About Breast Biopsy
It’s important to know that not all biopsies end in a cancer diagnosis! In fact, more than 80% of all breast concerns are found to be benign or noncancerous. At ARA Health, you are in very capable hands. During a needle biopsy, one of our subspecialized radiologists uses a needle to remove small amounts of breast tissue from an abnormal lesion. The tissue sample is then sent to a lab to be studied by a pathologist, who provides a diagnosis. Breast biopsies are safe, minimally invasive, and performed with a local anesthetic. There is minimal discomfort, and no stitches are required.
Breast biopsies can be performed using a few methods: ultrasound-guided biopsy, MR-guided biopsy, and stereotactic biopsy using X-ray guidance (mammography). Each is performed a bit differently:
- ULTRASOUND-GUIDED BIOPSY – most commonly used when an area of interest is visible on an ultrasound. The patient will lie on her back or turned slightly to the side. Local anesthetic is injected to ensure comfort during the procedure. The radiologist then creates a small nick in the skin to insert the biopsy needle and extract several tissue samples for evaluation. A small marker will be left at the biopsy site to facilitate easy location for follow-ups or surgery. The technologist provides an ice pack and post-biopsy instructions.
- STEREOTACTIC BREAST BIOPSY – used for lesions that are better visualized on mammography than ultrasound, such as breast calcifications. To perform stereotactic breast biopsy, we utilize breast compression through a mammography machine, with the patient either lying on her side or sitting upright. A local anesthetic is injected to ensure comfort during the procedure. The radiologist makes a tiny incision, inserts the needle, and removes several samples of tissue. A small marker will be left at the biopsy site to facilitate easy location for follow-ups or surgery.
- MRI-GUIDED BIOPSY – an advanced development in the diagnosis of breast cancer, most useful when a suspicious area is not clearly visible on a mammogram or ultrasound. Before the procedure, a local anesthetic is injected into the breast to numb it, and contrast material is given intravenously. The patient typically enters the MRI machine feet first. Using computer software, the radiologist determines the position and depth of the lesion for biopsy and obtains the necessary samples. A small marker will be left at the site of biopsy, facilitating easy location for follow-ups or surgery.
- CEM-GUIDED BIOPSY – the latest development in the diagnosis of breast cancer, most useful for women with dense breast tissue. Contrast-Enhanced Mammography (CEM) offers improved accuracy and visualization, enabling our physicians to guide the biopsy needle to a precise location. The breast is compressed between two plates while images are taken from multiple angles so the radiologist can locate the area of interest and obtain samples. A small marker will be left at the site of biopsy, facilitating easy location for follow-ups or surgery.
ADDITIONAL EXAMS
For some patients, physicians will request additional imaging, like breast ultrasound, breast MRI, or contrast-enhanced mammography. Keep in mind that these exams are more likely to rule out breast cancer than to end with a cancer diagnosis! Regardless of the outcome, you are in very capable hands with ARA Health. Our physicians are subspecialized in breast imaging, which means they are true experts in their field. And as part of our commitment to helping each patient achieve optimal breast health, we offer breast density and breast cancer risk assessments, which provide useful information in the creation of personalized screening strategies.
You have questions. We have answers.
Below you'll find answers to some of the questions we are commonly asked by patients. Please contact our ARA Cares Coordinator at (828) 436-5500 with any additional questions or concerns.
Please do not take aspirin or ibuprofen for 5 – 7 days prior to biopsy. Alert staff ahead of time if you are taking any blood thinners. On the day of your biopsy appointment, eat a light snack or meal 1 – 2 hours beforehand. Please wear a supportive bra to help maintain the post-biopsy dressing. It is helpful to wear a two-piece outfit so that just your top may be removed. Please allow up to 90 minutes for the appointment.
On the day of your appointment, you’ll change into a gown and remove all jewelry. The radiologist will be there to explain the procedure and answer any questions. A needle biopsy is performed with a local anesthetic to numb the breast in order to minimize discomfort. No stitches are required, and most women can resume normal daily activity following the appointment. An ice pack will be provided for placement inside the bra and must be worn for at least 4 hours.
After the biopsy, only Tylenol may be taken for discomfort for the first 48 hours. After that, aspirin or ibuprofen may be taken. The outer dressing may be removed after 24 hours. Please do not get the affected area wet until the dressing is removed. Patients must sleep in a bra for the first two nights and avoid strenuous activity for 48 hours. Excessive bleeding, pain, or fever is rare and should be reported to our office.
Biopsy samples are sent to a pathologist, who will analyze and provide your physician and ARA Health with a diagnosis. Your physician will contact you with results, usually within 3 – 5 days.
- 75-85% of women diagnosed with breast cancer have no family history.
- One in eight women will be impacted by breast cancer in her lifetime.
- When caught early, the five-year survival rate of breast cancer is 99%.
- Breast cancers found in women under age 50 often are more aggressive, making screening mammography an important health tool for women in their 40s.
- The cancer incidence rate increases with age, making annual mammography even more important to women ages 50+.
- Men can also get breast cancer, although it is much less common than it is for women.
All women are at risk for developing breast cancer. The two biggest risk factors are being female and getting older. Other factors that increase a person's risk include:
- being overweight or obese
- having a sedentary lifestyle
- drinking more than one alcoholic drink a day
- exposure to high-dose radiation, particularly before age 30 (e.g. radiation therapy)
- family history of breast cancer
- inherited genetic mutations
- using hormone therapy after menopause
Several factors can decrease a person's risk of breast cancer, including:
- maintaining a healthy weight
- exercising regularly, on average 3-4 hours a week
- one or more full-term pregnancies
- first full-term pregnancy before age 25
- breastfeeding for more than 15 months (total months across all children)
- menopause before age 50
Breast density measures the amount of fatty, glandular, and fibrous tissue in the breast. Dense breasts have more glandular and fibrous tissue than fat, and the only way to determine this is through a mammogram. Radiologists use a scale approved by the American College of Radiology. Women who have breast density of level A or B have more fatty tissue, while women with breast density of level C or D have more glandular and fibrous tissue, which means they have dense breasts. Dense tissue makes breast cancer more difficult to detect on a mammogram and is also a risk factor for developing breast cancer. Approximately 40% of women over age 40 have dense breast tissue. Women who have been identified as having category C or D density on a mammogram may sit down with our clinical specialist at our Breast Cancer Risk Assessment Clinic to discuss in detail what this means and how to best address it with a supplemental screening plan.
Experts agree that beginning breast screening at age 40 saves the most lives; however, women who have an increased risk of developing breast cancer should begin them earlier. Understanding your personal risk for developing breast cancer can empower you to make informed decisions about your own breast health. ARA Health's subspecialized breast radiologists, along with the American College of Radiology and Society of Breast Imaging, recommend:
Age 30: All women should undergo a breast cancer risk assessment (especially Black women and those of Ashkenazi Jewish decent).
Age 40: All women should have a 3D screening mammogram and plan to repeat them every 12 months (not just every calendar year).