Breast Biopsy Health Article

Definition

A breast biopsy is the removal of breast tissue for examination under a microscope by a pathologist. This can be accomplished surgically (excisional biopsy), or by withdrawing tissue through a needle (aspiration biopsy).

Purpose

A biopsy is recommended when a significant abnormality is found which cannot be identified conclusively by imaging studies. The abnormality in question might be a finding on breast self-examination, on routine physical or gynecological examination, or on a mammogram. Signs of concern in addition to palpable lumps include:

• severe breast pain
• changes in the size of a breast or the nipple
• changes in the shape of the breast or nipple
• pitting, dimpling or redness of the breast skin.
• nipple redness, irritation or inversion of the nipple which is new
• changes in the pattern of veins visible on the surface of the breast
• some types of nipple discharge

If imaging studies are not decisive, the differentiation of cancer from a benign breast condition must be determined using a biopsy. However, in pre-menopausal women, it may be appropriate to follow a lump by physical exam for one to two menstrual cycles before considering biopsy.

Precautions

Physical exam is not sufficient for evaluating significant breast abnormalities. About 30% of abnormalities thought to be benign by physical exam turn out to be cancerous, and 60% of those thought to be malignant prove to be benign.

The type of biopsy recommended should be considered carefully. The best approach will depend upon 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 and much less expensive than surgical biopsy. It is appropriate for most, but not all situations. However, some surgeons feel that it is less accurate.