What are the types of biopsy for breast cancer?

The American Cancer Society reports that “finding breast cancer early and getting state-of-the-art cancer treatment are the most important strategies to prevent deaths from breast cancer.” In an effort to achieve this, many women are advised to get regular screening mammograms and told to pay attention to any changes in the shape, appearance or feel of the breasts.

If a mammogram turns up a potential issue or the patient notices a change in the breast, that typically leads to additional screening and testing such as magnetic resonance or ultrasound imaging to get a better look at the suspicious lump or area. It may also lead to a biopsy of the breast.

During a breast biopsy, a sample of tissue is removed from the body and sent to the pathology lab for further testing. It’s a commonly-used diagnostic tool that can help your doctor determine whether you have cancer. But a breast biopsy isn’t a single thing for all patients.

RELATED: 10 celebrities get real about breast cancer

10 celebrities get real about breast cancer
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10 celebrities get real about breast cancer

Julia Louis-Dreyfus

The 56-year-old was most recently diagnosed with breast cancer soon after the 2017 Emmy Awards. She confirmed the diagnosis on Instagram, quickly calling attention to the plight of other women who don't have health care. 

"1 in 8 women get breast cancer. Today, I'm the one. The good news is that I have the most glorious group of supportive and caring family and friends, and fantastic insurance through my union. The bad news is that not all women are so lucky, so let's fight all cancers and make universal health care a reality," she wrote in the post

Angelina Jolie 

In 2013, at age 37, the actress wrote a New York Times piece about her experiences with breast cancer and the BRCA1 gene. She had an 87% risk of breast cancer, 50% risk of ovarian cancer, so she took preventative action, including a double mastectomy and the later removal of her ovaries and fallopian tubes.

"Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex," she wrote.

Continuing in the New York Times, But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.


Cynthia Nixon

At 40, the acclaimed actress was diagnosed with breast cancer after a routine mammogram in 2006. She decided to keep it private for a year after her diagnosis. 

At age 12, Nixon watched her mother battle breast cancer and knew the importance of preventative care. 

"I’ve learned that if you catch breast cancer early, the chances are overwhelmingly good that you’ll be cured. So my attitude, which very much mirrored my mother’s, was this wasn’t a big deal," the star said, according to Marie Claire

Giuliana Rancic 

In 2011, after the diagnosis of an early-stage tumor, the host underwent a double mastectomy and reconstructive surgery.

She said to Glamour: "....My doctor said, "We have great news in one breast and bad news in the other. You need to start thinking about a mastectomy." That had been the furthest thing from my mind. I knew nothing about breast cancer before this happened to me, and I thought mastectomy meant stage three or four cancer. I didn't have a big family history of it. I just never thought it would happen to me. I really didn't."

Shannen Doherty

The former "Beverly Hills, 90210" star was diagnosed in 2015 and regularly documented her battle on social media. After going through chemotherapy, she announced she's in remission in April 2017. 

"Moments. They happen. Today was and is a moment. What does remission mean? I heard that word and have no idea how to react. Good news? YES. Overwhelming. YES. Now more waiting. As every single one of my fellow cancer family knows, the next five years is crucial. Reoccurrences happen all the time," she shared on social media

Sheryl Crow

In 2006, the singer publicly announced she was battling the disease after she underwent "minimally invasive surgery." 

"I am inspired by the brave women who have faced this battle before me and grateful for the support of family and friends," she said according to ABC News

Olivia Newton-John

In 2017, the 68-year-old singer and actress revealed she was once again battling breast cancer. After her first diagnosis in 1992, she underwent a partial mastectomy as well as chemo. 

"I am really grateful for and touched by the worldwide outpouring of love and concern. Thank you. I am feeling good and enjoying total support from my family and friends, along with a team of wellness and medical practitioners both here in the US and at my Olivia Newton-John Cancer Wellness and Research Centre in Melbourne, Australia. I’m totally confident that my new journey will have a positive success story to inspire others!” she said exclusively to People in June

Melissa Etheridge

Because of the singer's family history, Etheridge was "vigilant" about examinations before eventually being diagnosed in 2004. 

