Nafisa Tejpar, MD, FACS
There are a variety of types of breast biopsy. Most of the time, the first choice is a needle biopsy which is done in your surgeon's office. However, sometimes we need to use mammography or and MRI to guide the needle placement. Other women will need a surgical biopsy which is done in the outpatient surgery center.
Biopsies are what tell us for sure whether something is benign or whether it is cancer.
Stereotactic needle biopsy: In this biopsy, mammograms are taken from 2 angles and then a computer maps the exact location of the mass to help guide the needle to the exact spot in question. This is often used when a tumor cannot be felt or seen on ultrasound as when a woman has suspicious microcalcifications (tiny calcium deposits).
Core needle biopsy is also done in your surgeon's office. This is much like the fine needle biopsy, but a larger needle is used. You are given a local anesthetic (something that numbs the area). The needle is often inserted 3 or more times to get the samples (called 'cores') A needle is inserted, guided by ultrasound, to take small samples from the lump or the area of the abnormality on the mammogram.
The fluid and tissue taken in needle biopsies are then sent to the lab.
After a needle biopsy you will probably have some bruising in the breast and tenderness for a few days. Your surgeon will likely give you suggestions to help minimize discomfort.
Radioactive seed localization & wire localization during surgical biopsies or small tumor removal:
Radioactive seed localization for small breast cancer tumors was developed by Mayo Clinic and the H. Lee Moffitt Cancer Center. This has several advantages over the traditional wire. The wire can move and some women report it being uncomfortable, plus it has to be done immediately before the surgery.
MOST IMPORTANTLY, research has shown that the use of the radioactive seeds increases the surgeon's ability to get 'clean margins' at the time of surgery. When a tumor is removed, it is removed with some surrounding tissue to catch any cancer cells that have migrated away from the actual tumor. The tissue is sent to pathology. If they find cancer cells in the edge of the tissue taken, you have 'dirty margins' and will need additional surgery to remove more tissue.
While I have always done everything possible to get 'clean margins' so my patients don't have to have a second surgery, the radioactive seed localization helps me do that even better. Studies show an overall 50% improvement in clean margins by surgeons with less discomfort to the patient and better cosmetic results.
But is a radioactive seed safe? The seed is about the size of a grain of rice and is removed with the tumor. IN March 2010, an article in the Orlando Sentinel described the procedure from both physician and patient perspectives. In my own research to determine patient safety from radioactive exposure, I have found that the exposure is miniscule and is safe for patients -- and for ME as a surgeon who does a large number of procedures in which I handle the seeds!
But what if it IS cancer?
In the meantime, you may find some of the resources I have listed to be helpful. Breast Disease and Breast Cancer Resource Page. It has links to information on breast disease, breast cancer, help in coping with a diagnosis, ways for your spouse or significant other to support you, and more.