Imaging tests such as mammograms and MRIs may suggest that a person has breast cancer. But the only way to know for sure is to take a tissue sample from the suspicious area and look at it under a microscope. The procedure done to remove the tissue from a suspicious area is called a biopsy.
A study has found that diagnosing breast cancer with a needle biopsy instead of a traditional open surgical biopsy is more efficient, less invasive, and may lead to better treatment outcomes.
The research was published in the October 2012 issue of the Journal of the American College of Surgeons. Read the abstract of “Preoperative Needle Biopsy Improves the Quality of Breast Cancer Surgery.”
There are several breast biopsy techniques.
As its name implies, open surgical biopsy is like regular surgery. After using local anesthesia to numb the breast and giving you an injection to make you drowsy, the surgeon uses a scalpel to cut through the skin to remove the tissue that will be examined. The surgeon may use ultrasound or mammogram imaging to find the right spot. Open surgical biopsy leaves a scar and usually takes more time to recover from than a needle biopsy.
In a needle biopsy, local anesthesia is used to numb the breast, and then the surgeon or radiologist uses a needle with a hollow center to remove a sample of cells from the suspicious area. The surgeon or radiologist may use ultrasound or mammogram imaging to guide the needle to the proper place in the breast. Needle biopsies leave no scar and usually don’t cause much pain or discomfort. In some cases, a needle biopsy can be done in your doctor’s office.
Still, needle biopsies do have a higher risk of a “false negative” result – a result suggesting that there is no cancer when there really is. This is probably because a needle biopsy removes a smaller amount of tissue than an open surgical biopsy and so may not pick up the cancer cells.
Medical guidelines say that about 90% of biopsies should be needle biopsies, the least invasive procedure. Still, earlier research has shown that about 70% of breast biopsies are open surgical biopsies. This means that many women who don’t have cancer are having unnecessary surgery. It also means that women who are diagnosed with breast cancer have to have a second operation to remove the cancer.
In this study, researchers analyzed information on 1,135 women diagnosed with breast cancer and treated at hospitals in Vermont between 1998 and 2006. Nearly 63% of the women were diagnosed after a needle biopsy.
Needle biopsies became more common during the study. From 1998 to 2000, about 49% of the women had a needle biopsy. From 2004 to 2006, the number went up to about 74%.
Compared to women who had needle biopsies, women who had open surgical biopsies:
- were more likely to have positive margins (meaning cancer cells were found at the very edge of the tissue removed); more surgery usually is needed to remove any remaining cancer cells; 37.4% of women who had open surgical biopsies had positive margins compared to 20.1% of women who had needle biopsies
- were less likely to have their lymph nodes assessed; this means that more surgery would need to be done if doctors decided that they wanted to see if the cancer had spread to the lymph nodes
Because women who had open surgical biopsies were more likely to have positive margins and less likely to have their lymph nodes checked for cancer, they were much more likely to need more than one breast cancer surgery:
- 56% of open surgery biopsy patients needed more than one surgery compared to 23.6% of needle biopsy patients
Where the women lived affected how likely they were to have a needle biopsy. Urban women (70.6%) were more likely to have a needle biopsy than rural women (57.5%).
If a mammogram or other imaging test has found a suspicious area in your breast, your doctor may recommend a biopsy. Before you have a biopsy, be sure to ask your doctor to:
- review the results of your mammogram and any other imaging tests with you
- show you the area in question
- explain the type of biopsy that’s recommended for you and explain why that type of biopsy is recommended; if open surgical biopsy is recommended, ask if needle biopsy can be done
- discuss how and why the biopsy will be performed
- tell you when and how you can get the biopsy results
For more information biopsy techniques and the pros and cons of each, visit the Breastcancer.org Biopsy page.