"I am the healthiest I have ever been in my life. It excites me every day when I can wake up and feel energy and feel good and feel purpose. The changes I made were big and not easy. Sugar is a drug, incredibly addictive. That one change can make a huge difference in your life," she said to ABC News in 2015

Christina Applegate

At 36 years old, the actress was diagnosed with breast cancer in 2008. After biopsies and a lumpectomy, as well as radiation, she tested positive for the BRCA gene.

Later, she underwent a double mastectomy. "It came on really fast. It was one of those things that I woke up and it felt so right," she says. "It just seemed like, 'I don't want to have to deal with this again. I don't want to keep putting that stuff in my body. I just want to be done with this.' & I was just going to let them go," she said according to CNN.

Rita Wilson

In 2015, it became known that the actress was battling breast cancer and underwent both a double mastectomy and reconstructive surgery. 

Since then, she's been outspoken about encouraging others to be vigilant about routine checks.

"Last week, with my husband by my side, and with the love and support of family and friends, I underwent a bilateral mastectomy and reconstruction for breast cancer after a diagnosis of invasive lobular carcinoma. I am recovering and most importantly, expected to make a full recovery. Why? Because I caught this early, have excellent doctors and because I got a second opinion," she said according to People


Depending on the location and characteristics of the lump or suspicious area that has precipitated the need for a biopsy, your doctor may conduct one of a few different types of biopsies including a fine needle aspiration, a core needle biopsy, a vacuum-assisted breast biopsy or a surgical biopsy.

Your doctor may also use imaging technology such as ultrasound, mammogram or MRI during the biopsy to get a better look at where the lump or lesion is so that the appropriate tissue will be sampled.

[See: 7 Innovations in Cancer Therapy.]

Fine Needle Aspiration

Fine needle aspiration is conducted on easily accessible lumps or suspected fluid-filled cystic lumps. As the fluid is withdrawn from the area, if it’s a cyst, it will collapse. The fluid that’s been removed is then sent to the lab to be tested for the presence of cancer cells. Breastcancer.org reports that this is the least invasive type of biopsy and usually leaves no scar.

Dr. Jeffrey Hawley, assistant professor of radiology at the Ohio State University Wexner Medical Center, says these types of biopsies are less commonly used, at least at Ohio State. “Basically, you’re just suctioning out a few cells” from the suspected tumor or lesion and putting those cells on slides for the pathologist to look at under a microscope. “There’s some disadvantages to that.

RELATED: Warning signs and risk factors of breast cancer

Warning signs and risk factors of breast cancer
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Warning signs and risk factors of breast cancer

Risk factors of breast cancer: obesity

(Photo via Getty Images)

Risk factors of breast cancer: lack of exercise

(Photo by Martin Barraud, Getty Images)

Risk factors of breast cancer: alcohol use

(Photo via Ron Chapple Stock, Getty Images)

Risk factors of breast cancer: an unhealthy diet

(Photo by Dean Belcher, Getty Images)

Risk factors of breast cancer: smoking

(Photo via Getty Images)

Common signs of breast cancer: a breast mass that is hard and/or irregular 

(Photo via Getty Images)

Common signs of breast cancer: changes in the skin of the breast such as puckering, irritation, scaling, dimpling, redness or thickening

(Photo via Getty Images)

Common signs of breast cancer: swelling of all or part of the breast, even with no specific lump

(Photo via Getty Images)

Common signs of breast cancer: enlargement or swelling of the lymph nodes in the armpit area

(Photo via Getty Images)

Common signs of breast cancer: nipple discharge, that is not breast milk

(Photo via Ron Chapple Stock, Getty Images)

Common signs of breast cancer: nipple retraction, which looks like a turning inward of the nipple

(Photo via Getty Images)


For example, if it does turn out to be positive for cancer, the pathologist is not going to be able to run the biomarkers off that sample,” meaning that there’s not enough tissue present to determine whether the cancer uses estrogen or progesterone to feed its growth, a critical piece of information that will help guide your treatment options.

