What to Expect at a Breast Biopsy
A dear friend was on her way to a breast biopsy this morning and text’d me saying that she was scared because she didn’t know what to expect – and that no one had told her about the procedure. This happens with all too much frequency and really gets my goat. Geesh. So much of the fear of this surgical and oncological world comes from the unknown. This is really the fundamental reason that I wrote the book: to give people the support and information to help them through tests, treatment and recovery.
So, please allow me to give you the basics of what a breast biopsy is and what can be expected during and after the test.
First things first, just because you need a biopsy doesn’t mean that you have cancer. Not all lumps are cancerous. Types of benign (non-cancerous) Lumps include:
- fibrosis – firmness in the connective tissues
- cysts – fluid-filled sacs and
- benign breast tumors – non-cancerous areas where breast cells have grown abnormally and rapidly, often forming a solid lump
The Silver Lining of today is that my girlfriend’s lump was NOT cancerous. So before you get yourself all worked up, please take one step at a time and don’t assume the worst. This is harder said than done, I know…especially coming from the girl whose lump WAS cancerous.
What is a Biopsy
One of the most important things to know is that: A biopsy is the only way to tell for sure if a breast change is cancer. Even though imaging tests like the mammogram and ultrasound can find a suspicious area, they cannot tell whether it’s cancer.
A biopsy removes some cells from the area of concern so they can be checked under a microscope. The cells can be removed using a needle or by doing surgery to take out part or all of the tumor. The type of biopsy depends on the size and location of the lump or suspicious area.
Another important thing to remember is that biopsies are not medical emergencies and can be scheduled at your convenience. Most people want them done asap. I know that I did.
Questions to Ask Before Having a Biopsy
Before having the procedure, I HIGHLY recommend taking a list of questions to your doctor’s appointment so that you can have a full understanding of the what, why, how and when’s of your procedure!
- What type of biopsy do you recommend? Why?
- How does the size of my breast affect the procedure?
- Where will you do the biopsy?
- What exactly will you do?
- How long will it take?
- Will I be awake or asleep during the biopsy?
- Can I drive home afterward, or will I need someone to drive me?
- If the abnormal area cannot be felt, how will you find it?
- If you are using a wire to help find the abnormal area, will you check its placement by ultrasound or with a mammogram?
- Can you draw pictures showing me the size of the cut and the size of the tissue you will remove?
- Will there be a hole there? Will it show afterward?
- Will my breast have a different shape or look different afterward?
- Will you put a clip or marker in my breast?
- Where will the scar be? What will it look like?
- Will there be bruising or changes in color of the skin?
- Will I be sore? If so, how long will it last?
- When can I take off the bandage?
- When can I take a shower?
- Will there be stitches? Will they dissolve or do I need to come back to the office and have them removed?
- When can I go back to work? Will I be tired?
- Will my activities be limited? Can I lift things? Care for my children?
- How soon will I know the biopsy results?
- Should I call you or will you call me with the results?
- Will you or someone else explain the biopsy results to me?
Types of Biopsy Procedures:
- Fine Needle Aspiration Biopsy: Fine needle aspiration (FNA) is the least invasive method of biopsy and it usually leaves no scar. You will be lying down for this procedure. First, an injection of local anesthesia (MAKE SURE YOU GET PLENTY OF PAIN MEDICINE!!!) is given to numb the breast. The surgeon or radiologist uses a thin needle with a hollow center to remove a sample of cells from the suspicious area. In most cases, he or she can feel the lump and guide the needle to the right place.In cases where the lump cannot be felt, the surgeon or radiologist may need to use imaging studies to guide the needle to the right location. This is called ultrasound-guided biopsy when ultrasound is used, or stereotactic needle biopsy when mammogram is used.
- Core Needle Biopsy Core needle biopsy uses a larger hollow needle than fine needle aspiration does. If you have this type of biopsy, you’ll be lying down. After numbing the breast with local anesthesia, the surgeon or radiologist uses the hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area. In most cases, the needle is inserted about 3 to 6 times so that the doctor can get enough samples (mine sounds like a BB gun making a “pop-pop-pop” sound). Usually core needle biopsy does not leave a scar (mine didn’t).If the lesion cannot be felt through the skin, the surgeon or radiologist can use an image-guided technique such as ultrasound-guided biopsy or stereotactic needle biopsy.
