Breast Biopsies

A "biopsy" of breast tissue is the process that involves removing a sample of the tissue in order to determine whether it is cancerous or benign (non-cancerous). This will follow other diagnostic breast imaging methods. A pathologist will examine the tissue with a microscope. This is the only definitive method to determine if the sample is cancerous or not.

A surgeon or radiologist will remove the tissue, depending on the type of biopsy. The pathologist is a type of physician that who performs analyses of tissue to determine their type. If cancer is found to be present in the biopsy sample(s), the pathologist will identify the type and stage of the cancer.

Britt-Marie Ljung, MD
Co-Director, Cytopathology

Biopsies may be done with breast imaging techniques and/or surgical procedures. There are many factors that are considered to determine the method that will be used including how suspicious the abnormality appears, the size, shape, location, number of abnormal areas, the patient's medical history and personal preference, and the doctors' recommendation. The following sections answer frequently asked questions about breast biopsies, and include important information on how best to prepare for a particular procedure.

Fine Needle Aspiration Biopsy

What is it?

You may be referred for a fine needle aspiration biopsy (FNA) if a lump is discovered in your breast. The FNA biopsy is used to assess the lump. A sample of the lump is obtained using a small, thin needle. The test often allows doctors to make a diagnosis within two to three days of the test.

What Complications Might Arise?

When carried out by an experienced practitioner, a fine needle aspiration biopsy is virtually free of significant complications. The most common complication is a slight bruising or tenderness of the area for a few days following the procedure. Discomfort should be relieved by an over-the-counter pain reliever such as Tylenol or the application of an icepack for short periods following your return home.

Please call the provider who ordered the FNA immediately if you experience any of the following symptoms after your biopsy. If your provide is a Breast Care Center practitioner, call (415-353-7070).

Swelling that doesn't go away
Continued bleeding
A fever over 101°Fahrenheit (38.3 °Celsius)
Pain that is not helped by Tylenol® or other non-aspirin products

How do I prepare for an FNA biopsy?

Wear two-piece clothing so that you only have to remove your top and bra for the examination.
Jewelry worn should be easily and quickly removable.

What happens and how long does an FNA biopsy take?
Your doctor will ask some questions about the lump:

Where it is?
How and when you first became aware of it?
Have you noticed any changes in it?

Next, the doctor will feel the lump. Before the actual biopsy is performed the doctor will give you an opportunity to ask any questions or express any concerns you might have about the procedure. After all your questions and concerns have been addressed, the actual procedure will begin.

Holding the lump with one hand, the doctor will precisely sample the lump with a thin needle held in a needle holder, which provides greater control. Usually, two to three samples will be required from the lump to provide an accurate diagnosis. During the procedure, the doctor will usually leave the examination room with one of the slides to check that there is enough tissue to prevent the need for a second office visit.

Each sample takes about 10 to 20 seconds to obtain. The whole procedure from start to finish usually takes no more than 10 to 15 minutes. However, please allow an hour for your visit because of registration and possible waiting time in the office. Generally, your results should be available from your surgeon's office in two to three working days. The results can be grouped into three categories:

Clearly benign: not cancer
Clearly malignant: cancer
Non-definitive, less clear: most often, this will be followed by a surgical biopsy

Who performs this biopsy?

Your surgeon or a cytopathologist will perform the fine needle aspiration.

Will my insurance cover an FNA?

Most insurance plans cover this exam but you should check with your insurance carrier to be certain. If you have HMO insurance, check with your plan to make sure that UCSF Medical Center is in your provider network.

How do I schedule an FNA?
Your doctor will schedule this procedure. You will need to bring the requisition from your doctor, picture identification and your insurance card. FNAs are available between 9:30 am and 5 pm.

If you are having an ultrasound guided fine needle aspiration biopsy call (415) 353-2573. The scheduling department is open from 7:30 am - 6:30 pm, Monday through Friday.

Where do I go to have an FNA?
Cytopathology Services, 1600 Divisadero Street, 2nd floor , Room R-200. Check-in is in Room 108, San Francisco, CA 94115, San Francisco (415) 885-7301.

When will the results be ready?
It takes between 3 and 5 days for the results to be available to your provider.

UCSF Fine Needle Aspiration Biopsy (FNA) Clinic informational brochure.

Needle (Wire) Localization Biopsy

What is it?
Needle localization biopsy is performed when you have an abnormality seen on a mammogram that cannot be felt. It is an outpatient biopsy that is done in two steps on the same day.

