The Free Press, Mankato, MN

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December 13, 2013

Ask Dr. K: Type of breast biopsy varies between patient to patient

DEAR DOCTOR K: My doctor saw something suspicious on my mammogram and wants to do a breast biopsy. I understand there are several biopsy techniques. Can you tell me what they involve?

DEAR READER: The invention of mammograms (X-rays of the breast) has saved many lives. Mammograms can spot a small, early breast cancer, and help doctors cure it.

What your doctor saw was a spot that looked like it might be cancer. The mammogram, and other breast-imaging techniques such as magnetic resonance imaging (MRI), cannot tell with certainty. If the mammogram looks suspicious, a biopsy is the only way to know for sure if there is a cancer.

In a biopsy, a part of the suspicious-looking area is removed by a minor surgical procedure. This tissue is analyzed in a lab to determine whether it is cancerous and, if so, how quickly it is likely to grow and spread. This information helps to guide treatment decisions.

A breast biopsy can be done in different ways, depending on the location and size of the abnormality and other factors.

A doctor can perform fine needle aspiration (FNA) in an office by inserting a slender needle into the breast and drawing out (aspirating) a small amount of tissue from a suspicious lump. The doctor may aspirate several samples.

In some cases, the doctor may use ultrasound images to guide the needle. Ultrasound shows when the tip of the needle has reached the suspicious area. Ultrasound has no damaging effects on the breast: Unlike a mammogram, ultrasound does not involve any radiation.

Most doctors prefer the large core needle biopsy method because it removes more tissue, and that makes for a more accurate diagnosis. A larger needle than the one used for FNA is used. The needle is inserted into the breast through a tiny incision. Using X-rays or ultrasound images as a guide, or by feeling the lump, the doctor moves the needle into the area of concern. He or she extracts one or more tissue samples through the needle using suction from a syringe.

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