Breast Biopsy Health Article

Definition

A breast biopsy is removal of breast tissue for examination by a pathologist. This can be accomplished surgically, or by withdrawing tissue through a needle.

Purpose

A biopsy is recommended when a significant abnormality is found, either on physical examination and/or by an imaging test. Examples of abnormality can include a breast lump felt during physical self examination or tissue changes noticed from a mammogram test. Before a biopsy is performed, it is important to make sure that the threat of cancer cannot be disproved or ruled out by a simpler, less invasive examination. A lump may be obviously harmless when examined by ultrasound. If this is not decisive, the presence of cancer or a variety of benign breast conditions can be determined using a biopsy.

Precautions

The type of biopsy recommended should be considered. This will depend on whether the area can be felt, how well it can be seen on mammogram or ultrasound, and how suspicious it feels or appears. Specialized equipment is needed for different types of biopsy and availability may vary. Generally, needle biopsy is less invasive than surgical biopsy. It is appropriate for most, but not all situations. However, some surgeons feel it is far less accurate.

Surgical biopsy

If an abnormality is not felt during a self examination, there are signs that indicate the need for medical attention. These include:

• severe breast pain
• changes in the size of a breast or the nipple
• changes in the shape of both breast or nipple
• pitting, dumpling or redness of the breast skin
• nipple redness, irritation, or inversion
• changes in the pattern of veins visible on the surface of the breast
• some types of nipple discharge

If the abnormality is not felt, a needle localization must be done before the actual surgery. After local anesthetic is administered, a fine wire is placed in the area of concern. Either x ray or ultrasound guidance is used. The patient is awake and usually sitting up.

There are two types of breast biopsy considered here, excisional and incisional. An excisional biopsy is a surgical procedure, where the entire area of concern and some surrounding tissue is removed. It is usually done as an outpatient procedure, in a hospital or free standing surgery center. The patient may be awake, and is sometimes given medication to make her drowsy. The area to be operated on is numbed with local anesthetic. Infrequently, general anesthesia is used.

An excisional biopsy itself usually takes under one hour. The total amount of time spent at the facility depends on the type of anesthesia used, whether a needle localization was done, and the extent of the surgery.

If a mass is very large, an incisional biopsy may be performed. In this case only a portion of the area is removed and sent for analysis. The procedure is the same as an excisional biopsy in other respects.