- Vacuum-assisted breast biopsy: Vacuum-assisted breast biopsy is a newer way of performing breast biopsy. Unlike core needle biopsy, which involves several insertions of a needle through the skin, vacuum-assisted biopsy uses a special probe that only has to be inserted once. The procedure also is able to remove more tissue than core needle biopsy does.For vacuum-assisted breast biopsy, you’ll lie face down on an exam table with special round openings in it, where you place your breasts. First, an injection of local anesthesia is given to numb the breast. Guided by mammography (stereotactic-guided biopsy) or ultrasound, the surgeon or radiologist places the probe into the suspicious area of the breast. A vacuum then draws the tissue into the probe. A rotating cutting device removes a tissue sample and then carries it through the probe into a collection area. The surgeon or radiologist can then rotate the probe to take another sample from the suspicious lesion. This can be repeated 8 to 10 times so that the entire area of concern is thoroughly sampled. Vacuum-assisted biopsy is becoming more common, but it is still a relatively new procedure. If you are having this form of biopsy, make sure that the surgeon or radiologist is experienced at using the equipment.
- Surgical (Open) Biopsy: A surgical biopsy is done by cutting the breast to take out all or part of the lump so it can be looked at under the microscope
- An incisional biopsy removes only part of the suspicious area, enough to make a diagnosis.
- An excisional biopsy removes the entire mass or abnormal area, with or without trying to take out an edge of normal breast tissue (it depends on the reason for the excisional biopsy).
- Biopsy Markers: After the doctor has taken out all of the tissue samples needed, a very small, safe marker or clip may be put in your breast at the biopsy site. These clips are tiny, surgical-grade, metal devices that show up on mammograms and are used to mark the biopsy site. The clip cannot be felt and should not cause any problems. It’s used to mark the area in case changes show up on future mammograms.
Waiting for Test Results
One of the challenges of testing is waiting for results, which can take anywhere from a few days to a week until the full report is prepared. The waiting time can certainly be fear inducing. It is important to engage in healthy coping mechanisms (deep breathing, yoga, running, meditation, talking with others) to make the time pass. Go ahead and acknowledge the fear and/or anxiety. You’re certainly entitled!
Right after the tissue sample is removed, it’s sent to the lab, where a pathologist looks at it. (A pathologist is a medical doctor who is specially trained to look at cells under a microscope and identify diseases.)
If the biopsy result is negative: it means that no cancer was found—the breast change is benign (not cancer). If you have any questions or you feel unsure about the results, you might want to get a second opinion or pathology review. (A pathology review is having another doctor look at your biopsy tissue.) Once you feel comfortable that you do not have cancer, be sure to:
- Have regular mammograms
- Keep seeing your health care professional for routine breast exams
- Be aware of any changes in your breasts, and report changes to your doctor right away
- Talk with your doctor about your risk of breast cancer
If the biopsy shows that the lump is cancer, the report will tell your doctor some important things about the cancer:
- Is it in situ or invasive?
- In situ means that the cancer started in a duct (tube that carries milk from the lobule to the nipple) and has not spread to the nearby breast tissue or to other organs.
- Invasive or infiltrating means that the cancer started in a lobule or a duct and has spread into nearby breast tissue. This type may spread to the lymph nodes or to other parts of the body through the lymph system and bloodstream.
- How fast is it likely to grow & spread? Pathologists use the microscope to look at the cancer cells to see what they look like and how they are arranged. This helps them figure out the cancer’s grade. The grade tells how slowly or quickly the cancer is likely to grow and spread.
- Is the cancer HER2-positive? Tumors with increased levels of the protein called HER2/neu are called HER2-positive. These cancers tend to grow and spread faster than other breast cancers. HER2/neu testing should be done on all newly diagnosed invasive breast cancers. HER2-positive cancers can be treated with drugs that target the HER2/neu protein.
- Will it respond to hormone therapy? Estrogen and progesterone receptors respond to the female hormones estrogen and progesterone. On breast cancer cells, these receptors can attach to the hormones which help the cancer grow. Some breast cancers have these receptors (these are called receptor-positive), and others do not (they’re receptor-negative). Finding out if a cancer has these receptors will help your doctor decide if hormone therapy will help you.
Be sure you understand your biopsy results and what they mean. Always ask for a copy of the pathology report to keep with your medical records.
Questions to ask about your biopsy results
After your biopsy results are back, it’s important to know if the results are final, definite results, or if another biopsy is needed. Here are some questions to ask if they are the final results:
If it’s not cancer…
- Do I need any follow-up?
- When should I have my next screening mammogram?
If it’s cancer…
- Is the cancer in situ or invasive?
- If the cancer is in situ, is it a type of cancer that can become invasive?
- Does the cancer seem to be growing and/or spreading slowly or quickly?
- Will the cancer respond to hormone therapy?
- Do I need more tests to learn the stage of the cancer? (The stage is how widespread the cancer is at the time it’s found.)
- What kind of treatment do you recommend for me, and why? Are there other options that might work?
- When will I need to start treatment?
Two really good websites (from which I curated most of the information above are the American Cancer Society & Breastcancer.org).