The only sure way to confirm a diagnosis of breast cancer is to perform
a biopsy—that is, to remove a small piece of the tumor, and
have it examined under a microscope by a pathologist—a specialist
in tumor identification. The sample can be obtained either with a
needle, or surgically.
If the tumor is small, or if there is a good possibility that it is
not cancerous, your physician may choose either a fine needle aspiration
or a core needle biopsy.
Fine Needle Aspiration, or FNA, is done with a very
thin needle connected to a syringe. The needle is moved in and out
several times to obtain the best sample possible. It feels like having
your blood drawn, and does not require a local anesthetic.
The material drawn into the syringe will be sent to
a pathologist for analysis. Even if no cancer cells are found, your
doctor may want to have the lump removed surgically.
Core needle biopsy is done with a larger needle, which can yield a
larger sample. The procedure can be done under a local anesthetic
and takes only a few minutes. It is the least invasive form of biopsy,
but it does require the expertise of a specialist. Most women who
have had the procedure report only minor discomfort.
The core biopsy is performed with a device that works
like an ear-piercing instrument: it propels a needle very rapidly
through the lesion. A special notch in the needle traps a sliver of
tissue for examination. Samples obtained with core biopsy are large
enough to be cut into thin slices and examined under the microscope,
providing a diagnosis that some doctors feel is more reliable than
that from a FNA. Several newer devices use a small rotating cutter
and vacuum to remove an even larger sample.
Whatever device is
used, if the lesion is non-palpable (in other words, cannot
be felt by hand) the needle is guided using special mammography
equipment, called a stereotactic unit. This equipment enables
the radiologist to place the needle precisely into the tumor,
even if it is as small as a pea. The needle can also be guided
with the help of a hand-held ultrasound unit.
The biopsy also can be done using ultrasound
equipment, or a special MRI scanner, to guide the needle. The
choice generally depends on what your physician is most comfortable
Another way your doctor may choose to obtain a biopsy is surgically.
A surgical biopsy is performed under local anesthesia, sometimes with
sedation. Most surgical biopsies are excisional, in other words the
surgeon removes (excises) the entire tumor.
The surgical biopsy takes about an hour, and causes
minimal post-operative pain that goes away in a few days. You can
usually begin doing non-strenuous work the day after the biopsy, although
you should not lift heavy objects for a few weeks. The incision usually
heals within ten days. You should avoid activities that bounce your
breast, such as jogging.
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