Because this is challenging to do with such a small sample size, the patient may have to go back and have another biopsy. Therefore, Hawley says “we typically do a core needle biopsy up front.”

Core Needle Biopsy

A core needle biopsy is used to extract cells from the center of a lump or suspicious area in the breast. Hawley says these procedures use “larger needles, typically a 14- or 18-gauge needle.” The doctor puts the needle “into the mass and takes out small, little cores of the tissue.”

Breastcancer.org reports that the needle is inserted on average three to six times. “For lack of a better description, they look like little pieces of spaghetti,” Hawley says. Those tissue samples are then sent off to pathology for diagnosis. “We typically use core needle biopsy for most anything,” he says. Patients will likely receive a local anesthetic during a core needle biopsy, and there could be some scarring afterward.

A 2014 study case published in the journal Case Reports in Oncology found that among the 712 patients studied between 2009 and 2013, core needle biopsy was “far superior” to fine needle aspiration because “in many cases [fine needle aspiration] was not conclusive.”

RELATED: Celebrities who have publicly battled breast cancer

Celebrities who have publicly battled breast cancer
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Celebrities who have publicly battled breast cancer
Toronto, Canada - September, 17 2015 - Actress Cynthia Nixon (best known for Sex and the City) was in Toronto promoting her indie film JAMES WHITE. TIFF15, Toronto International Film Festival September 17, 2015 (Richard Lautens/Toronto Star via Getty Images)
Sheryl Crowe arrives at the 2014 Vanity Fair Oscar Party on March 2, 2014 in West Hollywood, California. (Photo credit ADRIAN SANCHEZ-GONZALEZ/AFP/Getty Images)
LOS ANGELES, CA - AUGUST 01: Christina Applegate arrives at Dizzy Feet Foundation's 5th Annual Celebration Of Dance Gala held at Club Nokia on August 1, 2015 in Los Angeles, California. (Photo by Michael Tran/FilmMagic)
Actress Maura Tierney of Showtime's 'The Affair' poses in the Getty Images Portrait Studio powered by Samsung Galaxy at the 2015 Summer TCA's at The Beverly Hilton Hotel on August 10, 2015 in Beverly Hills, California. (Photo by Maarten de Boer/Getty Images)
US actress and UNHCR ambassador Angelina Jolie stands during a visit to a camp for displaced Iraqis in Khanke, a few kilometres (miles) from the Turkish border in Iraq's Dohuk province, on January 25, 2015. Run by authorities from the three-province autonomous Kurdish region of north Iraq with the help of the United Nations refugee agency, the UNHCR, Khanke aims to house 18,000 people, said the agency's Liena Veide. AFP PHOTO/SAFIN HAMED (Photo credit should read SAFIN HAMED/AFP/Getty Images)
LOS ANGELES, CA - AUGUST 13 NBCUNIVERSAL EVENTS -- NBCUniversal Portrait Studio, August 2015 -- Pictured: TV personality Giuliana Rancic from 'Fashion Police' poses for a portrait at the NBCUniversal Summer Press Day during the 2015 Summer TCA Tour at The Beverly Hilton on August 12, 2015 in Beverly Hills, California. (Photo by: Christopher Polk/NBC/NBCU Photo Bank via Getty Images)
SIMI VALLEY, CA - JULY 05: Nancy Reagan attends The Grand Opening of D23 Presents Treasures of The Walt Disney Archives on July 5, 2012 in Simi Valley, California. (Photo by Michael Kovac/FilmMagic)
BEVERLY HILLS, CA - MAY 24: Reporter Linda Ellerbee speaks during the 36th Annual Gracie Awards Gala at the Beverly Hilton Hotel on May 24, 2011 in Beverly Hills, California. (Photo by Frederick M. Brown/Getty Images)

By using the core needle biopsy approach, the authors determined that they “were able to collect sufficient material for the histological examination in order to direct patients to surgery or follow-up.” Although fine needle aspiration is initially less expensive, the authors note, “the actual costs involved tend to be higher for [fine needle aspiration] as it is less accurate and a core needle biopsy is often required” subsequently.

