctor will let you know of any specific post-biopsy regimens to follow like icing or maintaining pressure.

How big of a scar will I have?

Generally, biopsy scars are quite small if present at all. They are usually 2-3mm long and heal quickly and well. Unless you are looking for them, they are very difficult to notice to anything other than a trained eye, and again, are often not present.

What should I expect from my results?

Most people think that results come in two categories – ok and bad. But in truth, there are three categories: ok, bad, and “we’re not sure.” This “unknown” category does not mean that the radiologist missed the area. In breast disease, it means that more tissue is needed to ensure that there is not a cancer nearby. Often, this category of biopsy finding also reveals a “high-risk” lesion that is not cancer itself, but can be nearby to cancer or increase a woman’s general risk of having breast cancer in her lifetime. Having a biopsy with an atypical (but not cancerous) result will often require a surgical biopsy in order to obtain a larger sample and rule out a cancer, and should prompt a discussion with a trained breast surgeon.  As always, do not hesitate to reach out to a specialist to discuss the biopsy or results.

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