Types of breast biopsy procedures

There are several types of breast biopsy options available to patients.

Fine needle aspiration biopsy and cyst aspiration

Cyst aspiration and fine needle aspiration biopsy (FNAB) use a very thin needle attached to a syringe to withdraw a small amount of fluid (cyst aspiration) or tissue (FNAB) from the suspicious area. After numbing the breast, the radiologist uses ultrasound guidance to place the needle into the area of concern. After FNAB, this tissue is then looked at under a microscope.

If the cyst aspiration or FNAB doesn’t give a clear diagnosis, or your radiologist still has concerns, a core needle biopsy will usually be done the same day. There is no incision or scarring, and bruising is rare.

Core needle biopsy

A core needle biopsy (CNB) is much like a FNAB and is performed with local anesthesia to numb the breast. Using imaging guidance, a slightly larger, hollow needle is then used to withdraw small cylinders (or cores) of tissue from the abnormal areas in the breast. This is often more likely to give a clear result because more tissue is taken to be checked. These procedures are done in the outpatient setting. While a tiny incision is required, no stitches are needed. There is usually some bruising, and very little or no scarring.

Vacuum-assisted core needle biopsy

Vacuum-assisted biopsies are a type of CNB that can be done with systems like the Mammotome® or ATEC® (Automated Tissue Excision and Collection). For these procedures, the skin and breast are numbed. Using x-rays, ultrasound or MRI for guidance, a hollow needle is placed into the abnormal area of breast tissue. As compared to standard CNB, the vacuum helps collect more tissue and removes multiple tissue samples more rapidly. This allows for better patient comfort due to the shorter duration of the procedure. Vacuum-assisted core biopsies are also done in outpatient settings.

Stereotactic core needle biopsy

A stereotactic core needle biopsy uses x-ray equipment and a computer to analyze pictures of the breast. The radiologist uses a computer to pinpoint the abnormal area where the needle tip needs to go. This is often done to biopsy suspicious microcalcifications (tiny calcium deposits) or when a tumor cannot be felt or seen on ultrasound.

Magnetic Resonance Imaging (MRI) guided core needle biopsy

Sometimes the biopsy is guided by MRI. For instance, with the ATEC system discussed earlier, you lay face down on a special table with an opening that your breast fits into. Computers are then used to find the tumor, plot its location, and help aim the biopsy probe into the tumor. This is helpful for women with a suspicious area that can only be found by MRI.

UofL Health offers multiple locations for mammograms and other services such as breast biopsies. To schedule a screening mammogram at UofL Health, call 502-681-1405.

If you’ve been diagnosed with cancer, call UofL Health – James Graham Brown Cancer Center at 502-562-HOPE (4673) or visit our website at UofLBrownCancerCenter.org.

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About Brian Mattingly, M.D.

Brian Mattingly, M.D., is director of breast imaging at UofL Health – James Graham Brown Cancer Center and Medical Center East. He specializes in mammography, breast ultrasound, and breast MRI, as well as imaging guided biopsies and procedures using these modalities. He received a bachelor’s degree from Centre College, a master of science in biomedical engineering from the University of Kentucky and a medical degree from the University of Louisville School of Medicine. He completed his internship in internal medicine at Saint Vincent Hospital in Indianapolis, Ind., and both his radiology residency and breast imaging fellowship at Indiana University School of Medicine in Indianapolis, Ind. He is board-certified by the American Board of Radiology and is a member of the Society of Breast Imaging; American College of Radiology; Radiological Society of North America; and the American Roentgen Ray Society.

All posts by Brian Mattingly, M.D.