JOSE ERBELLA, M.D., FACS
General, Oncologic & Minimally Invasive Surgeries
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When a person or their doctor finds a new lump in their breast or when one is seen on their screening mammogram or ultrasound test, they should see a doctor and talk about whether a biopsy should be done. Sometimes doctors use different terms for a new growth in the breast such as a lump, bump, lesion, or even a density or calcification on a mammogram. All these things can mean the same thing and can be confusing at times, so lets just use the word "lump" to mean something that is newly found in the breast and we are worried about it.
A biopsy is a procedure that is done to take a tissue sample of the lump, so we can send it to a laboratory for testing and make sure it is not cancer. There are several different ways to perform a biopsy, but the two basic ways are either to use a needle to suck out a sample, or making an incision and cutting out a sample.
A needle biopsy to diagnose a solid breast mass usually involves making a tiny cut in the skin, and then a tubular needle that looks like a soft-drink straw with a hole near the end can draw in the lump to obtain a sample. The needle is usually attached to some suction device, and we use x-rays like a mammogram or an ultrasound machine to help guide the biopsy needle. Usually needle biopsies are a preferred first step to making the diagnosis. The advantages are that it is less invasive, doesn't require much recovery, and we can quickly get a result (many times by the next day) to then thoughtfully decide if surgery is the next step. The disadvantage is that it cannot completely remove the lump and although the results are very very accurate, they are not 100%.
The incisional type biopsy usually requires some sedation or anesthesia and is more of a minor surgery that is done in the operating room. Sometimes the lump can be completely removed this way. The disadvantage is that it is not a cancer operation, so if cancer is found, another surgery will have to be performed. Some people prefer to have the lump completely removed. It all depends on a patient's particular situation.
Here is an x-ray of a breast with a suspicious cluster of calcifications (in red circle) that is about to be biopsied.
Here is an x-ray of the breast tissue with the suspicious cluster of calcifications (in red circle) that was sucked out of the breast with a special needle.
Here's the final x-ray of the breast biopsy cavity showing that the calcifications are gone and I placed a tiny metallic marker in their place (green circle) to mark the location for future reference. The marker is smaller than Abe's eye.