Biopsies

At some point in your life, you may have a lump or change in your breast or an abnormal finding on a mammogram. To make sure it’s not breast cancer, you will have follow-up tests.

In many cases, breast cancer can be ruled out with a diagnostic mammogram, breast ultrasound or breast MRI.

If cancer can’t be ruled out, you will need to have a biopsy. A biopsy removes cells or tissue from the suspicious area of the breast. The cells or tissue are studied under a microscope to see if cancer is present.

A biopsy is the only test that can diagnose and confirm breast cancer.

Learn more about follow-up after an abnormal mammogram or clinical breast exam.

Try not to panic or worry

Although a biopsy can be scary, most breast biopsies in the U.S. don’t show cancer [1].

Still, a biopsy is needed to know whether or not something is cancer.

If breast cancer is found, it can be treated. With standard treatment, most people with breast cancers found early have a good prognosis (high chance of survival).

Learn about breast cancer treatment.

Types of biopsies

There are 2 main types of biopsies:

  • Needle biopsies. A health care provider removes tissue or cells with a needle.
  • Surgical biopsies. A surgeon makes a cut (incision) in the breast to remove tissue.

A core needle biopsy (a type of needle biopsy) is the standard method used to diagnose breast cancer. In some cases, a surgical biopsy may be needed.

Learn more about each type of biopsy in Figure 4.1

Figure 4.1:
Risks and Benefits of Needle Biopsy versus Surgical Biopsy

A needle biopsy uses a hollow needle to remove samples of tissue or cells from the breast.

A pathologist studies these samples under a microscope to see if they contain cancer. If they do, the pathologist will do further tests to learn about your cancer. This information helps you and your health care provider plan your treatment.

Needle biopsies can be used to study a:

  • Lump that can be felt (palpable mass)
  • Suspicious area that can only be seen on a mammogram or other imaging test (non-palpable mass)

There are 2 types of needle biopsies:

A core needle biopsy is the standard method used to diagnose breast cancer. In some cases, a surgical biopsy may be needed.

Learn about factors that affect prognosis and treatment.

A surgical biopsy can diagnose breast cancer and get complete information about the tumor.

Learn more about surgical biopsies.

  • What type of biopsy will I have? Why? How reliable are the results of this type of biopsy?
  • Will my lymph nodes be sampled? If so, will a sentinel node biopsy be done? If not, why not?
  • Who will perform the biopsy? How often does the radiologist or surgeon perform the type of biopsy I will have? Does he or she specialize in breast cancer?
  • How long will the biopsy take?
  • Will I be awake during the biopsy? Can it be done in your office or will I need to go to the hospital?
  • If I have a needle biopsy, who will evaluate the samples? How much experience does that person have with breast cancer? Will a cytopathologist be needed?
  • Will hormone receptor status and HER2 status tests be done? Others?
  • What medications should I avoid before the biopsy, and for how long? When can I resume my usual medications?
  • When will I get the pathology results?
  • Where will the biopsy scar be?
  • What side effects might I expect after the biopsy? What problems should I report to you?
  • When will I be able to return to my normal routine?
  • Will the tissue removed during my biopsy be X-rayed to make sure all of the suspicious tissue was removed?
  • Will my tumor be saved? Where will it be stored? For how long? How can it be accessed in the future?

Learn more about talking with your health care provider.

It may be helpful to download and print Susan G. Komen®‘s Questions to Ask Your Doctor About Breast Biopsies resource and take it with you to your next appointment. There’s plenty of space to write down the answers to these questions, which you can refer to later.

There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.

Can a biopsy miss breast cancer?

In some cases, a biopsy can miss breast cancer.

How can a needle biopsy miss breast cancer?

A needle biopsy can miss breast cancer if the needle takes a sample of tissue or cells from the wrong area or if there’s a problem with the sample.

Even when samples are taken from the correct area, false negative results can occur if the pathologist misinterprets the tissue or cells as benign (not cancer) when in fact, cancer is present.

How can a surgical biopsy miss breast cancer?

With surgical biopsies, it’s less likely breast cancer will be missed.

However, a surgical biopsy can miss breast cancer if the wrong area of tissue is removed.

The use of needle- and wire-localization procedures before the biopsy and X-rays of tissue samples after the biopsy help limit this problem. 

Getting a second opinion

Breast cancer is complex. You may want to get a second opinion before your biopsy, or after, when you have the results.

Most health plans allow you to get a second opinion as long as the second health care provider is a member of your health plan.

Learn more about getting a second opinion.

Breast biopsies do not cause cancer to spread

Exposing breast cancer to air during surgery or cutting through the cancer does not cause it to spread [2-4].

Surgical and needle biopsies do not cause breast cancer to spread [2-4].