When a breast lump is detected during examination, a breast surgeon will perform a triple assessment. First is a thorough clinical breast examination, including palpation to assess the lump, checking for nipple discharge, and inspecting the skin for abnormalities. After an ultrasound or mammography, if imaging reveals a breast lump classified as BI-RADS 4A or above, a biopsy is generally recommended. The doctor will use a needle to collect a tissue sample from the lump. This sample will be analyzed by a pathologist to determine if the lump is benign or malignant. Needle biopsy of the breast is very convenient and safe; there is no evidence that undergoing a needle biopsy will cause the malignant tumor to spread or turn a benign tumor into a malignant one.
Breast needle biopsies are generally divided into cytology and tissue examination, commonly referred to as fine needle and core needle, respectively. Fine needle aspiration (FNA) uses a thin needle, similar to those used for drawing blood, to extract only fluids and cells for analysis. It can indicate if the cell is likely benign or malignant, but cytology cannot lead to 100% conclusive results. Core needle biopsy uses a special trucut needle to extract a strip of tissue, allowing direct observation of tissue structure under a microscope to determine if the tissue is benign, or if malignant, whether it is breast cancer. Nowadays, cytology via fine needle is rarely performed; most breast biopsies are done by core needle, as it extracts more tissue, gives more accurate results, and helps doctors distinguish tissue types and whether there is invasiveness, which aids in formulating treatment plans.
The procedure is simple and usually performed in a clinic. The doctor will use an ultrasound to locate the lump, then inject local anesthetic at the biopsy site. Through a single incision, the doctor uses the core needle to take several samples under ultrasound guidance. The process takes about 5 minutes. After the needle is removed, the small puncture hole is compressed for 5 – 10 minutes to stop bleeding, then covered with a waterproof bandage that can be removed after bathing. The anesthetic generally wears off in about 30 minutes. The doctor may prescribe painkillers as needed. After the biopsy, it’s advised to rest for one day, normal activity can usually be resumed the following day, and the wound heals within 2 – 3 days.
In recent years, other sampling methods have emerged, such as Vacuum-Assisted Biopsy (VAB). Guided by X-ray or ultrasound, the biopsy needle is directed to the lesion, and vacuum suction helps draw the tissue into the needle. This method collects more breast tissue in one attempt than regular needle biopsy and is useful for sampling X-ray detected lesions, such as microcalcifications. For small benign tumors, VAB can even completely remove the lump. However, not everyone is suited for VAB; its use depends on the type and specific situation, so whether it is suitable should be discussed with the attending doctor.
Updated: 2025-08
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