Mammograms and ultrasounds are exams that provide images of the inside of the breasts. Imaging can reveal anomalies and provide information on breast health, but it does not provide a definitive diagnosis of the type of anomaly detected. If there is any concern, your doctor will order a biopsy.
In a breast biopsy, breast cell or tissue samples are collected for laboratory analysis. It’s the only test that can confirm whether cancerous cells are present.
Why undergo a biopsy?
Your doctor will recommend a biopsy if the mammogram and/or breast ultrasound images reveal abnormalities that are suspicious or indicative of cancer. To be clear, a biopsy does not mean that you have cancer! It is used to determine if cancer cells are present and this information can be obtained only by analyzing a sample of the tumour. Don’t forget—tumours can be malignant, but they are often benign.
A benign tumour is a non-cancerous tumour that does not spread to other parts of the body. It can be surgically removed and generally does not reoccur. The most common type of benign mass is fibroadenoma.
Malignant tumours are cancerous and can spread through the body via metastases. A large proportion of breast cancers are adenocarcinoma (ductal carcinoma, lobular carcinoma, etc.).
Types of biopsy
Several types of biopsy are available for analyzing an abnormality in the breast. Your doctor will choose the most appropriate method based on the location of the mass in the breast and whether it is palpable.
Fine-needle aspiration samples a small amount of tissue or liquid. It is used to determine if the abnormality is a cyst.
Core-needle biopsy uses a hollow needle (trocart) to sample tissue. Generally, three or four ultrasound-guided insertions are made.
Vacuum-assisted biopsy uses a larger needle and the sample is removed using suction. With this approach, more tissue can be sampled. It is also performed using ultrasound or stereotactic guidance.
How to prepare for a biopsy
There is no specific preparation for a biopsy other than to wear a shirt that provides easy access to the breast and avoid cumbersome jewelry. You should also inform your doctor in advance of any treatment or medication involving anticoagulants.
The biopsy process
There are different types of biopsies, but generally the procedure takes approximately 30 minutes. Your radiologist may use a small-calibre needle (three to five mm in diameter) for a microbiopsy, or a larger calibre (five to 10 mm in diameter) for a macrobiopsy. The procedure may be guided by a mammography machine (for a stereotactic biopsy) or by ultrasound (for an ultrasound-guided biopsy).
- The area to sample is identified using the guiding technology, the skin is disinfected and local anesthesia administered.
- A small four- to five-mm incision is made in the skin.
- Your doctor then guides the needle toward the tumour. When the needle is positioned, the samples are extracted. You might hear a sudden popping sound from some of the equipment. This procedure is not painful because it is performed under local anesthesia, but the sound can be surprising.
- The technologist will apply a bandage after the exam.
- The medical team might insert a metal wire known as a harpoon. Protruding slightly from the skin, it serves to identify where the sample was taken.
- Once the biopsy is complete, the samples are sent to a laboratory for analysis.
After the biopsy, the technician will give you post-procedure instructions. You can resume your normal daily activities, but avoid strenuous arm exercises and showers for 48 hours.
A biopsy causes more discomfort and side effects than other diagnostic tests. A few days after the test, you might notice an ecchymosis (commonly known as a bruise) or edema (swelling) in the area examined, along with sensitivity or slight pain. There is no cause for concern. This discomfort could last up to two weeks and is a normal side effect.
However, if you have unexplained fever, significant bleeding or sharp pain at the biopsy site, you should go to the emergency department.
How are the results provided?
Results are available three to four weeks after the biopsy. Your doctor will share them with you at an appointment. This is when you will learn if the abnormality that was examined is benign or malignant.
A word of advice: don’t go to this appointment alone! Even if the diagnosis is negative for breast cancer, the stress and emotions of what you have been through could hit all at once.
On the other hand, if the diagnosis is positive for breast cancer, you might be bombarded with information: stage, grade, molecular receptor, etc. Your doctor might recommend additional tests to learn more about the type of cancer you are facing and which treatment is most appropriate for you. Bring someone you trust to take notes and support you during this ordeal.
Together we have gone through part of the breast cancer diagnosis process, from first worrisome symptom, to mammogram, ultrasound and finally biopsy. Throughout this journey, it is important to remember that 90% of breast symptoms are ultimately benign and only 10% are cancerous. Nonetheless, when cancer is caught early, it can be more easily treated using less aggressive treatment. When in doubt, an ounce of prevention is worth a pound of cure!
If you have any questions or concerns about breast cancer, we’re here for you before, during and after diagnosis. Call our confidential line: 1 855 561-PINK.
We would like to thank the Ordre des technologues en imagerie médicale, en radio-oncologie et en électrophysiologie médicale du Québec (OTIMROEPMQ) for its assistance in writing this article.
BIBLIOGRAPHY
« Biopsie du sein micro-biopsie ou macro-biopsie guidée par échographie | CHU de Québec-Université Laval ». Consulté mai 2023 https://www.chudequebec.ca/patient/maladies,-soins-et-services/traitements-et-examens/examens/biopsie-a-l-aiguille-du-sein.aspx.
Ruban rose. « Diagnostic cancer du sein ». Consulté le 14 octobre 2021. https://rubanrose.org/minformer/depistage-et-diagnostic/diagnostic/