Having an annual screening mammogram is stressful. While some of you may have normal findings, some may be advised a biopsy. This may increase anxiety and cause much worry. At this point, it is important to know that nearly 4 out of 5 breast biopsies are benign.

Here are few things to keep in mind if you have been advised a breast biopsy.

A breast biopsy means that the doctor will sample a small piece of tissue from the suspicious area in the breast. This is not a surgical procedure. It is a simple test which you can undergo safely in an OPD setting like a clinic.

The idea of performing a biopsy of the abnormal area is to help assess whether it is benign(non-cancerous) or malignant(cancerous) and identify the type and grade of malignancy. In the past, surgeons removed abnormalities through incisions in the breast. Now, when an abnormality is seen on your mammogram or ultrasound, a simple image-guided biopsy is performed instead. Biopsies are much preferred compared to fine needle cytology (FNAC) tests that were performed in the past. They provide substantial tissue for a clear histopathology diagnosis and have the added
advantage that in case of malignancy, tumor marker tests can be processed with the same sample.

Not all lumps are large and palpable (felt by the hand). Some abnormalities that are small and seen only on mammography or ultrasound, can be sampled using imaging guidance to ensure accuracy. These biopsies are performed under local anesthesia on an outpatient basis, unlike surgical biopsies that require admissions, more extensive anesthesia and recovery time. Image -guided breast biopsies are minimally invasive with no cuts or stitches and usually take less than half an hour.

No special preparation is needed for an image-guided breast biopsy. However, when you are scheduling your biopsy, it is very important that you inform your doctor about any illnesses that you have and specifically regarding the medications you are currently on. As you know, certain medications, most commonly Aspirin, Ibuprofen, anti-inflammatory drugs and specifically blood thinners such as Heparin and Coumadin can increase bleeding. Your doctor may ask you to stop these medications for a few days prior to your biopsy.

These biopsies usually take less than 30 minutes. Prior to the procedure, the
radiologist will re-image the breast and document the area of concern. Once
ascertained, local anesthesia will be injected with a tiny needle to make the area numb. You will be wide awake during the biopsy and should have no pain or discomfort. The biopsy needle is then inserted under image guidance in the abnormal area and pieces of tissue are sampled and sent to the pathology lab for analysis. After a breast biopsy, the tissue needs to be processed in the laboratory and this typically takes 3-5 working days. If the histopathology report shows malignancy, few other tests are usually performed. These include tumor markers such as ER, PR and Her 2. These tumor markers play an important role in planning further treatment.

Following the biopsy, specifically, mammography and MRI guided biopsies, a tiny titanium clip is left behind through the needle at the biopsy site. This is done so that if the biopsy shows malignancy, the metallic clip seen on your mammogram would serve as a marker to guide the breast surgeon to remove the exact area. These clips are compatible with MRI and come in various shapes. If the results are benign, these clips remain in the breast and will be seen on your annual follow-up mammograms.

Following the biopsy, some women may feel slight discomfort once the effects of anesthetic medication wears off. Most women are extremely comfortable and return to work on the same day.

Post procedure instructions will be explained to you following the biopsy. You must contact the doctor if there is severe pain and or redness at the site or fever following the biopsy. These could be signs of infection and are extremely rare as the test is performed using sterile and aseptic precautions.

Once you receive the biopsy reports, you must visit your radiologist and referring physician or surgeon. They will analyze the report and conclude whether the reports were concordant with imaging or not and give advice regarding what should be done next.

Having a biopsy recommendation after your routine screening mammogram can result in a lot of anxiety. Discuss your report with your radiologist. Once you are assured of how painless and quick the procedure is, undergoing a biopsy is lot easier. Waiting for your reports can be unnerving. Try to distract yourself by doing what you like, whether it is watching a movie or going for a long walk in your favorite park.

Remember, the purpose of performing screening mammograms is to detect breast cancer at the earliest. That means we can afford to accept benign biopsies rather than missing breast cancer. Do not hesitate to get the test done when recommended. Early detection saves lives.

Dr. Tanvi Jakhi
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