Breast Biopsy

A breast biopsy is usually recommended if:

• A lump is felt during a physical exam.
• A suspicious area is seen on a mammogram, ultrasound, or MRI.
• There are changes in the skin or nipple, or other concerning symptoms.

• Fine Needle Aspiration (FNA): Uses a very thin needle to remove fluid or cells.
• Core Needle Biopsy: Uses a larger needle to remove small cylinders of tissue—commonly used and done with local anaesthesia.
• Stereotactic Biopsy: Guided by mammogram imaging to target tiny abnormalities.
• Ultrasound-Guided Biopsy: Uses ultrasound to guide the needle to the right spot.
• Surgical Biopsy: Removes part or all of the suspicious area in the operating room (less common now unless needed).

A stereotactic biopsy is a mammogram-guided procedure that removes a sample of a suspicious breast lump, to be sent to the laboratory for examination. It involves using a needle and angle calculations with a mammogram machine to reach the area of concern with suspicious tissue. This method is used for calcifications and other non-palpable growths not visible on ultrasound.

An ultrasound-guided biopsy is used to accurately find and take samples of suspicious tissue visible on ultrasound. The two types of ultrasound-guided biopsies are fine needle aspiration biopsy and core biopsy. 

A fine needle aspiration biopsy is specifically chosen for lumps that are more likely to be fluid-filled. If the specialist suspects this, a fine needle is inserted into the lump at which stage it may collapse once the fluid is drawn out. If the lump persists, the specialist may perform another fine needle aspiration to remove tissue for further examination. 

Core biopsy is a procedure which requires a wider needle to find and remove a sample of the tissue to be examined. 

Both methods use local anaesthetics and do not require special preparations, such as fasting.

In an ultrasound-guided cyst aspiration, the radiologist applies gel on the breast skin and uses an ultrasound probe to locate the cyst. Once the cyst is visible, they guide a needle to the cyst and drain the fluid within it. The fluid can be sent to the laboratory or disposed of, depending on whether the radiologist suspects an infection. This procedure is fast and simple, local anaesthetic to numb the area.

This procedure involves making a small incision (cut) into the breast to remove the lump or area of interest so that a clear diagnosis can be made. This is a surgical procedure and will usually require a general anaesthetic.

A seroma drain is a drainage tube which may be placed in the wound during surgery. This helps drain out the fluid that builds up under the skin over a few days or weeks following breast surgery- this natural body fluid is referred to as "seroma'. The breast nurse will remove the drain sometime after the breast surgery.

This procedure is performed by the radiologist just before the breast surgery, and it allows the surgeon to locate the area to be operated on. The wire localisation can be either mammogram-guided or ultrasound-guided- whichever modality offers a clearer view.