There are six types of biopsies doctors can conduct to determine if a lump in the breast is malignant or benign and many can be performed on an out-patient basis without surgery. The type of biopsy procedure a doctor chooses is based on a number of factors, including the size of the lump and where it's located in the breast.
Fine Needle Biopsy
A fine needle aspiration (FNA) biopsy involves using a small needle that is inserted into the breast to remove a small sample of the lump for examination. This procedure is used when lumps are located near the surface or are otherwise easy to reach, It also allows doctors to determine if the lump is cyst, since it will collapse after being lanced by the needle and drain.
Ultrasound Guided Core Biopsy
One of two types of procedures known as "core biopsies," the ultrasound-guided core biopsy uses sound waves to pinpoint the exact location of a lump so that a large needle can be inserted into the lump to extract tissue samples. This procedure is used for hard-to-reach lumps. Local anesthetic is used to numb the area before the procedure.
Stereotactic Needle Biopsy
Similar to an ultrasound biopsy, a stereotactic needle biopsy uses a type of mammogram film called SCOUT film to pinpoint the exact location of a lump. The film of the lump and surrounding area is then used to guide a needle into the lump and along its perimeter, where it takes tissue samples. A local anesthetic is administered to the breast to numb the area before the procedure begins.
Open Excisional Biopsy
The oldest breast biopsy method involves a doctor cutting open the breast and extracting the entire lump along with some surrounding tissue for examination. This procedure is performed less frequently because less-invasive methods are available. However, it removes the lump and allows for a complete examination of the lump and surrounding area.
Sentinel Node Biopsy
One of the newest biopsy methods for breast cancer, the sentinel node biopsy, removes anywhere from one to three lymph nodes into which lymph nodes vessels near a tumor are most likely to drain. The procedure is conducted during a mastectomy or lumpectomy. Dye is injected into the breast so that it can spread into the area under the armpits where lymph nodes are located. Using the dye, a surgeon can locate the sentinel node or nodes and remove them for examination. This allows physicians to determine if the cancer has started to spread beyond the breast without removing all the lymph nodes.
What Biopsies Show
The cells extracted from a breast tumor allow a doctor to determine if a lump is benign or malignant. If it is malignant, tissue taken in a biopsy reveals whether a tumor is estrogen positive or negative--a major factor in determining treatment--and if the tumor has any other unusual characteristics. It also allows a physician to get an idea of how large a tumor is--or the exact size if it's removed entirely--to determine the stage of the cancer, another important factor in deciding on treatment. The sentinel node biopsy lets doctors know whether the cancer has spread into the lymph nodes, yet another key factor in determining whether the cancer is in its earliest stages or has progressed.
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