Why a breast biopsy may be necessary.

A change in your breast, such as an abnormality detected by a mammogram or a lump found by you or your doctor, may or may not be cancerous. In order to determine whether an area of concern is malignant (cancerous) or benign (not cancerous), a physician must perform a biopsy. A breast biopsy is the removal of a sample of breast tissue for examination and is the only definitive way to determine if an abnormality is cancerous or not.

Fortunately, 80 percent of biopsies result in a benign diagnosis. However, if cancer is present, it is crucial that you know the type and stage of the disease as early as possible. Through early detection and accurate diagnosis, more treatment options are available and a complete recovery is more likely.

What is a breast biopsy?

A biopsy is may be required if your mammogram or ultrasound (sonogram) shows an abnormality or if you a suspicious lump on physical exam. A biopsy is the removal of all or part of a lesion for examination under the microscope. This is the only definitive way to determine if a lesion is benign (non-cancerous) or malignant (cancerous). Of the one million breast biopsies performed on American women each year, approximately 80% are benign.

Different biopsy techniques: A biopsy can be done using either a needle or surgery to remove all or part of the lesion (abnormality). There are two common biopsy techniques: Stereotactic Core needle biopsy and Surgical biopsy.

Stereotactic Core Needle Biopsy: Uses a small needle with a special cutting edge to remove small samples of tissue from the lesion. The area of concern is sampled under local anesthesia with special computerized (stereotactic) mammographic or ultrasound guidance. This technique conserves normal breast tissue, and if no cancer is found, core biopsy eliminates the need for surgery. This is a minimally invasive non-surgical method of biopsy, with accuracy equal to that of surgery. Radiologic Associates uses only the most advanced form of stereotactic core biopsy, the Mammotome.

Advanced Breast Biopsy Instrument (ABBI): ABBI is a specialized type of surgical biopsy using local anesthesia and computerized guidance to locate and sample the abnormality. This technique uses a large bore needle and has no advantages over small needle stereotactic core biopsy. It is rarely used today.

Open Surgical Biopsy: Until the last few years, most biopsies were open surgical biopsies. First, a radiologist places a wire into the breast via mammography, locating the suspicious site. This is only minimally uncomfortable. Then the surgeon, using the wire as a guide, makes an incision in the breast and removes a large section of tissue (about the size of a golf ball) for examination. Removal of such a large piece of tissue can permanently disfigure the breast. The surgery usually requires I day of recuperation at home.

An open surgical biopsy can be performed as well. If the lump is too small to be felt, the radiologist will use needle localization (J wire) to help the surgeon locate the lesion. Using X-ray as a guide, the radiologist inserts a wire into the breast through a needle until the tip of the wire approximates the abnormality. This should be only minimally uncomfortable.

The surgeon then uses the wire as a guide to the area to be biopsied. The wire and tissue are removed and examined under the microscope.