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Duke Medicine: Breast biopsy under the microscope

Posted April 30, 2012 8:21 p.m. EDT

It is possible that -- like thousands of women in this country -- you could find a lump in your breast this year.

The good news is that the statistics are on your side: The vast majority of suspicious masses in the breast -- about four out of five -- are benign. To know for sure, your doctor might recommend a biopsy.

What can your doctor learn from breast biopsy? How are they performed? We asked Duke Cancer Institute breast surgeons Dr. Lisa Tolnitch and Dr. Shelley Hwang these questions and more.

Why do I need a biopsy?

Tolnitch: Any persistent, suspicious mass or abnormality detected by ultrasound or mammogram needs a biopsy to determine whether it is benign or cancerous. A scoring system called BIRADS (Breast Imaging Reporting and Data System) helps us determine which lumps require follow-up. A BIRADS score of 4 or 5 should be biopsied.

How are they done?

Tolnitch: Most often, a surgeon, primary care doctor, or ob-gyn does a biopsy in their office with a core needle. A core needle is hollow and can remove cores of tissue, but not the entire lump or mass.

The procedure can also be done with vacuum assistance, which provides a larger tissue sample. A small incision is necessary with vacuum-assisted core needle biopsy. The biopsy can also be done under ultrasound or mammogram guidance -- which helps the doctor better visualize the mass during the procedure.

Hwang: There is usually a mammogram machine or ultrasound machine in the room, as well as an assistant to collect the biopsy specimens. For mammogram-directed biopsies (“stereotactic” biopsies), the patient will be on her stomach; for ultrasound-guided biopsies, the patient lies on her back.

For more information about how accurate biopsies are, recovery and more, read the full post at Duke Medicine, Go Ask Mom's sponsor, shares health tips and information on Tuesdays.