The only definitive way to diagnose breast cancer.
If a mammogram or physical exam reveals something abnormal or suspicious in your breast, your doctor may recommend a breast biopsy. During a breast biopsy, a board-certified radiologist specializing in breast imaging will remove small tissue samples from your breast to gain more specific information. The sample is sent to highly-specialized pathologists who analyze it for signs of breast cancer. If the tissue sample confirms a breast cancer diagnosis, we can gather specific information about the extent of disease. At MedStar Health, we also analyze breast biopsies for tumor markers which can help us anticipate how a tumor may respond to treatment. We also offer genetic counseling which can help you and your family manage hereditary breast cancer risks for future generations.
Biopsies are critical in helping your doctor accurately diagnose cancer and determining which treatment options will be most effective. There are different breast biopsy procedures available, and your doctor will order the type of biopsy that is most appropriate for you. It is important for you to ask questions about your biopsy so that you know what to expect. Having all of the information before the procedure will help you feel more comfortable and prepared.
Types of breast biopsies
Minimally invasive breast biopsies
Our breast surgeons recommend minimally invasive breast biopsies whenever possible to minimize your discomfort while accurately obtaining the tissue sample needed for diagnosis. Minimally invasive biopsies are outpatient procedures, which means they do not require an overnight stay in the hospital. They offer a variety of benefits compared to more invasive biopsies, including:
- Reduced risk of infection
- Less recovery time
- Less scarring
At MedStar Health, some of the minimally invasive biopsies we perform include:
Fine-needle aspiration: This diagnostic procedure uses a very thin needle attached to a syringe to remove a sampling of cells. Your doctor may need to take multiple samples to collect tissue from various areas around the abnormality.
Core needle biopsy: A core needle biopsy uses a hollow needle that is slightly larger than what is used in fine-needle aspiration to remove a small sample of breast tissue. A tissue marker is left in place to designate the area that was sampled. Patients often describe the procedure as uncomfortable but tolerable. This procedure requires little recovery time, and there is no significant scarring to the breast.
Image-guided biopsy: Sometimes, we cannot feel the abnormality because it is too small or is in a difficult-to-reach place. In those situations, a MedStar Health board-certified radiologist specializing in breast imaging may perform a guided core needle biopsy, using imaging technology to help guide the needle to the appropriate area. A radiologist technologist who also specializes in breast imaging may assist the radiologist. Like a core needle biopsy, a tissue marker is left in place to designate the sampled area. Recovery is quick with minimal breast scarring.
- MRI-guided biopsy: MRI (magnetic resonance imaging) guides a radiologist to the site of abnormalities to remove samples for examination and diagnosis. We often use this procedure to take samples of the abnormal areas we cannot easily detect on a digital mammogram or ultrasound.
- Stereotactic biopsy: The procedure uses a special computer to guide a needle to a suspicious area seen on a mammogram.
- Ultrasound-guided biopsy: This is a highly accurate procedure to evaluate suspicious masses within the breast that are visible on breast ultrasound, even if they were not felt on self-examination or clinical examination. After placing an ultrasound probe over the site of the breast lump and using local anesthesia, the radiologist guides a biopsy needle directly into the mass. Then we take tissue specimens using either an automatic spring-loaded or vacuum-assisted device. An ultrasound does not involve radiation exposure from X-rays to locate suspicious tissue.
Vacuum-assisted biopsy: A vacuum-assisted biopsy uses either stereotactic mammography, ultrasound, or MRI imaging to pinpoint the location of the breast mass. Your doctor inserts a needle, and a vacuum withdraws breast tissue, capturing it in the sampling chamber of the device.
The procedure is similar to a core needle biopsy, but your doctor may have to insert a needle several times to remove sufficient tissue samples. A vacuum-assisted biopsy uses a specialized instrument, which allows the doctor to remove several samples through a single incision.
An open biopsy is a more invasive procedure than a core needle biopsy or vacuum-assisted biopsy, but the results are usually more accurate because it removes larger tissue samples. The recovery period for an open biopsy is longer as well. You will need stitches following the procedure, and it will probably take a whole day to recover. In addition, there will likely be a small scar.
