What are the different types of breast biopsy procedures and what do they involve?

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What are the different types of breast biopsy procedures and what do they involve?

Breast biopsy procedures include:

fine needle aspiration biopsy (FNAB),


core needle biopsy (CNB),


vacuum-assisted breast biopsy, and


excision biopsy (surgery).

How is a fine needle aspiration biopsy (FNAB) done?

A fine needle aspiration biopsy (FNAB) can be done in several different ways:

Fine needle aspiration biopsy (FNAB) for palpable growths: A palpable growth is one that can be felt. The patient usually sits up while the doctor inserts a small hollow needle with a syringe to withdraw (aspirate) fluid and cells from the growth for testing. To guide the needle to the site, the doctor simply feels (palpates) the suspicious area. When the needle reaches the mass, the doctor suctions out a sample with the syringe. The doctor repeats this procedure several times. If the mass is a cyst, the withdrawn samples will consist mainly of fluid and the cyst may collapse, relieving any pain the patient feels. If the mass is solid, the samples will consist primarily of tissue cells.
By analyzing the samples immediately after their withdrawal, a doctor may be able to determine that they came from a cyst and simply discard them, diagnosing the growth as benign. In all other cases, fluid and tissue samples are placed on slides and then analyzed in a laboratory by a pathologist.

Guided FNAB for Non-Palpable Growths: When a growth is too small or deep to palpate (feel), the doctor must locate it with one of several imaging techniques. First, the patient lies face down on a table with the breasts suspended through an opening. With stereotactic mammography, mammograms of the suspicious breast site are taken from different angles to form a virtual three-dimensional (stereotactic) image that precisely pinpoints the location of the suspicious area. The computer then uses a motor to guide a small hollow needle to the site to remove the samples. The withdrawn samples are then analyzed for the presence of cancer. Ultrasound and MRI are other imaging techniques that may be used to guide breast biopsies.

How is a core needle biopsy (CNB) done?

A core needle biopsy (CNB) can also be done in several different ways:

Core needle biopsy (CNB) for palpable growths: This procedure is similar to FNAB for palpable growths except that that the needle used has a wider diameter and is equipped with a cutter that removes cores of tissue up to a half-inch long. A key advantage of this procedure is that the samples are larger than in FNAB and thus enhance the possibility of making an accurate laboratory analysis.


Guided CNB for Non-Palpable Growths: This procedure also uses a wide needle with a cutter that removes cores of tissue large enough to enhance the accuracy of laboratory analysis. However, because the growth is deep in the breast or otherwise not palpable, stereotactic imaging, ultrasound, or MRI is used to locate the growth.

How is a vacuum-assisted breast biopsy done?

Vacuum-assisted breast biopsy uses a special instrument and imaging guidance to remove samples of breast tissue through a single, small skin incision. This technique allows the surgeon to remove more tissue through a single incision than is possible with a traditional core biopsy and is a much less invasive procedure than an open surgical biopsy.

The vacuum-assisted biopsy involves the placement of a biopsy probe using radiology imaging studies for guidance. Stereotactic mammography, ultrasound, and MRI have all been successfully used to identify the abnormal areas to be sampled by vacuum-assisted breast biopsy. Once the biopsy probe has been positioned, a vacuum pulls the breast tissue through an opening in the probe into the sampling chamber of the device. Then a rotating cutting device in the instrument removes the tissue sample, which is carried through the biopsy probe to a tissue collection receptacle.

The surgeon or radiologist then turns a control knob on the biopsy probe that moves the sampling chamber to a new position. This procedure is repeated until all desired areas have been sampled. In this way, samples can be taken all around a suspicious area through a single insertion of the biopsy probe. With a traditional core biopsy, sampling of multiple areas would involve repeated insertions of the biopsy instrument.

The vacuum-assisted biopsy technique is performed under local anesthesia and leaves a small incision that does not require stitches for closure. It takes less than an hour to perform, and patients can usually return to normal activities soon after the procedure.

How is an excision biopsy of the breast done?

An excision (surgical) biopsy can also be done in different ways:

Surgical biopsy of palpable growths (lumpectomy): This procedure removes part or all of a breast growth, or lump. The doctor makes an incision one or two inches (about 2.5 to 5 cm) across and removes the sample. If the lump is small and measures an inch (2.5 cm) or less across, the doctor usually removes the entire lump for testing. If the lump is large, the doctor usually removes only a portion of it for testing. If cancer is found, the rest of the lump can be removed at the time of the biopsy or at a later time.
The doctor closes the opening with sutures or clips which remain in place for about a week. Patients who receive general anesthesia rather than a local will require about an hour to recover from drowsiness after the surgery.

Surgical biopsy for non-palpable lumps: This procedure is similar to lumpectomy except that the growth is first located by mammography or other imaging studies and then "marked." The doctor inserts a needle that conveys a wire with a hook on the end into the breast, all the while using the image as a guide. After anchoring the hooked wire to the lump, the doctor withdraws the needle and performs the surgery. Another option is to inject a dye to mark the spot rather than using a hooked wire.

What is the time frame for receiving the results of a breast biopsy?

For small biopsies and fine needle aspirations, the results may be available the next day. The results of most breast biopsies will be available within a few days. Sometimes special testing must be performed, and the results may take a bit longer. The radiologist or surgeon performing the procedure will be able to give you and idea of the approximate time frame that the result will be available. Your physician should also let you know how the result will be communicated to you.

Breast Biopsy At A Glance

A breast biopsy procedure is usually done to determine whether a growth in the breast is cancerous or benign.

A lump or other sign of breast cancer in a man or woman may warrant a breast biopsy.

A breast biopsy can be done with a needle or by a surgical procedure.

Non-surgical biopsies tend to be less stressful and minimize the risk of complications.

Non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis.

The biopsy may be done with imaging guidance.
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