Breast Biopsy

What is a breast biopsy?

A breast biopsy is a diagnostic procedure in which a tissue sample is obtained from a suspicious lesion for the purpose of histological examination.

It is the only method that can definitively confirm whether a lesion is benign or malignant.

A recommendation for biopsy does not mean a cancer diagnosis. It means that histological confirmation is required.

When is a biopsy needed?

A biopsy is indicated when:

• there is a suspicious imaging finding (BI-RADS 4 or 5),
• there is discordance between clinical examination and imaging,
• an increase in size of a known lesion is observed,
• there is a persistent palpable nodule without clearly benign characteristics.

The decision is based on a combination of clinical and imaging data. Many biopsies are prompted by findings picked up during routine breast screening, and it is worth remembering that the great majority of these findings prove to be benign conditions.

Types of Breast Biopsy

Core Needle Biopsy (CNB)

This is the most commonly used method. It is performed under local anesthesia, with ultrasound or mammographic guidance. Multiple cylindrical tissue samples are obtained. Advantages: high diagnostic accuracy, minimally invasive, does not require general anesthesia.

Vacuum-Assisted Biopsy (VAB)

This is used when the lesion is small, involves microcalcifications, or a larger tissue sample is required. It provides a larger specimen and in some cases can completely remove small benign lesions.

Fine Needle Aspiration (FNA)

This is primarily used for cysts and lymph nodes. It is not the method of choice for diagnosing breast cancer due to limited histological information.

Surgical (Excisional) Biopsy

In a minority of cases — for example when a needle biopsy result is inconclusive or discordant with imaging — the whole lesion may be removed in the operating room for examination. This is performed under anesthesia and is essentially a small operation. It is no longer the routine first step, because needle techniques now provide a diagnosis in most situations without surgery.

Is the biopsy painful?

The procedure is performed under local anesthesia. The patient typically feels mild pressure and slight discomfort during the administration of the anesthetic. The total duration is approximately 15-30 minutes.

After the biopsy, mild pain, a small hematoma, or localized tenderness may occur. Serious complications are rare.

How reliable is it?

Core needle biopsy has high diagnostic accuracy when there is a correct indication, adequate tissue sampling, and concordance with imaging findings.

Diagnostic evaluation is based on triple assessment: clinical presentation, imaging, and histological result. In cases of discordance, re-evaluation may be required.

What information does the biopsy provide?

In cases of malignancy, histological examination determines: the histological type, the grade of differentiation, hormone receptor expression (ER/PR), HER2 expression, and the proliferation index (Ki-67).

This information is essential for treatment planning.

How to read your pathology report

A pathology report can look intimidating, but each line has a clear purpose, and we go through it with you together. The histological type tells us what kind of cells are involved and whether a process is in situ (confined) or invasive. The grade describes how different the cells look from normal tissue, which gives a sense of how the lesion is likely to behave. The receptor results — ER, PR, and HER2 — and the Ki-67 index reveal the biology of the tumor and are the very factors that determine which adjuvant therapies may be beneficial.

You do not need to memorize these terms or interpret them alone. The role of your surgeon is to translate the report into plain language, explain what it means for you specifically, and outline the options clearly so that the next steps feel understandable rather than overwhelming.

After the biopsy

The patient can return to daily activities immediately, avoiding strenuous exercise for 24 hours.

The result is usually available within a few days. Communication of the findings takes place during a scheduled medical appointment, with a thorough review of the results and discussion of the next steps.

Important message

A biopsy is a diagnostic tool — not a therapeutic procedure.

In the majority of cases, the result is benign. Even when malignancy is confirmed, the biopsy represents the first step toward targeted and effective treatment.

Knowledge of the histological type enables precise, personalized treatment planning.

For reliable, independent information on breast biopsy and diagnosis, you may consult the National Cancer Institute’s breast cancer resources.