We perform two types of open biopsies:
- Excisional biopsy: We make an incision in the breast and remove the entire mass.
- Incisional biopsy: We remove only part of the mass.
If we cannot feel the lump, there are two different ways we can identify the mass in preparation for the surgical biopsy:
- During a wire-guided biopsy, a radiologist inserts a thin, hollow needle into your breast. The needle tip rests on the abnormality, and a fine wire is threaded through to rest on the abnormal tissue. The wire has a tiny hook at the end to grab onto the breast tissue. The radiologist then removes the needle, leaving the wire in place.
- You will get a second mammogram to ensure that the wire is resting in the proper position. Once the radiologist confirms that it is in place, they will secure the wire with tape. During the following biopsy or lumpectomy, the surgeon removes the wire. to
- SAVI SCOUT localization allows our radiologists to identify the mass without needing to place a wire, eliminating discomfort and inconvenience. Instead, they use a reflector smaller than a grain of rice, which can be placed precisely in the tumor up to 30 days before the procedure. When it’s time for the biopsy, your surgeon uses SAVI SCOUT to detect the activated reflector, which guides precise removal of cancerous tissue.
- Magnetic seed localization (MSL) is a new technique that involves inserting a tiny pellet the size of a grain of rise into the mass up to 30 days before surgery using image guidance. The seed marks the area that needs to be removed during your open biopsy and will be removed with the biopsy on the day of surgery. Because the procedure is wireless, it’s much more comfortable and convenient for the patient as they go about their daily lives until the biopsy procedure.
Sentinel Lymph Node Biopsy
As cancer cells spread, they can metastasize through the lymphatic system (the nodes, tissues, and organs that produce and store infection-fighting white blood cells). Sentinel lymph nodes are the first lymph nodes the cancer cells encounter with as they move from their tumor of origin.
Sentinel lymph node biopsy is surgery to identify, remove, and microscopically examine the lymph nodes directly in the pathway of spreading cancer cells. This helps your care team assess whether breast cancer has spread to lymph nodes under your arm, which are the most likely lymph nodes to contain breast cancer.
In this procedure, only lymph nodes affected by abnormal cells are removed, increasing the potential for a cure while eliminating the need for a more complicated surgery in most cases. We use two methods to identify a sentinel lymph node, and sometimes they are used together.
- Radioisotope: With this method, you receive an injection in the nuclear medicine department before going to the operating room. Based on where the radioisotope travels, your doctor determines if the lymph fluid in your breast cancer is draining to the lymph nodes in your armpit.
- Blue dye: Your surgeon injects blue dye into your breast during the operation. Based on where the dye travels, your doctor determines if the lymph fluid in your breast cancer is draining to the lymph nodes in your armpit.
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With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.
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Elizabeth C Allen, AGNP-C
Denise N. Blackbourne, PA-C, MS
Marc E Boisvert, MD, MBA
Surgical Oncology & Breast Surgery
Lucy Maria De La Cruz, MD
Maen Jamel Farha, MD
Ian Thomas Greenwalt, MD
Mary Gleason Mills, FNP
Mary Gleason Mills, FNP
Atsuko Okabe, MD
Jennifer Daniella Son, MD
Breast Surgery & General Surgery
Patricia B Wehner, MD
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3800 Reservoir Rd., NW Georgetown Lombardi Comprehensive Cancer Center Ground Floor Washington, DC 20007
1133 21st St., NW Bldg. 2 Ste. 800 Washington, DC 20036
3001 S. Hanover St. Baltimore, MD 21225
40900 Merchants Lane Ste. 102 Leonardtown, MD 20650
110 Irving St. NW Washington Cancer Institute 1st Floor Washington, DC 20010
7501 Surratts Rd. Ste. 305 Clinton, MD 20735
18101 Prince Philip Dr. Ste. 6100 Olney, MD 20832
12 MedStar Blvd. Ste. 180 Bel Air, MD 21015
5601 Loch Raven Blvd. Smyth Building Suite 403B Baltimore, MD 21239
9101 Franklin Square Dr. Baltimore, MD 21237