• Breast Biopsy
A breast biopsy is a procedure in which your doctor takes out cells or a small piece of tissue from part of your breast. They look at it under a microscope for signs of cancer. It’s the only way to know for sure if a possible trouble spot is cancer.
Why Is a Breast Biopsy Done?
If your doctor finds something suspicious during a routine breast exam, mammogram, or ultrasound, they may recommend this test. Possible signs of trouble include:
- A lump or mass that you can feel in your breast.
- Masses filled with fluid (cysts) or small calcium deposits (microcalcifications).
- Nipple problems like bloody discharge.
Types of Breast Biopsy Procedures
Your doctor will recommend a breast biopsy procedure based on things like:
- The size of the lump or suspicious area
- Where it is
- Whether there’s more than one unusual area
- If you have other medical problems
- What you prefer
Your doctor may take a sample of tissue through surgery or through a procedure called a minimally invasive biopsy. Minimally invasive procedures offer:
- Less scarring
- Less pain
- Lower risk of infection
- Possibly lower hospital costs
- Shorter recovery time
- Return to typical daily activities right away
Common minimally invasive biopsy procedures include:
Fine-needle aspiration. Your doctor uses a small needle to take a sample of cells from the area in question. If the lump is a cyst (a fluid-filled sac), the procedure may cause it to collapse. This fluid will be looked at under a microscope for any signs of cancer. If the lump is solid, cells can be smeared onto slides for examination.
Ultrasound-guided core biopsy. Your doctor puts a needle into the breast tissue. Ultrasound helps confirm the exact location of the potential trouble spot so the needle goes to the right place. Tissue samples are then taken through the needle. Ultrasound can see the difference between cysts and solid lesions.
Vacuum-assisted breast biopsy. A suction device gets more fluid and cells through the needle. It can cut down on the number of times the needle needs to be inserted to get samples.
Stereotactic biopsy. The medical team centers the area to be tested in the window of a specially designed instrument. Mammogram films called SCOUT films are taken so a specialist called a radiologist can examine the area to be biopsied. After using medicine to numb the area, the radiologist makes a small opening in your skin. They put a needle into the breast tissue, and computerized pictures help confirm the exact placement. Tissue samples are taken through the needle. It’s common for medical professionals to take multiple tissue samples (about three to five).
Surgical procedures include:
Open excisional biopsy. This is surgery to remove an entire lump. The tissue is then studied under a microscope. If your doctor takes a section of normal breast tissue all the way around a lump (called a lumpectomy), the biopsy is also considered a breast cancer treatment. In this technique, they may put a wire through a needle into the area to be biopsied. An X-ray helps make sure it’s in the right place, and a small hook at the end of the wire keeps it in position. The surgeon uses this wire as a guide to find the suspicious tissue.
Sentinel node biopsy. This method helps ensure that only the lymph nodes most likely to have cancer are removed. It pinpoints the first lymph node a tumor drains into (called the sentinel node). To spot it, your doctor puts a radioactive tracer, a blue dye, or both into the area around the tumor. That helps them figure out which lymph nodes are the first to receive drainage from the breast. These nodes would possibly be the first to be invaded by cancer cells. One to three sentinel nodes are usually removed and tested for cancer. If the sentinel node is positive, there may be other positive lymph nodes upstream. If it is negative, it is highly likely that all of the upstream nodes are negative.
You may also have an axillary node dissection. Your doctor takes out at least six of the lymph nodes under your arm and sends them to a lab to be checked for cancer. This is a very reliable way to check the extent of your cancer. But it can take longer to recover, and it can have complications like arm swelling (lymphedema) or nerve damage.
After surgery, watch for warning signs of an infection or swelling in your arm or hand. Call your doctor right away if you notice a buildup of fluid, redness, or other symptoms of infection.
Cells or tissues that are removed are given to a pathologist, a doctor who specializes in diagnosing suspicious tissue changes.
Risks of Breast Biopsies
Breast biopsies are relatively safe. Risks include:
- Bruising
- Swelling
- Mild pain
- Bleeding
- Infection
A change in how your breast looks, depending on how much tissue the doctor removes and how it heals.
Oncotype DX Test for Breast Cancer
If you’re diagnosed with breast cancer, your doctor may recommend the Oncotype DX test. Depending on the type cancer you have, the test can tell doctors if ithe cancer is likely to come back at some point.
The Oncotype DX analyzes a sample of a cancer tumor to see the activity of certain genes that can affect the cancer’s outcome and how likely it is to grow and spread. The test uses tissue taken during the initial biopsy or surgery. It measures the breast cancer genes. (You might hear it called a “21-gene signature.”) Your doctor might suggest the test if you have:
- Stage I or II invasive breast cancer
- Estrogen-receptor positive (called ER+) cancer, meaning the disease’s cells grow in response to the hormone estrogen
- Cancer that isn’t in the lymph nodes
You may also have it you’ve recently been diagnosed with ductal carcinoma in situ (DCIS). It can help in deciding whether you have radiation treatments.
Higher Score Means a Higher Risk
The test looks at 21 different genes within the cells of a tumor sample. Certain patterns suggest a more aggressive cancer that is more likely to come back after treatment. The test results show a score between 0 and 100.
If you have early-stage invasive breast cancer and are over 50 years old, the scoring is as follows:
- A score between 0 and 25 means you have a low risk of the cancer returning if you get hormone treatment. With this score you probably will not benefit from receiving chemotherapy.
- A score between 26 and 100 means you have a higher risk that the disease might come back. Both hormone treatment and chemotherapy are likely to be recommended.
If you have early stage invasive breast cancer and are age 50 or younger, the scoring is as follows:
- A score of 15 or smaller means you have a low risk of the cancer returning if you get hormone treatment. You probably will not benefit from receiving chemotherapy.
- A score between 16 and 20 means you have a low to medium risk of the cancer returning if you get hormone treatment. There may be a small benefit of receiving chemotherapy, but the benefits may not outweigh the risks of side effects.
- A score between 21 and 25 means you have a medium risk of the cancer returning if you get hormone treatment. The benefits of chemotherapy may outweigh the risk of side effects.
- A score between 26 and 100 means you have a higher risk that the disease might come back. Both hormone treatment and chemotherapy are likely to be recommended.
If you’ve been diagnosed with DCIS, the results are called a DCIS score , and the numbers are different:
- A score of 38 or lower means you have a low risk of cancer returning, and the risks of radiation treatments outweigh any benefits for you.
- A score between 39-54 means you’re at medium risk and it’s unclear if radiation will help.
- A score greater than 54 means you’re at high risk of the cancer coming back. You’ll likely benefit most from radiation therapy.
• HER2 FISH Testing for Breast Cancer
When you get a diagnosis of breast cancer, your doctor will use several tests to learn details about your tumor and the best way to treat it. The FISH (fluorescence in situ hybridization) test checks the DNA of your cancer cells for extra copies of the HER2/neu gene.
This gene makes proteins called HER2 (human epidermal growth factor receptor 2) that attach to the surface of all breast cells. In healthy tissue, the proteins help cells grow, divide, and do repairs. If your breast cancer cells have too many copies of this gene, they make too much of the protein. This can make your tumor grow faster.
FISH testing can tell your doctor whether you have this type of cancer, called HER2-positive breast cancer, or a HER2-negative cancer with normal levels of the protein.