How do I prepare for a needle localization biopsy?

If you did not have your previous mammograms at UCSF Medical Center, you must bring your previous mammograms with you. If you call the facility where it was performed, they will tell you how to obtain these images on film. If the facility offers a CD of the images, please ask them to print out film images. The radiologist compares the images from prior exams to the current exam to assist in the interpretation. In general, the UCSF radiologist will want to compare your last five years of mammogram films to the results of the scheduled mammogram.
Do not wear talcum powder, deodorant, lotion or perfume under your arms or on your breasts. These substances can cause artifacts making the images harder to interpret.
Wear two-piece clothing so that you only have to remove your top and bra for the examination.
Jewelry worn should be easily and quickly removable.
You may be asked to complete a brief breast health questionnaire.

What happens and how long does a needle localization biopsy take?

Step I - Radiology: Finding the Abnormal Tissue

In a sitting or standing position, your breast will be positioned for a mammogram, ultrasound, or MRI to find the exact location of the abnormal tissue. Once the area is identified, a radiologist will numb your breast with a local anesthetic. A needle is inserted and a small wire threaded through the needle. The tip of the needle is placed near the abnormal tissue. Accurate placement of the wire is checked by mammogram. The wire is securely taped in place. This procedure can take up to one hour to perform.

Most women report no pain, but feel pressure and pulling. Some women feel faint or dizzy. If you have any unusual symptoms or sensations, tell the technologist assisting you or your radiologist so they can help you.

Step II - Same Day Surgery: Biopsy the Abnormal Tissue

During a needle (wire) localization biopsy, the abnormality identified on a mammogram is surgically removed. Anesthesia that you and your physician have discussed is administered. A surgeon uses the wire imserted earlier to locate the abnormal tissue and remove it. The tissue is sent to radiology to be X-rayed. The radiologist and surgeon will confirm that the tissue found on the mammogram was removed. Most women experience no change in the breast beyond a surgical scar. You will feel some lumpiness near the incision from scar tissue. Some patients experience some pain, swelling and discomfort, which subsides in a few days.

You will be brought by wheelchair from radiology, where the wire was inserted, to same day surgery. Family or friends may be with you before and after the wire localization, but not during the procedure.

The biopsy is an excisional biopsy, meaning that the abnormality seen on mammogram is surgically removed. You will be given the anesthesia that you and your physician have discussed. The surgeon uses the wire to locate the abnormality and remove it in the operating room. The specimen, once removed from the breast, is then sent to radiology to be X-rayed. The radiologist and the surgeon communicate to confirm that the abnormality seen on mammogram has been removed.

There will be a scar on the breast after the biopsy. In general, your surgeon will be able to tell you where the incision (or scar) is expected to be on your breast. Most women do not experience a marked change in the appearance of the breast beyond the surgical scar. The swelling and bruising that you may experience will resolve. You will, however, be able to feel lumpiness near the surgical site from scar tissue after the biopsy. The time that the surgery takes can vary. Ask your surgeon to give you an estimate of how long the procedure will take.

A needle localization biopsy is generally well tolerated and most patients return to their full range of activities by the next day. However, occasionally there are patients who experience considerable pain, swelling and discomfort after this procedure. These symptoms should be reported to your doctor.

Who performs a needle (wire) localization biopsy?
The technologist will perform the mammogram. The radiologist will place the needle in your breast. Your surgeon performs the biopsy.

Will my insurance cover this exam?
Most insurance plans cover a needle localization biopsy but you should check with your insurance carrier to be certain. If you have HMO insurance, check with your plan to make sure that UCSF Medical Center is in your provider network.

How do I schedule a needle localization biopsy?
Your surgeon's office or practice assistant schedules both your needle localization and the surgery on the same day. Call your surgeon's office at the Breast Care Center, (415) 353-7070 from 8:00 am - 4:30 pm, Monday through Friday if you have questions.

Where do I go to have this exam?
1600 Divisadero Street, 2nd floor , Room H2906, San Francisco.

For more information on needle (wire) localization biopsy, also known as Ultrasound-Guided Breast Biopsy, visit RadiologyInfo.org.

Stereotactic Core Biopsy

What is it?