[See: Breast Pain? Stop Worrying About Cancer.]

Vacuum-assisted Breast Biopsy

Vacuum-assisted breast biopsy is similar to core needle biopsy but removes more tissue with a single insertion of a special probe. It’s a relatively new procedure also sometimes called minimally invasive breast biopsy, and it's not as widely available as other types of biopsies, Breastcancer.org reports.

This procedure removes more tissue than a core needle biopsy, and it's typically conducted under a local anesthetic. Your doctor will insert a tiny clip (a tissue marker) into the breast to mark where the sample was removed so that it can be more easily found for follow up testing or surgery.

Because more tissue is removed during a vacuum-assisted breast biopsy than is during a core needle biopsy, the sample size of tissue is greater, which may lead to more accurate results.

RELATED: What Foods You Should Eat or Avoid to Prevent Breast Cancer

What Foods You Should Eat or Avoid to Prevent Breast Cancer
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What Foods You Should Eat or Avoid to Prevent Breast Cancer

Prevent breast cancer by adopting a healthy lifestyle. Whether they contain body-boosting antioxidants or powerful micronutrients, these 13 foods are linked to lower breast cancer risk. Plus, find out what foods you should avoid.

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According to flaxseed researcher Dr. Lilian Thompson, PhD from the Unversity of Toronto, research suggests that flaxseed may reduce the risk of breast cancer. Flaxseed contains plant omega-3 fatty acid ALA and lignans, which both inhibit tumor growth, as well as protective antioxidants.

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Oily Fish

A recent study in the British Medical Journal found that women who ate the highest levels of omega-3 fatty acids from fish had a 14 percent lower risk of breast cancer compared to women who consumed the least. Oily fish like salmon and tuna are great sources of omega-3 fatty acids.

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Cruciferous vegetables

Vegetables in the cabbage family like broccoli, cauliflower and Brussels sprouts can protect against estrogen-dependent cancers. In addition to being a good source of carotenoids and fiber, cruciferous vegetables naturally contain chemicals called glucosinolates, which are known for their anticancer effects.

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Walnuts, which have anti-inflammatory health benefits, have been linked to a reduced risk of breast cancer in animal studies.

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Dark green, leafy vegetables

Leafy greens like spinach, kale, broccoli and collard greens are significant sources of carotenoids, a micronutrient linked to reduced breast cancer risk. Researchers at Harvard Medical School found that women who consumed high levels of carotenoids had 15-20 percent lower risk of breast cancer compared to women who ate the lowest levels.

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Red, Yellow and Orange Vegetables

Other sources of carotenoids include vibrant vegetables like sweet potatoes, carrots and squash. Science suggests eating foods high in this micronutrient may reduce your risk of breast cancer.

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Green Tea

Researchers from Columbia University Medical Center found the consumption of green tea extract to inhibit two growth factors that promote tumor cell growth among women with breast cancer. The polyphenols in green tea may explain these anti-cancer properties.

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Whole Grains

Research suggests that diets high in fiber can lower your risk of breast cancer by reducing the levels of estrogen in blood. Whole grains are an excellent source of fiber, as well as beans, brown rice and oatmeal.

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Varieties of seaweed like nori, kombu and wakame are high in cancer-fighting carotenoids. Sprinkle shreds of seaweed on top of salads and soups.

