Biopsy: the last piece of the puzzle

An abnormal mammogram does not automatically mean that breast cancer is present. However, it does require further testing to determine what was abnormal about the mammogram. Typically, other forms of imaging are used to further evaluate a lesion and if those are still suspicious for cancer, a piece of tissue is required to make a final diagnosis.

The Good News

Not everything that appears abnormal on a mammogram is cancer. There are false positives associated with every type of test, where a test is read as positive but in fact there is no disease. False positives are seen with a mammogram approximately 15% of the time, but they are still a useful screening tool.[1]

The Biopsy

These are the different types of biopsy that can be performed:

  • Fine Needle Aspiration (FNA): Ultrasound is used to localize the area of concern and a small needle with a syringe attached is passed through the tumor while watching it on the monitor. As the tissue passes through the small needle, the structure of the tissue is destroyed, but individual cells can be seen.
  • Core Needle Biopsy (CNB): Ultrasound is used to localize the area of concern and a sample of the tissue is taken with a sizable needle that has a hollow center. This is done so that the structure of the tissue can be preserved, as opposed to individual cells as in FNA.
  • Incisional biopsy: This requires a palpable mass, or one that can be felt when pressing on the skin. An incision is made in the skin just above the site of the suspicious mass and a small portion of the mass is taken out. The incision is closed with suture after this procedure.
  • Excisional biopsy: The entire tumor is removed and examined by a pathologist.

FNA and CNB can be done in an office setting where as both incisional and excisional biopsy are surgical procedures. This must be taken into account when determining the best way to collect a tissue sample.

Planning Your Biopsy

Before you have your biopsy performed, you should discuss these things with your doctor:

  • Why the biopsy is being performed
  • What the potential findings may be
  • What are the alternatives to biopsy

Biopsies are invasive procedures, no matter what type is performed. Each time a biopsy is performed, a scar will be made, even if it is just from a needle. Thus, the decision to perform a biopsy must not be made in haste, but should be carefully thought out. You must also be prepared to handle the results, which is why discussing the potential findings with your doctor beforehand is important. A biopsy is the last piece of the puzzle when it comes to making a diagnosis. From that point on, your mind should be focused on surviving, if you are indeed diagnosed with cancer.


1  Mammography. (2011). Retrieved from Radiology

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.