Stereotactic core biopsy was developed as an alternative to surgical biopsy. It is a less invasive way to obtain the tissue samples needed for diagnosis. This procedure requires less recovery time than does a surgical biopsy, and there is no significant scarring to the breast. Your doctor, the radiologist and you may consider this type of biopsy when there is an abnormality found on a mammogram that cannot be felt. The radiologist can make a judgment about whether the procedure is technically feasible and your doctor may recommend it in your particular situation.

How do I prepare for a sterotactic core biopsy?

If you did not have your previous mammograms at UCSF Medical Center, you must bring your previous mammograms with you. If you call the facility where it was performed, they will tell you how to obtain these images on film. If the facility offers a CD of the images, please ask them to print out film images. The radiologist compares the images from prior exams to the current exam to assist in the interpretation. In general, the UCSF Radiologist will want to compare your last five years of mammogram films to the results of the scheduled mammogram.
Do not wear talcum powder, deodorant, lotion or perfume under your arms or on your breasts. These substances can cause artifacts making the images harder to interpret.
Wear two-piece clothing so that you only have to remove your top and bra for the examination.
Jewelry worn should be easily and quickly removable.
You may be asked to complete a brief breast health questionnaire.

What happens and how long does a stereotactic core biopsy take?

After checking in, you will be asked to change into a hospital gown and escorted to the biopsy room. The technologist will ask you to lie face down on the special examination table, making sure you are as comfortable as possible. Your breast will be positioned through a special round opening in the table. The table will then be elevated so the doctor and technologist can work from below. The procedure generally takes 45 minutes to 1 hour.

Step I - Finding the Abnormal Tissue

The first part of the procedure will seem much like your mammogram, except that you are lying down instead of standing up. Your breast will be compressed with a compression paddle, just as it was during your mammogram. A confirming x-ray will be taken to ensure that the area of the breast containing the lesion is correctly centered in the paddle window. When the position is confirmed, two stereo X-rays will be taken. They are called stereo images because they are images of the same area from different angles. With the help of a computer, the exact positioning of the biopsy needle is determined from these stereo images.

Step II - Biopsy of the Abnormal Tissue

Using this information, the doctor will then position the device which holds the biopsy needle for the correct angle of entry. Next, the doctor will numb the biopsy area by injecting a local anesthetic into your breast. This will be done with a very tiny needle and you may feel a slight sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will insert the biopsy needle into your breast. Another set of stereo X-rays will then be taken to ensure proper needle placement. Once placement is confirmed, the physician will tell you to hold very still while the tissue samples are acquired. When the physician has retrieved all the samples, the compression paddle will be released from your breast. The nurse or technologist will then apply pressure to the biopsy site for five to ten minutes to prevent bleeding. Afterwards, a dressing will be applied which you will wear home.

Who performs a stereotactic core biopsy?
The technologist and the radiologist work together to position you for the biopsy. The radiologist performs the biopsy.

Will my insurance cover this exam?
Most insurance plans cover a stereotactic core biopsy but you should check with your insurance carrier to be certain. If you have HMO insurance, check with your plan to make sure that UCSF Medical Center is in your provider network.

How do I schedule a stereotactic core biopsy?
Call (415) 885-7441. The scheduling department is open from 8 am - 4:30 pm, Monday through Friday.

Where do I go to have this exam?
1600 Divisadero Street, 2nd floor , Room H2906, San Francisco.

When will the results be ready?
The provider who ordered the core biopsy will receive the results in 5 to 7 days. If you are not notified in person or by telephone, call the ordering provider. If your provider is a Breast Care Center practitioner, call (415) 353-7070.

For more radiology information on stereotactic core biopsy, also known as stereotactic (mammographically guided) breast biopsy, visit RadiologyInfo.org.

Surgical Biopsy

During a surgical biopsy, a surgeon removes a portion or all of the suspicious tissue. The suspicious tissue is examined under a microscope by a pathologist who checks for cancer cells and makes the diagnosis.

Instructions Before a Surgical Breast Biopsy

If you are going to undergo a surgical biopsy, the following information will help you to prepare. We hope this information helps make the experience more comfortable for you. If you have any questions regarding the instructions, please contact the Breast Care Center staff.

