What to Expect From Your Breast Biopsy

Breast cancer screening with routine mammograms is essential for the early detection of cancer. If your mammogram or other imaging shows any abnormality, a biopsy will be recommended.

What is a Breast Biopsy?

A biopsy is a procedure that removes a piece of tissue or fluid (sample) from any suspicious area identified during screening. The sample will be examined in a lab to look for cancer cells.

A breast biopsy can be done in several ways. The type of biopsy you will have depends on several factors, including how big the abnormality in your breast is, where it is located, if there is more than one suspicious area, your overall health, and your personal preferences. Types of breast biopsies include:

Fine needle aspiration: This uses a thin, hollow needle to take a small amount of tissue or fluid from your breast.
Core needle biopsy: A larger hollow needle is used to remove a larger sample of tissue or
Incisional or excisional biopsy: A surgery that removes part of the tumor (incisional) or all the tumor (excisional).
Lymph node biopsy: This removes tissue from the lymph nodes under the arm to check for cancer spread.

Understanding the Results of Your Breast Biopsy

After an examination, a pathologist will prepare a detailed report that describes the important characteristics of the sample, such as the size, weight, color of the tissue, how the cells look under a microscope, any tests for proteins and cell growth rate, and a diagnosis or summary of the findings.

Understanding Benign Breast Biopsy Results

The majority of breast biopsies do not find cancer. Your results may describe a non-cancerous change in the breast. You may see the following terms to describe non-cancerous changes to the breast:

Adenosis
Sclerosing adenosis (SA)
Apocrine metaplasia
Cysts
Columnar cell change (CCC)
Columnar cell hyperplasia (CCH)
Collagenous spherulosis (CS)
Duct ectasia
Columnar alteration with prominent apical snouts and secretions (CAPSS)
Papillomatosis
Fibrocystic breast changes

Many benign breast conditions do not need to be treated unless they are causing symptoms, and most do not affect your future breast cancer risk. Talk to your healthcare provider about any concerns you may have about benign breast biopsy results.

Understanding Cancerous Breast Biopsy Results

If cancer cells were found in your breast biopsy sample, your pathology report will provide additional information about the cancer’s characteristics. This will help you and your cancer care team decide what treatment plan is best for you. Here is some of the information you may see in your pathology report and how to interpret it:

Invasive or Noninvasive

Noninvasive breast cancers are located in the milk duct where they started. This is also referred to as ductal carcinoma in situ (DCIS). DCIS is considered a precancer or stage 0 breast cancer. Invasive breast cancer has spread to nearby tissue or beyond the breast and includes cancers from stages I to IV.

Grade of the Cancer

The grade of the cancer describes the size, shape, and growth rate of the tumor. This is different from the stage of the cancer.

Grade 1 cancer cells look slightly different from normal cells and usually grow
Grade 2 cancer cells look noticeably different from normal cells and grow at a faster
Grade 3 cancer cells look very different from normal cells and are growing at a faster

Hormone Receptors

The cancer cells in your breast biopsy sample will be checked for estrogen and progesterone hormone receptors. If your cancer tests positive for either of these hormone receptors, the cancer is using hormones to grow, and hormone therapy may be an appropriate treatment.

On your pathology report, you may see the following information describing your hormone receptors:

A percentage describing how many cells test positive for
An Allred score, which combines the percentage of cells with receptors and how well the receptors show This score is shown with a number from 0 to 8, with a higher number describing more receptors that are easily seen.
The word positive, meaning receptors are present, or negative, which means receptors are not

HER2

HER2 is a protein that controls breast cell growth. It is normal to have some HER2 protein, but some cancers produce too many, causing breast cancer cells to grow and divide in an uncontrolled way.

You may see a HER2 designation of “equivocal” on your pathology report. This means the HER2 status is unclear, and a second test may be recommended to determine the HER2 status of your cancer. If your cancer expresses HER2 on one test but not the other, it may be classified as HER2-low.

Stage of the Cancer

Breast cancer is staged based on the size of the tumor, the spread of the cancer, and additional characteristics of the tumor like grade, hormone receptor status, and HER2 status. The staging system looks at information in three categories, labeled T, N, and M:

The size of the tumor and whether it is invasive (T).
Whether the cancer is in the lymph nodes (N).
Whether the cancer has spread to other parts of the body (M).

These categories are used to determine the numerical stage of your breast cancer. Learn more about breast cancer staging here: www.southerncancercenter.com/breast-cancer

Type of Breast Cancer

In addition to the information above, your biopsy may have found cancer cells for one of these types of breast cancer:

Inflammatory breast cancer: This is a rare breast cancer that has symptoms of swelling or reddening skin and usually does not present with a lump.
Paget’s disease: This is a rare type of cancer located in the nipple and the
Phyllodes tumors: These tumors start in the connective tissue of the Most of these tumors are benign, but they can be malignant.

Learn More About Breast Cancer Screening and Treatment

If you have any questions about breast cancer screening, your mammogram report, or your biopsy results, please consult your physician. They can help address any concerns you may have.

If you have a family history of breast cancer, call 251-625-6896 to schedule a consultation with one of our providers specializing in genetic risk evaluation, or learn more about Southern Cancer Center’s High Risk Breast Cancer program here: www.southerncancercenter.com/high-risk-breast-cancer