Breast Biopsies

Breast Biopsies Sydney Breast Surgeon Dr Susannah Graham

A breast biopsy is a test that removes tissue or cells from the breast so that it can be examined further by a pathologist. This gives us important information about the breast tissue, to help with making a diagnosis and planning treatment. There are several types of biopsy used to take samples of tissue and cells from the breast. These include:

  • Fine needle biopsy (also called or fine needle aspiration biopsy, FNA or FNAB)

  • Cyst aspiration

  • Core biopsy

  • Vacuum-assisted core biopsy (or VACB)

Each of these types of biopsies are done in a slightly different way and give us different information. Dr Graham will discuss the advantages and limitations of different types of biopsies. She will also discuss why she recommends a particular type of biopsy. These biopsies are most commonly done by radiologists under imaging guidance. More information and the potential risks and complications will also be provided to you by the person doing the biopsy.

Dr Graham advocates the National Law and Australian Health Practitioner Regulation Agency (AHPRA) guidelines that any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

1. Fine Neelde Biospy (FNB) +

There is no special preparation required for a fine needle aspiration, and it is usually a quick & simple procedure. A small needle is placed through the skin into the breast. The needle is gently moved through the tissue to collect cells. Once the needle is removed, pressure is applied to the breast to help stop bruising. If the lump is not able to be felt easily, the needle may be placed into the breast under ultrasound or mammogram guidance. Local anaesthetic may be used to numb the skin and part of the breast. A fine needle biopsy is usually uncomfortable, but not painful and results are available quickly after your procedure.

Limitations of a fine needle biopsy include: Sometimes there may not be enough cells or tissue in the sample to make a definite diagnosis. Even if lots of cells are seen, a diagnosis may not be able to be made (inconclusive result).

2. Cyst Aspiration +

Cyst fluid is removed (often under ultrasound guidance) using a small needle passed through the breast into the cyst. Cyst fluid may or may not be sent to the pathologist to be looked at under the microscope.

3. Core Biopsy +

A core biopsy is usually a quicl procedure and no special preparation is required. Most commonly it is performed under the guidance of ultrasound or mammogram and is always done under local anaesthetic to numb the area being biopsied. Local anaesthetic is injected to numb skin and breast tissue and a tiny cut is made in the skin and the core biopsy needle is put through the cut into the breast tissue. When the sample is taken, there is a clicking noise (an automatic needle is used to take the biopsy). The procedure is repeated several (usually 3-5 times) though the same skin cut until enough tissue has been collected.

Following the procedure, pressure is applied to help stop bruising and a dressing is applied. Simple pain medication may be required once the local anaesthetic wears off. Unlike a fine needle biopsy, more tissue is removed using a core biopsy, meaning a definite diagnosis is more likely.

Limitations of a core biopsy:

Sometimes a core biopsy may not give a definite answer, and more tests may be required to confirm or exclude cancer. It does tend to take longer to perform and side effects like bruising and pain are more common than with a fine needle biopsy. Rarely, significant bruising and bleeding can occur, it can result in a lump in the breast and can take a few weeks to disappear.

4. Vacuum-Assisted Stereotactic Core Biopsy (VACB) +

A VACB is a specialised type of core biopsy that is used to remove lots of small pieces of tissue from the breast. It is a similar needle to the core biopsy, but special needles with suction help remove the sample of tissue from the breast.

The procedure uses specialised technology (sterotaxis) to guide the needle to the correct position. This is needed when there is an abnormality that can be seen on mammogram but cannot be felt or seen on ultrasound. Sometimes a VACB is performed under ultrasound.

The biopsy is performed with you lying face down on a table, placing the breast through a hole in the table (sometimes it is performed sitting up). The breast will be compressed to hold it in position, similar to a mammogram but not as firmly. With the breast held in position, a mammogram picture is taken to locate the area to be biopsied

The skin is numbed using local anaesthetic and the biopsy needle is put into the breast and a vacuum is applied, several small samples of tissue are removed as the needle moves in an out of the breast. A metal clip is often inserted to make sure the area can be found again easily. A mammogram picture is taken to confirm that the correct area has been sampled and dressings are applied.

Advantages of VACB:

  • More tissue is removed than with a fine need or core biopsy which increases the chance of getting a definite results.
  • Abnormal tissue that is only visible on mammogram can be sampled
  • Performed under local anaesthetic
  • No special preparation required

Limitations of VACB:

  • Sometimes, after being placed into position on the table for the procedure, we find that some patients are not suitable for this procedure. This can be due to unpredictable technical reasons. If this happens, the reasons will be discussed with you ad alternatives will be discussed.
  • Bruising is more common than with fine needle or core biopsy.
  • Sometimes the result is still inconclusive or a more serious abnormality is identified and surgery is still required.
  • It may not be suitable for people that have difficulty lying down.
  • It usually take an hour or more to perform.
  • Rarely, significant bruising and bleeding can occur, it can result in a lump in the breast and can take a few weeks to disappear.