What is a Breast Biopsy?
A breast biopsy is a procedure to remove a small sample of cells, fluid, or tissue from a problem area of the breast. The sample is then examined by a pathologist under a microscope and may undergo additional laboratory testing.
If a lump, unusual calcifications, tissue distortion or other change is detected during a breast exam, mammogram, ultrasound or MRI that cannot be fully explained by imaging alone, a biopsy may be recommended. It is the only test that can confirm whether a suspicious breast finding is cancerous.
Being referred for a biopsy does not mean that breast cancer has already been diagnosed. Many breast changes that undergo biopsy are found to be benign.
Why Can Imaging Not Always Give a Final Answer?
Mammograms, ultrasounds, and MRI scans show the appearance and location of a breast abnormality. They can indicate whether an area looks suspicious, but they cannot always reveal exactly what the cells are.
A biopsy answers a different question. It allows a pathologist to examine the actual tissue and determine whether it shows:
- Normal breast tissue
- A benign condition
- Atypical or precancerous changes
- Non-invasive cancer
- Invasive breast cancer
This is why a biopsy may be recommended even when a lump cannot be felt. Small calcifications or tissue changes seen only on imaging may still need microscopic examination.
What are the Symptoms that Prompt this Test?
Your health care provider may recommend a Breast Biopsy if you have any of the following:
- A breast lump or thickening
- An abnormal mammogram.
- An abnormal breast ultrasound finding
- An abnormal breast MRI result
- Changes in the size or shape of breasts
- Skin dimpling or puckering of the breast
- Nipple inversion
- Unexplained nipple discharge
- Breast swelling or redness
- Enlarged lymph nodes near the breast or underarm
Which Type of Breast Biopsy May Be Used?
The type of biopsy depends on the size, appearance, depth and location of the abnormality. Whether it is palpable or only seen on imaging also affects choice.
Fine-Needle Aspiration
A small amount of cells or fluid is drawn up in a thin needle. May help to determine if a lump is fluid filled or solid but gives less information on the tissue than a core biopsy.
Core-Needle Biopsy
A hollow needle collects several small cylinders of breast tissue. Because the tissue structure is preserved, a core biopsy usually provides more information than fine-needle aspiration and is commonly used to assess suspicious breast findings.
Surgical Biopsy
An incisional biopsy removes part of an abnormal area, while an excisional biopsy removes the whole lump or suspicious area. Surgical biopsy may be considered when needle sampling is unsuitable or when previous results do not fully explain the imaging finding.
Why Is Imaging Sometimes Used During a Biopsy?
Not every breast abnormality can be felt by hand. Imaging guidance helps the clinician place the needle accurately into the area being investigated.
The process depends on the original detection of the finding:
- Ultrasound-guided: If the abnormality is visible on ultrasound
- Stereotactic or mammography-guided: Often for calcifications or changes noted on a mammogram
- MRI-guided: When the best visualisation of the target is provided by MRI
Imaging guidance helps to get tissue from the right place
How is the Test Performed?
- Inform your healthcare provider about any medications you are taking, especially blood thinners.
- Tell your healthcare provider about any allergies, including allergies to local anaesthetics.
- Follow instructions on food and drink if sedation is to be used.
- Follow any other instructions you were given prior to the procedure.
What Happens to the Sample in the Laboratory?
The sample is sent to a pathology laboratory, where it is processed into thin sections and examined under a microscope.
The pathologist looks at:
- The type of cells present
- How the cells are arranged
- When the tissue is benign, atypical, pre-cancerous or cancerous
- Whether the cancer is confined to the ducts or lobules
- Has the cancer spread into the surrounding tissue
- The grade of a cancer if present
If breast cancer is identified, additional tests may assess biomarkers such as hormone receptors and HER2. These results can help healthcare providers understand the cancer and plan treatment.
How to Understand Breast Biopsy Results?
Benign Result
A benign result means no cancer was found. Possible findings include cyst-related changes, fibroadenoma, fat necrosis, inflammation, or other non-cancerous breast conditions.
A benign result may require no further procedure when it clearly explains the imaging finding. Follow-up imaging or additional assessment may still be advised in some cases.
Atypical or High-Risk Result
Some results are abnormal looking cells but not cancer. Examples are atypical hyperplasia and some other high-risk breast lesions.
These results may increase the risk for breast cancer in the future, or require a larger sample to exclude disease in the vicinity. Your healthcare provider may recommend surgical removal, closer imaging follow-up, or specialist review.
Malignant Result
A malignant result means cancer cells were identified.
The report may describe:
- Whether the cancer began in a duct or lobule
- Whether it is non-invasive or invasive
- The tumour grade
- Biomarker findings when tested
A breast biopsy confirms the diagnosis, but additional imaging and clinical assessment may be needed to determine the stage and plan treatment.
Inconclusive or Non-Diagnostic Result
Sometimes the sample does not contain enough representative tissue to provide a clear answer. The biopsy may then need to be repeated or performed using a different method.
“The reference ranges vary depending on the laboratory and the methodology used. Individuals must consult their healthcare provider for correct interpretation of the results.”
What Happens After the Result?
The next step depends on whether the finding is benign, high-risk, cancerous, or inconclusive.
Follow-up may include:
- Routine or short-interval breast imaging
- Surgical removal of a high-risk lesion
- Repeat biopsy
- Biomarker testing
- Breast surgeon or oncology referral
- Additional imaging for treatment planning
- Discussion of treatment options when cancer is confirmed
The pathology report should always be reviewed with the healthcare provider who requested the biopsy.
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