Why is a breast biopsy ordered? Why is it done?

Breast cancer in women has increased considerably in recent years. Both genetic predisposition and environmental factors play a role in this increase in breast cancer. Breast cancer can be detected by breast ultrasound and mammography. Additional tests such as MRI, scintigraphy and breast biopsy are required to determine the type of treatment.

Breast Biopsy

Taking a needle biopsy from the pathological appearance detected in the breast in a clinical setting under ultrasound guidance is performed with fine needle biopsy, Tru Cut biopsy or vacuum biopsy, the procedure is called incisional biopsy. The biopsy during the determination of the type of surgery by removing the pathological, that is, bad appearance in the breast during surgery and waiting for the result is called frozen biopsy, and the procedure is called excisional biopsy.

In summary, incisional biopsy is the process of removing a part of the pathological appearance of the breast with a needle under ultrasound guidance in a clinical setting and testing the suspicious lesion; excisional biopsy is the process of removing the entire mass in the surgical setting.

How is a breast biopsy performed?

Breast biopsy is usually performed in a clinical setting. The patient arrives on foot and is awake. General anesthesia is not required. The area to be biopsied is prepared locally, and the area to be biopsied is determined with ultrasound guidance.

The patient is given the appropriate position and the area is anesthetized with local anesthesia under ultrasound guidance. The procedure is usually performed with a fine needle in axillary lymph nodes and with a Tru cut needle in breast masses. Since local anesthesia is applied, no significant pain is felt.

A needle is used to take a piece from the pathologic, i.e. risky areas, and it is sent to the pathology laboratory with a special solution. Thus, a definitive diagnosis is made with tissue diagnosis and the type of treatment is determined.

In appropriate patients, vacuum biopsy can sometimes be performed, and the entire mass can be removed in this way. However, there is controversy about this.

Especially in patients diagnosed with BIRADS-4 BIRADS-5 with a high probability of cancer, biopsy provides a definitive diagnosis, determines the type of cancer and allows the treatment and medications to be determined.

Breast Biopsy Methods

Breast biopsy is a method of taking and evaluating a piece of a pathologic, i.e. malignant, mass in the breast.

There are two types of breast biopsy: Incisional and excisional biopsy.

Incisional biopsy is the removal of a piece from the mass in the breast and sending it to pathology. According to the pathology result of the mass, the type of surgery and oncologic treatment protocol is decided.

Two methods are used in incisional biopsy;

  • Fine Needle Biopsy: This method usually gives good results not in breast masses but in pathologic-looking lymph nodes in the armpit.
  • Tru Cut Biopsy: Also called cutting needle biopsy. The breast mass is entered with a relatively thick needle after local anesthesia under ultrasound guidance in a clinical setting, 3-4 pieces are taken and removed. The pieces are sent to pathology in a special liquid. Results are usually available within 1-2 days. This method is more effective and accurate in determining the type of mass. This method is usually used.
  • Excisional biopsy is the removal of the entire mass in the breast and sending it for examination. It is done in two ways:

Vacuum biopsy is performed in a clinical setting. With a special device, the mass in the breast is marked and the entire mass is removed by vacuum method. Hospitalization is not required. It is generally used in masses such as fibroadenoma, which are considered to be more benign.

Surgical biopsy is the removal of the entire mass during surgery and sending it to pathology.

Is preparation necessary before a breast biopsy?

No preparation is required before breast biopsy. The procedure is performed in a clinical setting under local anaesthesia with ultrasound guidance. Since general anaesthesia is not required, fasting is not necessary. The patient arrives and leaves the clinic on foot.

Risks of breast biopsy

Breast biopsy is performed under ultrasound guidance. Therefore, there is generally no great risk. However, like all needle procedures, there is a risk of infection, bleeding, haematoma and pain afterwards.

Is breast biopsy harmful?

Breast biopsy is not harmful. On the contrary, it is a very useful method. It is a very good method because it allows intervention before the patient's mass becomes troublesome. Because the type and degree of the mass is determined by breast biopsy.

How long does a breast biopsy take?

In breast biopsy, the patient comes to the clinic, is given a suitable outfit and lies on an ultrasound stretcher. The mass is visualised again by ultrasound. After local anaesthesia, 3-4 pieces are taken under ultrasound guidance and placed in appropriate liquids. The procedure takes 30-45 minutes including preparation.

Breast Biopsy Prices

Pricing is based on current prices. Pricing may vary depending on the number of masses to be biopsied, the lymph node, and the pathology specialist to which the piece to be sent.

Things to Consider After Breast Biopsy

After the breast biopsy, the patient can return to her normal life. It is only necessary to avoid excessive sports activities and bathing on the same day. She can take a bath 24 hours after the biopsy. It may be necessary to renew the dressing in case of bleeding.

Things to Know About Breast Biopsy

Breast biopsy is more accurate when performed with a Tru cut biopsy. Fine needle biopsy is usually useful in the axillary lymph nodes where the mass has spread.

When breast biopsy is performed under appropriate sterilization conditions, the risk of infection is almost zero. If the patient is on blood thinners, bleeding and hematoma may occur afterwards. It is important to inform your doctor about this.

Does the patient feel pain during the biopsy?

Since local anesthesia is used during the procedure, there is usually no pain, but stress and tension may cause pain-like sensations. Trusting your doctor and trying to relax will increase your comfort during and after the procedure. If there is pain after the biopsy, painkillers can be taken, there is no contraindication.

Is a biopsy definitive?

When a biopsy is performed directly from the mass under ultrasound guidance or when the entire mass is surgically removed, it usually gives a definitive diagnosis in pathology. However, in some types of cancer, a second biopsy with ultrasound guidance may be required upon the request of the pathologist.

Is there pain in the breast after a biopsy?

Women who have had a breast biopsy may worry about the aftermath. Even when blood is drawn from the arm, there may be a slight pain at the needle site afterwards.

Taking a piece from the mass in the breast is a more complicated procedure than blood sampling. Depending on the location and the pain threshold of the patient, some patients may experience pain for 2-3 hours after the biopsy. In this case, painkillers can be taken, there is no contraindication.

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Md. Rengin TürkgülerMd. Rengin TURKGULERInterventional Radiologist
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