Introduction to Breast Biopsies

A biopsy is a procedure used to find out whether an abnormality found through imaging like a mammogram(MAM-O-GRAM) — A screening test that uses x-rays to look for breast cancer or ultrasound(ALL-TRA-SOUND) — An imaging technique that uses sound waves to differentiate types of tissue is benign(BE-NINE) — A growth in the body that is neither invasive nor cancerous and has a very low risk of spreading, premalignant(PRE-MA-LIG-NENT) — A growth that will worsen and grow into a cancer, becoming malignant if not removed, or malignant(MA-LIG-NENT) — A cancer or abnormal tumor that grows uncontrollably and may spread to other parts of the body.

During a breast biopsy, a small amount of the breast tissue in question is removed so it can be examined more closely. There are several techniques that doctors can use to obtain tissue samples from the breast. Ask your doctor which one is best for you. We will discuss fine needle aspiration(FINE NEE-DOL AS-PER-A-SHUN) — The withdrawal of fluid or tissue from the body with a needle, core needle biopsy(CORE NEE-DOL BYE-OP-SEE) — Removal of tissue using a large needle, ultrasound-guided biopsy(ALL-TRA-SOUND GUY-DID BYE-OP-SEE) — A technique that uses sound waves to direct the placement of a needle in order to obtain tissue, stereotactic biopsy(STAIR-E-O-TAK-TIC BYE-OP-SEE) — A technique using x-rays to guide the placement of a needle in order to obtain tissue, MRI-guided biopsy(M-R-I GUY-DID BYE-OP-SEE) — A technique that uses an MRI machine to locate a growth and direct the placement of a needle in order to obtain tissue, and excisional biopsy(EX-SIZ-SHUN-OL BYE-OP-SEE) — Surgical removal of a larger piece of abnormal tissue or an entire small mass.

Fine Needle Aspiration

Fine needle aspiration (FNA) is when a doctor inserts a very small needle into the mass and pulls the needle back and forth. By moving the needle back and forth, the doctor is obtaining cells from the mass.

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Core Needle Biopsy

A core needle biopsy is performed in a similar way to a fine needle aspiration, but the needle is much larger. Since the needle is larger, it can obtain more tissue. This technique is like using an apple-coring tool (but a biopsy takes a much, much smaller core). An apple-corer removes the center of an apple without damaging the rest of it.

Instead of throwing away the apple’s core, with a core needle biopsy, doctors keep the removed tissue and analyzes it. Compared to an FNA, core needle biopsies may be a little more uncomfortable and cause a bruise because the needle is larger.

Ultrasound-guided, Stereotactic, and MRI-guided Biopsies

Ultrasound-guided, stereotactic, and MRI-guided biopsies are performed using similar needles to the core needle biopsy. However, the biopsy is now performed using the guidance of an ultrasound, mammogram (x-ray(EX-RAY) — Energy particles that pass through tissue to obtain an image of the body), or MRIA loud banging machine that uses magnets to obtain pictures of the inside of the body; magnetic resonance imaging machine. You may recognize some of these tools from your diagnostic testing. During a biopsy, a radiologist(RAY-DEE-OL-O-JIST) — A doctor who interprets or reads images of the body (or surgeon) uses these instruments to locate the abnormal tissue and “watch” as the needle enters the mass. Now the radiologist is more certain the sample was collected from the correct location.

Excisional Biopsy

An excisional biopsy is performed when a surgeon makes a small incision in the skin and removes a larger piece of the mass, or even the whole mass if it is small. Following an excisional biopsy or stereotactic biopsy, the radiologist may take additional images of the removed tissue and the breast to confirm the suspicious tissue was obtained.

Let’s use the dandelion to help you understand the different biopsies a little better.

Biopsies are like a gardener taking a small piece of a weed to determine if it is truly a weed, like a dandelion, or just a normal flower, like a daisy. The gardener can remove just a tiny piece of a leaf, the whole leaf, and if necessary, the whole plant.

Fine needle aspiration is like taking a tiny speck of a leaf and trying to decide if the plant is a dandelion. As you can imagine, a tiny speck is not very helpful if you cannot see the whole plant. Core needle, ultrasound-guided, stereotactic, and MRI-guided biopsies are like removing a larger part of the leaf so the gardener can do more tests and obtain more information about the plant. Finally, an excisional biopsy is like removing the entire leaf or the whole plant. When you remove the whole plant, it becomes very easy for the gardener to tell if it is a dandelion.

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