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Breast Biopsy

A patient receiving a sterotactic biopsy.
A patient receiving a stereotactic biopsy.

At Johns Hopkins, diagnostic evaluation results are known the same day. Biopsy, if needed, may also be done on the same day with results being available 24-72 hours later.

Only 20 percent of breast lumps are cancerous, but that doesn’t make the experience of getting a breast biopsy any less overwhelming. At the Johns Hopkins Breast Cancer Center, our staff is uniquely sensitive to each woman’s needs during her biopsy. We provide initial opinion immediately after the biopsy and a pathology diagnosis usually within 24 hours. Breast tissue biopsies are sent from all over the United States to our breast cancer pathologists. Having quick access to these expert diagnosticians is a great benefit to our patients.

Specializing in Minimally-Invasive Breast Biopsies

Every breast biopsy is precisely targeted to disrupt only the suspicious breast tissue, leaving the rest of the breast intact. In fact, 90 percent of breast biopsies can be obtained in a minimally-invasive manner without an incision or general anesthesia.

Your physician will recommend the most minimally-invasive procedure possible depending on the size and location of your mass. Having an expert opinion about the type and grade of cancer will affect your treatment from the very beginning. We offer the following biopsies:

Breast biopsies that need only local anesthesia:

  • Fine needle breast biopsy – When the mass is easily felt by the physician or easily seen on ultrasound, a fine needle biopsy may be recommended. Local anesthesia is used to numb the area and a fine needle is used to withdraw enough tissue for examination under a microscope. This procedure is performed by a radiologist or surgeon. Sometimes, lymph nodes in the armpit can also be assessed this way.
  • Stereotactic breast biopsy – This kind of biopsy is performed when the breast lump is so small that it cannot be felt during an exam or if suspicious microcalcifications were seen on a mammogram. You will lie on a table on your stomach, with your breast dropping through an opening to allow for the breast to be biopsied. While the breast is compressed by mammography paddles, the image is projected on a computer screen. A special needle designed to obtain tissue samples is guided to the suspicious mass. Several samples will be taken and images will confirm that an adequate amount was removed for examination under the microscope. This procedure is performed by a radiologist.
  •  Ultrasound-guided core biopsy – This kind of breast biopsy is performed when the lump is palpable during an exam or if it is easily seen on an ultrasound. Using ultrasound to locate the mass, a large needle withdraws tissue samples for examination under the microscope.
  • Skin punch biopsy – This kind of biopsy is performed when inflammatory breast cancer or Paget’s disease is suspected. A tiny device that looks like a miniature cookie cutter is used to core out a piece of the skin of the breast (in the case of inflammatory breast cancer) or a piece of the nipple/areola complex (in the case of Paget’s disease). Usually, one to two stitches are needed to close the puncture site.

Breast biopsies using local or general anesthesia:

  • (Open) Excisional biopsy – This biopsy is done making an incision in the breast and removing tissue from the suspicious area. It is sent to a pathologist for a diagnosis. Excisional biopsy and lumpectomy should not be confused with one another. Lumpectomy is performed when there is a known diagnosis of breast cancer and the mission is to remove all of the cancer with a health margin of tissue around the tumor. An excisional biopsy is not asurgical treatment, it is diagnostic.
  • Sentinel lymph node biopsy – The sentinel lymph node is the lymph node in the arm pit that is the first place cancerous breast tumors can spread. Also called the guard node, it is identified using a special blue dye or radioactive isotope that is injected before the surgery. Following the path of the dye or isotope, your surgeon will identify the sentinel node, remove it, and send it to pathology for review. Knowing if the cancer has spread to the nearby lymph nodes is a critical part of staging and treatment of breast cancer. This procedure is performed when there are known invasive breast cancer cells in the breast, or when mastectomy is being done for the treatment of DCIS. If the sentinel lymph node is positive for cancer, additional lymph nodes are removed to determine the extent of disease.
  • MRI-guided biopsy – During this kind of biopsy, your physician uses an MRI machine to get a precise reading on the location of the tumor. By doing so, your physician can make sure that he or she is pinpointing the tumor and removing enough tissue to get an accurate reading of the biopsy under the microscope.
 

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ArtemisArtemis: Take advantage of a free subscription to Artemis, our electronic medical journal on breast cancer. Find out more.
 

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