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Breast Biopsy
Questions about the definition, risks and results of breast biopsy.
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AskedPublicly Submitted Question
1/8/2018My report states: Dense parenchymal tissue is noted. In the left breast 3 o'clock retroareolar aspect there is an 8mm hypoechoic nodule, slightly larger than on the prior study (6mm) from February 2017. This has overall benign features however, could represent a papilloma.

The left breast 1 o'clock 2cm from the nipple there is a 6mm, likely compensated cyst. The examination demonstrates no suspicious cystic or solid abnormality.

Assessment: BI-RADS Category 4: suspicious finding.
I am 29 years old woman. Should I be worried?

I apologize for several questions below, but I greatly appreciate your insight! Thank you!!!

What is the recommended type of biopsy? How reliable are the results of this type of biopsy?

Is it preferred to have a radiologist or a surgeon perform an ultrasound guided biopsy?

Is better to just have the lumps surgically removed immediately instead of only doing the biopsy if finances are not an issue?

What is the criteria used to determine whether a breast tacker marker is needed? What are the benefits of using a tracker marker? Is it recommended that a marker be put in? If so, what is the preferred type and brand? What are the risks?

I have several allergies and would prefer not to have the clips. What is the downside to not having the clips?

The breast surgeon stated that I had a swollen lymph node. I believe it was on the opposite breast from the lumps though. Should I insist that they be sampled? If so, should I request a sentinel node biopsy be done? If not, why not?

Should hormone receptor status and HER2 status tests be done? Others?

Should I request that the tissue removed during my biopsy be X-rayed to make sure all of the suspicious tissue was removed?

Should I request that my sample be saved?

Is it better to have a breast biopsy or surgery done during a certain time of the menstrual cycle?

Thank you very much!!!
RepliedJHU's Breast Center Reply
1/8/2018First, try not to worry! A biopsy is the only way to determine exactly what the nodule is.

A core needle biopsy is done by numbing your skin/tissue, inserting a needle and extracting a sampling of the nodule. That sample goes to Pathology and is analyzed under the microscope. The results are very reliable to determine what the cells are.

You definitely should have a breast radiologist perform the ultrasound guided biopsy.

No, you should have the biopsy first to determine what the lump is. If it is benign (not cancer), your mind is relieved. If it is cancer, you'll need more surgery anyway.

Our breast radiologists always leave a marker clip in when doing a biopsy. This is a way to localize exactly where the lump is if you need surgery, and if no surgery, a way to watch that area on follow-up imaging. Ask the radiologist about type/brand. There are virtually no risks from the marker clip. Some women get scar tissue around the biopsy site. Marking the site also helps to ensure that the correct area was biopsied. The markers are made of materials that will show up on your follow-up mammogram. The presence of the marker can be very reassuring when seen on follow-up mammograms because it shows exactly where the area was biopsied. This can prevent the need for future biopsies in that same area.

The downsize of not having the clip is that the exact site biopsied may not be seen on future breast imaging and you could end up getting the same area biopsied again.

The swollen lymph node should be looked at on ultrasound. If it looks suspicious, the radiologist may decide to do a core needle biopsy or take some of the fluid through a needle to analyze it (called a Fine Needle Aspiration). No, you would not request a sentinel lymph biopsy as it would be done for a known breast cancer during breast cancer surgery to make sure it hasn't spread into lymphatic system.

Hormone receptors and Her2/neu tests will be run if the biopsy shows breast cancer.

They cannot tell by xray of the tissue whether all suspicious tissue was removed. Once pathology determines what the lump was, a treatment recommendation will be given.

Slides of the biopsy are kept in Pathology Dept.

Your menstrual cycle can produce changes in your breast and also make them more tender, but biopsies are not typically scheduled around the menstrual cycle.

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