Breast Biopsy Procedures

If a lump is discovered, then the next probable course will be to get a biopsy done to determine what it is. In most cases, lumps are benign (a cyst for example). If you need a biopsy, here is what you need to know.

Differences in Breast Biopsies

There are different biopsies that can be done to determine what the lump is, and if it is cancerous, whether or not the cancer has spread. I had two: a breast core biopsy (which determined that I, in fact, had breast cancer), and a sentinel lymph node biopsy (which determined that no cancer was found in my lymph nodes).

Breast Core Biopsy or a Core Needle Biopsy

This biopsy is done by a radiologist under local anesthesia with the guidance of an ultrasound. This differs from a simple needle biopsy as the needle is larger, and is hollow to allow for more tissue to be removed at one time. Since more tissue is removed the results are more accurate.

The ultrasound is used to help identify what the lump is and where it is located in the breast. When I had my mammogram, my radiologist didn’t like the look of one of my lumps so he strongly advised an immediate biopsy (he literally said to me, “I don’t like the look of this one”). So, I had an immediate core needle biopsy right there. I had three lumps in my breast, one of the lumps was the one I was concerned about, and two very small ones that I didn’t even know were there. The two small ones turned out to be benign cysts.

Breast Core Needle Biopsy Procedure 

First thing, the area of concern is identified on the ultrasound. Second, the area where the radiologist will remove the tissue will be numbed with local anesthesia – expect this to hurt a little. You won’t feel the actual needle removing the tissue but you will feel these smaller needles and they do pinch. The tissue samples will then be removed with a thicker needle that can accommodate larger tissue samples.

During the procedure you will hear a series of clicks – that is the needle removing the tissue at the site. After this procedure, you will be a little sore around that area. I had some bruising, and some bleeding at the cut sites (they tested more than one lump) but they healed up quickly.

Sentinel Lymph Node Biopsy

The sentinel lymph node biopsy is done a little different, and it will be under general anesthesia, meaning you will be put under. A radioactive substance and a blue dye will be injected near the actual cancerous tumor site, and where ever it first travels to is where the sentinel lymph node is.

What is a Sentinel Lymph Node?

A sentinel lymph node is the first single lymph node, or grouping of lymph nodes, that could indicate that a cancer has spread as this is where the cancer first travels to if it has traveled at all. A lymph node’s job is to assist the body in the removal and filtration of toxins, bacteria, and cancer cells.

After the sentinel lymph node biopsy, you will be either node-negative or node-positive. Node-negative means that there was no cancer present in the first lymph nodes that the dyes have traveled to.

Sentinel Lymph Node Biopsy. Image courtesy Cancer.gov.

Sentinel Lymph Node Biopsy. Image courtesy Cancer.gov.

The Sentinel Lymph Node Biopsy Procedure

You will be asleep during this procedure. In my case, I had one doctor inject the radioactive substance and the dye into me, and another surgeon doing the actual following of the path and removal of the lymph nodes. Both substances injected in you will help to identify the lymphatic path – the radiocolloid makes the path accurate and the blue dye helps to easily see it. The radiocolloids used in this procedure will stay in the sentinel lymph node, and any remaining radioactive substance lingering in your body will soon dissipate so you shouldn’t worry about yourself glowing at nighttime.

Once the single lymph node (could be a cluster of lymph nodes depending on your body’s path) is identified – the radiocolloid and blue dye will follow the same path to the first lymph node – then that lymph node is removed for further testing. If there is no cancer present, it is referred to as node-negative, and it means that no cancer was found in the first lymph node and has not spread to other lymph nodes. If there is cancer present in the sentinel lymph node, it is referred to as node-positive, and it means there is a chance the cancer has spread to other parts of the body via the lymphatic system.

Benefits and Side Effects of Removing Lymph Nodes During Sentinel Lymph Node Biopsy

The major benefit of this biopsy is to identify if the cancer has spread. When the lymph nodes are identified with the radioactive dye, they are removed. If it is just the one, then only one lymph node is removed. If multiple lymph nodes look suspicious or are colored, then they will be removed at this time.

Side effects of this procedure will be swelling at the site, bruising, and soreness. You will have a definite scar from the surgery right under the arm at the breast. If many lymph nodes are removed you may end up with lymphedema, which is the build up of lymph fluids.

For more information on my breast cancer path and how it may help you if you are going through it, visit