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You have a lump or some other change in your breast. Most breast lumps or other changes are not cancer. However, to be sure, your doctor tells you that a biopsy must be done. What is a Biopsy?

You have a lump or some other change in your breast. Most breast lumps or other changes are not cancer. However, to be sure, your doctor tells you that a biopsy must be done.

A biopsy is minor surgery to take out all or part of a breast lump or the tissue in question. A doctor called a pathologist looks at the biopsy tissue under a microscope to see if cancer is present. A biopsy is the only way to know for sure if a breast change is benign (not cancer) or malignant (cancer).

This article contains information that can help you to:

- Prepare for your biopsy
- Learn what happens during a biopsy
- Know what to expect while awaiting the diagnosis
- Review your treatment choices if cancer is found
- Understand the terms used when talking about breast cancer
- Learn about the different resources available

Although this section has a lot of information, every woman's case is different. Be sure to ask your doctor and nurse what your care will involve. You also may want to share this section with family and friends who have questions.

Before your biopsy

It's important to discuss your biopsy with doctors, nurses, and other members of your health care team so that you can take an active part in your care. Talking with other women who have had a biopsy will also help you understand the procedure.

You will have many important questions, and your doctor is the best person to answer them. Most women want to know what the biopsy will be like and what will happen if they have cancer. It's often helpful to write down questions as you think of them.

To help you remember what the doctor says, you may want to take a family member or friend with you. Many women also find taking notes useful while talking with their doctor. Ask the doctor to explain anything that is not clear.

- What type of biopsy will I have?
- How long will the biopsy take?
- Will I be put to sleep?
- Can I eat or drink before the biopsy?
- Will the biopsy leave a scar?
- How soon will I know if I have cancer?
- If I do have cancer, what other tests will need to be done?
- What are my treatment choices if I have cancer, and how soon will treatment start?

What happens during a biopsy

You have a choice between two procedures for your biopsy. The most common is the two-step procedure. For this procedure, the biopsy is done first. Then if cancer is found, treatment begins a week or two later. Some women choose a one-step procedure. When this is used, the woman is treated immediately if cancer is found. This section explains each of these procedures.

Two-step procedure

Most women have biopsies in the hospital outpatient or "same day surgery" department. They usually do not need to stay overnight. Your doctor or nurse will tell you if you may eat or drink before surgery. At the hospital, you will have some routine tests such as blood and urine tests, a chest x-ray, and an EKG (electrocardiogram), which records the activity of your heart. These tests tell your doctor about your general health. Sometimes these tests are done a few days before the biopsy.

You will be asked to sign a paper called an "informed consent form." It explains what the doctor is going to do and gives your permission for the procedure. If you do not understand this form, be sure to ask the doctor or nurse to explain it to you.

When it is time for the biopsy, you will be taken to the operating room. You will be given local or general anesthesia. For local anesthesia, the doctor injects some medicine in the breast so you won't feel anything as the lump is removed. For general anesthesia, you will be put to sleep for a short time while the doctor removes the suspicious tissue. The doctor often removes all of the lump or area in question (excisional biopsy). This type of biopsy usually takes about an hour.

The pathologist then checks the tissue to see if it is cancer. Using a procedure called a frozen section, the pathologist looks at thin slices of frozen tissue under a microscope. It takes just a few minutes and is a quick way of telling if cancer is present. If the lump is very small or if a more detailed study is needed, the pathologist looks at the tissue using a procedure called a permanent section. The results of this test are usually known in a few days. From the permanent section the doctor can tell the type of breast cancer and learn other information that may be needed to plan treatment.

If the biopsy shows cancer and enough tissue is available, the pathologist does more tests called hormone receptor assays. These tests tell whether the cancer needs the female hormones, estrogen and progesterone, to grow. Doctors do hormone receptor assays at the time of the biopsy because the tissue needed for these tests may be hard to get later on. This information is important to help the doctor decide how the cancer should be treated.

After the biopsy, you will be taken to your room or the outpatient care area. Most women have very little discomfort after a biopsy. If you have general anesthesia, you will probably be sleepy and want to rest. Depending on how you feel, you will be ready to go home 2 to 3 hours after the biopsy. It's best for a family member or friend to take you home. Before leaving the hospital, you will get instructions on how to take care of the incision. If you have any questions, ask your doctor or nurse.

You should be able to return to your normal routine within a day or two. However, for the next week or so your breast may be sore and slightly bruised. Also, the incision may feel firm for 3 to 4 months.

You may be told the results of your biopsy before you leave the hospital. However, the results from a permanent section will take a few days. If you have cancer, your doctor will talk with you about treatment options. Treatment for breast cancer usually begins within a couple of weeks after the biopsy. This gives you time to:

- Learn about treatment options and breast reconstruction.
- Get another medical opinion.
- Have tests that tell if the cancer has spread to other parts of the body.
- Prepare yourself emotionally.
- Make personal and work arrangements.

A short delay between the biopsy and treatment will not reduce the chances that your treatment will be successful.

One-step procedure

After talking about treatment choices with their doctor, some women choose the one-step procedure. This means they have a mastectomy immediately if their biopsy shows cancer. If you have a one-step procedure, you probably will go to the hospital the night before your biopsy. Some routine tests such as blood and urine tests, a chest x-ray, and an EKG are usually done to tell the doctor about your general health.

You also will be asked to sign a consent form that gives your doctor permission to do more surgery if the biopsy shows cancer. If you do not know what treatment is planned, be sure to ask your doctor or nurse to explain it to you. Shortly before your surgery, you will be given some medicine to help you relax. Then you will be taken to the operating room where the anesthesiologist will put you to sleep. The surgeon will remove the suspicious tissue and send it to the pathologist. The pathologist will check for cancer by looking at frozen sections of the tissue. If the tissue is not cancer, the biopsy will take about an hour. You will probably be able to go home later that same day or the next day.

If cancer is found, the doctor will remove part or all of the breast at that time. You will need to stay in the hospital for 3 to 5 days after this surgery.

Your doctor can use several biopsy methods to remove tissue for the pathologist to examine. The choice depends on such things as the size and location of the lump or suspicious area and your general health. Ask your doctor which of these methods will be used for your biopsy:

- The use of a needle and syringe to try to drain the lump. If the lump is a cyst (a fluid-filled sac that is not cancer), removing the fluid will collapse it. No other treatment will be needed.
- Fine-Needle Aspiration. The use of a thin needle and syringe to collect cell clumps or single cells from the lump.
Needle Biopsy. The removal of a small piece of breast tissue using a needle that has a special cutting edge; also called a core needle biopsy.
- If cancer is not found using fine-needle aspiration or needle biopsy, the doctor will most likely do an excisional or incisional biopsy. The doctor uses these tests to make sure cancer cells were not missed by the needle.
- Excisional Biopsy. The removal of all of the lump. Used most often, it is the current "standard" procedure for small (less than about an inch in diameter) lumps. Also called a lumpectomy.
- Incisional Biopsy. The removal of part of the lump. This method may be used if the breast lump is large.
- Mammographic Localization With Biopsy. Used when a breast change can be seen on a mammogram (an x-ray of the breast) but cannot be felt. In this procedure, the doctor uses the mammogram as a guide for placing small needles (needle localization) at the site of the breast change. Sometimes dye is used instead of needles to mark the site. The suspicious tissue then can be removed for examination by the pathologist

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