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

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 As the fluid is withdrawn from the area, if it’s a cyst, it will collapse.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

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

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

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

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.

Copyright 2017 U.S. News & World Report