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Extra Virgin Olive Oil

Studies suggest that the natural antioxidants in good-quality extra virgin olive oil may help fight breast cancer by suppressing the expression of cancer genes. The oil is pressed without heat or chemical treatments, thereby preserving valuable phytonutrients.

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University of Missouri researchers found that a compound called apigenin, commonly found in parsley and other plants, stopped or slowed down tumor formation in rats with a certain type of breast cancer. Try mincing parsley on top of your dishes for a healthy boost.

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Folic Acid-Rich Foods

One study found that folate, a vitamin found in dark green leafy vegetables and citrus fruits, can mitigate the adverse effects of alcohol consumption on breast cancer risk, according to the American Cancer Society. Another good way to get folic acid is by taking a daily multivitamin.

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Peanut Butter

A study published in Breast Cancer Research and Treatment last month found a link between regular peanut butter consumption in childhood and a decreased risk of developing benign breast disease, which is a known risk factor for breast cancer. While it's too early to suggest that peanut butter lowers breast cancer risk, it doesn't hurt to swap junk food with all-natural peanut butter-topped veggies and nuts at the kids' snack time.

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Avoid these foods that are linked to an increased risk of breast cancer.

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You'd be surprised to find that even a little alcohol consumption can be unhealthy. According to the American Cancer Society, even a few alcoholic drinks a week may increase the risk of breast cancer in women.

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High-fat Dairy Food

U.S. News reports that even as little as one serving of high-fat dairy foods per day can increase the risk of breast cancer by nearly 50 percent, according to a study published in the Journal of the National Cancer Institute. Foods like whole milk and cream are considered high-fat dairy products.

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Red Meat

Researchers from the University of Leeds found that women who consumed red meat every day had a 56 percent greater risk of breast cancer than women who ate no red meat, stressing the importance of eating this protein in moderation.

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Processed Meat

Processed meats, like bacon, sausage and ham, are also on the chopping block. The same study revealed women who consumed these foods often had a 64 percent greater risk of breast cancer than those who ate none.

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While sugar consumption has not been directly linked to breast cancer risk, eating unhealthily can promote obesity, which is associated with higher breast cancer risk. Limit your intake of cakes, cookies, sweetened cereals, sugary beverages and other sweets.

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However, some patients may experience bleeding after the procedure and exercise is not indicated for about 24 hours after the procedure. Any bruising or pain that results is usually controllable with over-the-counter painkillers.

Surgical Biopsies

Lastly, surgical biopsies, also called excisional biopsies, are more involved procedures that are less commonly used these days, Hawley says. They involve cutting out all or part of a lump and usually require local anesthesia. Once the lump or a section of the lump has been removed or excised, the incision will be sewn up and the tissue sent to the lab for testing. These biopsies nearly always leave a scar, which can be problematic for some patients.

“When you’re having surgical biopsy, there’s a lot of disadvantages to that,” Hawley says. Although it was considered the gold standard for a long time, newer equipment and techniques have made it a less desirable option these days, in part because it’s surgery that requires anesthesia, operating room time and sometimes a short stay in the hospital. The other biopsy approaches “are outpatient procedures. You come in and you’re gone within an hour or two. So it’s a lot easier and more convenient to do it this way.”

In addition, after a surgical biopsy, a positive result typically requires additional surgery to “evaluate the regional lymph nodes,” to determine whether the cancer has spread to them, Hawley says. Use of non-surgical biopsy approaches may allow your doctor to combine these surgical steps (biopsy, lumpectomy and lymph node surgery) potentially reducing the number of surgeries you’ll have. As such, the use of surgical biopsies has dropped in recent years, but Hawley says they may be more common in outlying or smaller hospitals that don’t have access to newer equipment or techniques.

RELATED: Go Pink -- 13 Treats for Breast Cancer Awareness Month

Go Pink: 13 Treats for Breast Cancer Awareness Month
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Go Pink: 13 Treats for Breast Cancer Awareness Month

Read on to discover pink-colored and pink ribbon sweets that are perfect for raising awareness during breast cancer month and throughout the year.

