Core Biopsy of the Breast

The Procedure Explained

How is a
Core Biopsy done?

When a lady presents with a lump in the breast, and we have a doubt in mind - Is it cancer?, there is one - and only one - way to confirm it. This involves 'pulling' out a small piece of tissue from that lump and sending it across to the Pathologist, who will 'harden' it, slice it, place on a slide and see under the microscope, to see if he can see any cancerous cells. The procedure of pulling out a tissue from a tumor, anywhere in the body, is called a 'biopsy'. In the breast, we use an instrument which has a long needle, with a slot at the tip, for tissue from the breast to fit into. It as called as 'Core Biopsy'.

There are two Specialists who will do Core Biopsy:
If the lump is 'felt' by hand, then a Surgical Oncologist can do a Core biopsy in his minor operating room.
If the lump is small and 'not felt' by hand, but seen on an Ultrasound or Mammograhy, then the Radiologist will do an 'Ultrasound guided' or 'Vacuum guided' Core Biopsy. Of course the Radiologist can also do the biopsy when the lump is felt by hand as well.

Following is a brief idea of how a Surgical Oncologist does a Core Biopsy in the Operating Room.

Instructions

Core Biopsy of the breast is an Outpatient (OPD) procedure; it means, it does not need an indoor admission. Simple Instructions before 'you' reach the Hospital for the biopsy (I am writing, as if 'you' are the one undergoing the biopsy, for ease of description):

There is no need for fasting. You can have a light breakfast in the morning, if being done in the morning hours (which is usually the time I prefer).
Please carry all the reports, especially the mammography reports, so the doc can doubly check the site and side of the lump.
Always keep in mind, any allergies of any medicine that you may have, and always inform the doc prior hand.
You are expected to be accompanied by one relative at least.

The Procedure

Core Biopsy of the breast is an Outpatient (OPD) procedure; it means, it does not need an indoor admission. Simple Instructions before 'you' reach the Hospital for the biopsy (I am writing, as if 'you' are the one undergoing the biopsy, for ease of description):

There is no need for fasting. You can have a light breakfast in the morning, if being done in the morning hours (which is usually the time I prefer).
Please carry all the reports, especially the mammography reports, so the doc can doubly check the site and side of the lump.
Always keep in mind, any allergies of any medicine that you may have, and always inform the doc prior hand.
You are expected to be accompanied by one relative at least.

At the Hospital, the doc will examine you once more, to assess the location of the lump. After Examination and confirmation, the doc will sit with you and your relative and explain the whole procedure and answer your doubts.

The doc will then take a 'written and informed consent for the biopsy' from you, co signed by your relative

The nurse will wheel you into the operating room and help you lie on the operating table. The breast, from where the biopsy is to be done, will be cleaned with appropriate solutions to make that area sterile and you will be properly covered with towels, except a small area on the breast from where the biopsy is to be done.

The doc will now join. He will inject 'Local Anesthesia' at the site of biopsy with a small needle. The anesthesia will make that area numb. He will then take a very small cut (about 5 mm) in the anesthetized area. Using the special core biopsy gun, he will pull out multiple 'pieces' or 'cores' of the tumour, usually about 4 to 6 'good sized' cores. After that, he will put a tiny single stitch on that cut and give a sterile dressing. The whole procedure barely takes 10 to 15 minutes

You will be wheeled to the recovery room, where you will lie down for about ten to fifteen minutes. The nurse will enquire if you have pain, if so, will help you with an analgesic. This is usually a pain free procedure for most and pain, even if it happens, is very mild.

The doc will show you the 'cores', pack them up properly in a solution. The cores are sent to a Pathologist for testing. Doc will prescribe an oral antibiotic and a pain killer for a few days. You can now go home.

Chemotherapy Planning: Images to come soon

Post Biopsy Instructions

There is nothing specific as such, but the following points can be kept in mind:

  • You can have a bath daily, no issue of water going on the biopsy site. You can even remove the dressing during bathing, and apply a fresh small band aid after bath.

  • There is no restriction on food. You can eat whatever you wish.

  • The single stitch will be removed four days later, when you may be meeting the doc with the pathology report of the biopsy.

  • Occasionally, due to blood seeping below the skin, some women will have a 'bruise' like discoloration of the skin around the area of biopsy. This will disappear in a couple of weeks, and is not a cause of concern.

The Biopsy Report

The Histopathology report will confirm the cancer (or refute it, if it turns out to be non cancerous). Below is an explanation for you to understand, but please note that this is not a comprehensive explanation and many more possibilities are there beyond what is written below. There are two parts in the report:

  • 1. Confirmation of cancer - the words 'Infiltrating Duct Carcinoma' or 'Infiltrating Lobular Carcinoma' will be written. These are the two common types. There are a few rare other types of cancers also, not mentioend here. Sometimes, it is not a 'full blown cancer', but a 'pre cancerous stage', in which case it will be mentioned as 'Ductal Carcinoma in situ (DCIS), No invasive element seen'

  • 2. ImmunoHistoChemistry (IHC). This decides the 'type' of the cancer. There are three variables described - ER (Estrogen Receptor), PR (Progesterone Receptor), and CerbB2 (HER2neu). Each of these can be either positive or negative. Depending on the combination of which is positive and which is negative, the type of cancer is decided.

The type of cancer, along with the findings on the staging tests, and the Clinical Examination, will decide the further course of treatment. A better understanding of the planning would be found in the section on Breast Cancer Treatment Planning

The Importance of Core Biopsy


Core Biopsy is the single most important test, as it tells us about the nature of the cancer a woman has. And the 'type' of breast cancer has a very important influence in selecting the sequence of treatment. For example, for a stage 2B cancer (a small lump of about 3 cm and maybe one or two nodes in the armpit), if the biopsy is suggestive of a ER positive, low grade cancer, we may operate first; but if the biopsy is suggestive of a Triple negative breast Cancer, then we will definitely consider giving chemotherapy first. This planning of sequence of treatment is very crucial, to ensure the best possible survival.


TOPICS IN THIS SECTION

All the links are in blue colour. You can click the links to go to that page. The page you are presently reading is pink in color


Journey of BC: Diagnosis


1. I feel a lump! - The first visit to doctor
2. Is it really cancer? - Confirmatory tests
3. What is the stage? - Staging and fitness tests
4. Will it be surgery first? or chemo first? - Treatment planning and sequence

Journey of BC: Surgery


5. Should I conserve or remove breast? - Choice of Surgeries for breast cancer
6. How long will be the surgery? - Admission and Surgery
7. Care after surgery - Precautions and guidelines
8. What next? - The Pathology Report

Journey of BC: Further Treatment


9. How many chemo cycles? - Chemotherapy Consultation
10. Is a PORT necessary? - ChemoPORT insertion
11. Will I be normal during chemo? - The Chemotherapy time
12. Is Radiation painful? - Radiation Therapy
13. Yes!! I did it! - Treatment is over
14. How frequently do I meet doc? - Follow up guidelines

Other Topics


Risk Factors - The Risk Factors for Breast Cancer
Symptoms of Breast Cancer - Know the Symptoms of Breast Cancer
Early Detection of Breast Cancer - The Guidelines

Mammography, MRI, Ultrasound of the Breast
Core Biopsy - The Procedure - You are presently on this page

Neo Adjuvant Chemotherapy (NACT) - For LABC
Sentinel Node Biopsy - How is it done?
Targeted Therapy - Trastuzumab
Hormone Therapy - Who gets it?