YOU WILL NEED TO HAVE A RESPONSIBLE ADULT WITH YOU TO DRIVE YOU HOME. It is unsafe and against hospital policy to permit you to drive home after surgery when you have received any medication that might slow your responses (anesthesia, pain medication, or any medication to relieve anxiety).
NOTHING TO EAT OR DRINK AFTER MIDNIGHT on the night prior to your surgery. Any medications that you take should be taken at the usual time with a sip or two of water. People with diabetes, heart disease, and other illnesses should contact their primary care physicians for directions. Inform us if you are taking Coumadin® or other blood thinning medication.
DO NOT TAKE ASPIRIN or aspirin containing products for 10 days prior to your surgery. Tylenol® is okay. Stop vitamin E for ten days before your surgery. The amount of vitamin E in a multivitamin is okay.
Wear comfortable clothing: a two-piece, loose outfit with a zipper or buttons in front is the easiest to put on. Some women prefer a loose dress with zipper or buttons in front. Wear a supportive non-wire bra (such as a sports bra or a bra with fasteners in the front). The bra will provide comfort and support after your procedure. PLEASE WEAR A BRA FOR 3-4 DAYS FOLLOWING SURGERY, EVEN WHILE YOU SLEEP. This minimizes post-operative bleeding and will make you more comfortable.

Instructions After Surgical Breast Biopsy

Pain Management

People experience different types and amount of pain or discomfort following surgery. The goal of pain management is to assess your own level of discomfort and to take medication as it is needed. You will have better results controlling your pain if you take pain medication before your pain is severe.
You will be given a prescription for Vicodin® for pain. It is recommended that you take medication for pain on a regular schedule when pain is felt. After a biopsy, most people find that it is sufficient to use ibuprofen (Advil® or Motrin®) or Tylenol®. You can start with ibuprofen and add Vicodin® (or another drug) as needed for comfort. People are different. If one plan to decrease your pain is not working, it will be changed. HEALING AND RECOVERY ARE IMPROVED WITH GOOD PAIN CONTROL.
An ice pack may be helpful to reduce pain and swelling, but it is not required. It will probably not benefit you after the first 24 hours.
Please notify us of any drug allergies or reactions. Vicodin® is a narcotic and should not be taken with alcoholic drinks. Do not use narcotics while driving.
Narcotics can cause or worsen constipation, so increase your fluids, eat high fiber foods (like prunes and bran) and make sure you are up and walking.
CALL YOUR DOCTOR OR NURSE IF MEDICATION IS NOT HELPING YOUR PAIN, IF YOU HAVE PROBLEMS WITH MEDICATION(S) OR YOU ARE CONSTIPATED.

Incision (Scar) and Dressing Care

Your scar has both sutures and steri-strips (small white strips of tape) and is covered by gauze and plastic dressing.
DO NOT REMOVE THE STERI-STRIPS OR SUTURES. We will remove the dressing in 7-10 days. We will also remove the sutures (unless they absorb on their own) in one to two weeks. If the dressing or steri-strips fall off, do not attempt to replace them.
You may shower the day after the surgery if the plastic dressing is on.
If you have gauze and paper tape, you may remove it 2 days after surgery and shower after that. Towel dry your incision thoroughly after showering. BE CAREFUL NOT TO TOUCH OR REMOVE THE STERI-STRIPS OR SUTURES.
Bruising or slight skin discoloration often occur after surgery. If you experience a great deal of swelling, please call the Breast Care Center.
A low-grade fever (under 100°F) is normal the day after surgery.

Activity

Avoid strenuous activity, heavy lifting, and vigorous exercise until the stitches are removed.
Walking and most regular activities may be resumed by the next day.
If possible, plan to take the day off or plan a lighter day following the surgery.

Follow-Up Care

The pathology results from your biopsy should be available within 7 - 10 days after your surgery.
We will contact you with the results by telephone or at your next post-operative visit. Please let us know the telephone number(s) where you may be reached.
Follow-up appointments are generally made before surgery with your physician and possibly a nurse. Please contact the Breast Care Center if you do not have or remember an appointment.

Contact us at the Breast Care Center (415) 353-7070 for the following problems, any unanswered questions, or emotional support needs. Ask to speak with a nurse during the day or the answering service in the evening to reach your doctor or the doctor on call.

Pain that is not relieved by medication

Fever more than 100°F or chills

Excessive bleeding (a bloody dressing)

Excessive swelling

Redness outside the dressing

Discharge or bad odor from the wound

Allergic or other reactions to medication(s)

Constipation (no bowel movements)

Anxiety, depression, trouble sleeping, need more support

Photo credits: Catherine Metzger