Toasted Coconut Rice Krispie Treat

These tasty and pink twist on the popular treats are made without butter.

Image Credit: Pinterest via Crazy for Crust

Plum Semifreddo

This plum-filled dessert is perfectly pink to support breast cancer awareness.

Image Credit: Pinterest via Bon Appetit

Tea Cookies

These pink sweets can be served in tea cups, which makes them the perfect dessert for a Pink Party.

Image Credit: Pinterest via The Cake Blog

Pink Ribbon Oreos

These homemade sandwich cookies feature the breast cancer ribbon.

Image Credit: Pinterest via Sweet Treats & More

Pink Ribbon Cupcake Pops

These pink cake pops are perfect to raise breast cancer awareness with or without the breast cancer ribbon sprinkles.

Image Credit: Pinterest via Love from the Oven

Chocolate Pink Ribbon Swiss Roll Cake

This Swiss roll cake is delicious and can be made with hearts as well.

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Pink Ribbon Cookies

These sugar cookies can be made in the shape of the breast cancer ribbon to support awareness.

Image Credit: Pinterest via Dawn's Recipes

Pink Trash Popcorn

This sweet popcorn is a good source of whole grains, which is recommended as a part of a healthy diet to decrease the risk of breast cancer.

Image Credit: Pinterest via Something Swanky

Pink Cinnamon Buns

These Pink Cinnamon Buns are made with Portuguese sweet bread.

Image Credit: Pinterest via Joe and Sue

Cute Little Cakesicles

This dessert places cake on a popsicle stick for a fun twist. Make the cakesicles with pink sprinkles to support the cause.

Image Credit: Pinterest via Love from the Oven

Frosted Pink Lemonade Cookies

These pink cookies would fit right in at a bake sale to raise money for breast cancer research.

Image Credit: Pinterest via Eat Pray Read Love

Pink Ribbon Pink Velvet Cupcake

These cupcakes are a delicious take on red velvet to support breast cancer awareness with their pink coloring and breast cancer ribbon topping.

Image Credit: Pinterest via Love from the Oven


Image-Guided Biopsies

Hawley says most biopsies are conducted with the assistance of imaging technology such as ultrasound, mammography or MRI. The determination of which patient gets which type of imagery is made on an individual basis.

“The most common type we do is the ultrasound-guided biopsy. It’s probably the easiest on the patient, so typically we’ll do that for most of our biopsies,” Hawley says. In this approach, the doctor uses an ultrasound machine to create an image of the suspicious area and uses that to help guide where to extract tissue.

[See: The 10 Best Diets for Healthy Eating.]

In some patients, the use of mammogram (and sometimes tomosynthesis, or 3-D mammography) can help guide the doctor’s needle or scalpel. This process, also called a stereostatic biopsy, is often used when the mass is not palpable, meaning it’s difficult to feel during a physical exam. During this procedure, the doctor takes “pictures of the breast from different angles to triangulate and calculate where the lesion is. It allows us to figure out where it is in space.” This approach is often used with calcifications, small deposits of calcium in the breast that are typically benign but need to be checked, as “they don’t typically show up as well on ultrasound,” Hawley says. “We’ll also do stereostatic biopsy if we have a suspicious finding on a mammogram that we can’t identify on ultrasound,” such as an area of tissue distortion or asymmetry.

Lastly, MRI may be used to help guide the biopsy in some rarer cases. This procedure is “a little more involved because you’re having an IV [an intravenous line into a vein for the contrast dye that helps create the image] and getting an MRI,” which involves lying inside a noisy, magnetized tube. MRIs can be distressing to people with claustrophobia, and it’s an expensive procedure. However, MRI is a very sensitive tool that can pick up small lesions that would be missed on ultrasound or mammogram. Therefore, “we usually reserve it for high-risk populations,” Hawley says.

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