What to Expect from Your Breast Biopsy

What Is a Breast Biopsy?

A biopsy is a diagnostic procedure used to evaluate tissue for signs of disease. It involves removing a piece of tissue or small amount of fluid, called a sample, from the suspicious area that was identified during screening. This sample is then examined in a laboratory to look for cancer cells.

A breast biopsy can be done in one of several ways. The recommended method depends on factors including the size and location of the breast abnormality, whether there is more than one abnormality, the individual’s overall health, and more. Types of breast biopsies include:

• Fine needle aspiration: This type of biopsy uses a thin, hollow needle to take a small amount of tissue or fluid from the breast.
• Core needle biopsy: Like fine needle aspiration, this type of biopsy uses a larger hollow needle to take a larger tissue or fluid sample.
• Incisional or excisional biopsy: This type of biopsy is a surgery that removes part (incisional) or all (excisional) of the tumor for testing.
• Lymph node biopsy: This type of biopsy removes tissue from the lymph nodes under the arm. Physicians use it to check for signs of spreading cancer.

After the tissue sample has been taken, it is sent to a medical laboratory. There, it will be tested by a pathologist who prepares a detailed report of the sample’s important characteristics.

Benign Breast Biopsy Results

Most breast biopsies do not find cancer. Breast tissues undergo many changes over time that are benign and no cause for concern. Other changes may require medical attention but aren’t cancer. The following biopsy report terms describe non-cancerous changes:

• Adenosis
• Sclerosing adenosis (SA)
• Apocrine metaplasia
• Cysts
• Columnar cell change (CCC)
• Columnar cell hyperplasia (CCH)
• Collagenous spherulosis (CS)
• Duct ectasia
• Columnar alteration with prominent apical snouts and secretions (CAPSS)
• Papillomatosis
• Fibrocystic breast changes

Many of these conditions do not need to be treated unless they are causing symptoms. Many of them also have no effect on the risk of developing future breast cancer. Individuals should speak with a healthcare provider about symptoms or any concerns regarding benign breast biopsy results.

Cancerous Breast Biopsy Results

If cancer cells were found in the biopsy sample, the pathology report will include additional information about the cancer’s characteristics. This information will help the cancer care team understand your condition better, allowing them to recommend the best treatment plan for you. Following are some terms you may see on your pathology report:

Noninvasive or Invasive

Noninvasive cancer cells are found only in the milk duct where they initially formed. They may also be described as ductal carcinoma in situ (DCIS). This is considered pre-cancer or stage 0 breast cancer. Invasive cancer cells, meanwhile, have spread to tissue near the milk duct or beyond the breast.

Cancer Grade

The biopsy report will also include the cancer’s grade. This is a numbered scale that describes a tumor’s size, shape, degree of abnormality, and growth rate. Cancer grade is a separate identifier from its stage but is used to determine the stage. Grades include:

• Grade 1: Cells look slightly different from normal cells. The tumor usually grows slowly.
• Grade 2: Cells look noticeably different from normal cells. The tumor grows at a fast rate.
• Grade 3: Cells look very different from normal cells. The tumor grows at a fast rate.

Hormone Receptors

Hormone receptors are special proteins found inside cells. They bind to certain hormones, provoking a response from the cell. Part of a breast cancer biopsy includes checking for hormone receptors that bind to estrogen or progesterone. If the tumor tests positive for either type of receptor, then it is using hormones to grow. This means hormone therapy may be an effective treatment.

On a biopsy pathology report, the word “negative” indicates that no hormone receptors are present. “Positive” indicates that there are receptors present. If the hormone receptor report is positive, it will also include the following information:

• The percentage of cells that test positive for receptors
• An Allred score, which is numbered from 0 to 8 based on the percentage of cells that test positive for receptors and on how well receptors show up on tests

HER2

HER2 is a protein responsible for controlling breast growth. Some amount of HER2 protein is normal in healthy breasts. Certain types of cancer produce too much HER2, however, causing uncontrolled cell division and growth. By measuring the quantity of HER2 present in breast cancer, oncologists can determine what type of cancer is present and plan a more effective treatment.

Individuals may see the term “equivocal” on a pathology report. This indicates that the amount of HER2 is unclear. Second tests may be requested to determine a cancer’s HER2 status.

Cancer Stage

Finally, the pathology report will include the cancer’s stage. This is scaled from 0 to IV based on an overall understanding of the tumor and its behavior, including its grade, hormone receptor status, HER2 status, and how much cancer cells have spread. Higher stages indicate more serious cancers requiring more aggressive treatments.

Cancer Type

In addition to stage, the biopsy report may also designate a special type of breast cancer. Types include:

• Inflammatory breast cancer: This rare type usually does not present with a noticeable lump, instead causing swelling or reddened skin.
• Paget disease: This rare type develops in the nipple and areola.
• Phyllodes tumor: This type develops in the connective tissue in the breast. While usually benign, Phyllodes tumors are sometimes malignant.

Frequently Asked Questions About Breast Biopsy

What is a biopsy, and why is it necessary?

A biopsy involves removing a small tissue sample for examination to confirm whether cells are cancerous. Breast biopsies are typically requested after a routine mammogram or other test detects a tissue abnormality in the breast. The biopsy helps medical oncologists come to a more conclusive diagnosis.

How else is breast cancer diagnosed?

Along with a biopsy, breast cancer diagnosis usually involves a combination of a physical exam, mammography, ultrasound, and MRI.

What do physicians learn from a breast biopsy?

Breast biopsies can provide information about whether a tumor is invasive, its grade, the presence of certain proteins, the stage of cancer, and the type of cancer.

Do all breast biopsies identify cancer?

Most biopsies do not identify cancer. The procedure can also be used to confirm that an abnormality is benign and may not need treatment.

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