General Information on Breast Biopsy
- Breast Biopsy Overview
- Digital Spot-View Mammography Improves Breast Biopsy
- Breast Biopsy with Ultrasound Image Guidance
- Breast Biopsy with Prone (Face Down) Stereotactic Image Guidance
- Breast Biopsy with Upright Stereotactic Image Guidance
- Relative Cost of Different Breast Biopsy Methods
A breast biopsy involves removing a sample of breast tissue to determine whether it is cancerous or benign (non-cancerous). There are several different types of breast biopsy. The biopsy method most suitable for a particular patient depends on a number of factors, including:
- whether or not an abnormality can be felt or only seen with imaging
- how suspicious the abnormality appears on x-ray (or feels on palpation)
- the size, shape, and other distinct characteristics of the abnormality
- the location of the abnormality in the breast and in relation to other anatomic structures
- the number of abnormalities detected during physical examination or with x-ray imaging
- the patient's medical history and current medications
- the preference of the patient, as long as an option is medically safe and appropriate
In addition, the systems available at a given breast imaging center or surgical center may influence which method of biopsy a patient receives. For example, vacuum-assisted biopsy (brand name, Mammotome or MIBB) is currently not available at all facilities.
Many biopsy methods rely on image guidance to help the radiologist or breast surgeon precisely locate the lesion (abnormality) within the breast. Imaging may be necessary when a lesion (breast abnormality) cannot be felt during examination and is only detected on imaging studies such as mammography or ultrasound. It may also be necessary to use imaging to assure that a mass felt during examination is, indeed, the same abnormality noted on a mammogram or ultrasound.
If image guidance is required, each of the factors listed above will also be considered in terms of what type of image guidance is most appropriate for the biopsy. Biopsy methods that may require image guidance include:
- fine needle aspiration biopsy (FNA)
- core needle biopsy
- vacuum-assisted biopsy (Mammotome or MIBB)
- large core biopsy (ABBI)
- open surgical biopsy (excisional or incisional)
Of these methods, FNA, core needle, and vacuum-assisted biopsies are performed as percutaneous ("through the skin") procedures rather than surgical biopsies. Click on one of the biopsy methods listed above for a detailed explanation of the procedure.
Though percutaneous ("through the skin") biopsy methods only provide partial information for pathologists, they are usually very accurate when performed by a skilled radiologist or surgeon who has significant experience with image guidance.
However, because percutaneous biospies only provide samples of tissue (and not the entire lesion as a surgical biopsy does), occasionally, additional procedures may be needed for final diagnosis and treatment of a breast abnormality. This is especially true if there are faint calcifications (calcium deposits), small or low density masses, or diffuse (spread out) abnormalities. Diffuse lesions can be difficult to locate accurately in two stereotactic x-ray views.
Therefore, women should always discuss the risks and benefits of any recommended procedure with their physicians before deciding on the most suitable diagnostic option. Click here to learn more about the different methods of breast biopsy.
A recent advance in the field of mammography is digital mammography. Digital (computerized) mammography is similar to standard mammography except that breast images are obtained using a system that is equipped with a digital receptor and a computer instead of a film cassette. Digital spot view mammography is often used during breast biopsy and typically allows a faster and more accurate stereotactic biopsy. This usually results in a shorter procedure, increasing patient comfort.
With digital spot-view mammography, images are acquired digitally and displayed immediately on the system monitor. Traditional stereotactic biopsy requires a mammogram film be exposed, developed and then reviewed, significantly increasing the time before the breast biopsy can be completed. Today, the majority of facilities use digital mammography when image guidance is needed for stereotactic biopsy.