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Breast biopsy

Bonnie N Joe, MD, PhD
Laura J Esserman, MD, MBA
Section Editor
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editor
Wenliang Chen, MD, PhD


In the patient with a palpable breast mass or suspicious mammographic abnormality, the obligatory diagnostic technique is percutaneous biopsy. Surgical biopsy should not be used as a diagnostic tool unless percutaneous palpation-guided or image-guided biopsy is not feasible [1].

The types and choice of method for breast biopsy and postoperative care and follow-up, including reviewing biopsy results and the potential need for rebiopsy, are reviewed here. The clinical features and diagnosis of a breast mass and screening for breast cancer that might indicate the need for breast biopsy are reviewed elsewhere. (See "Clinical manifestations and diagnosis of a palpable breast mass" and "Screening for breast cancer: Strategies and recommendations".)

The treatment of specific breast diagnoses identified through breast biopsy (eg, invasive ductal carcinoma, ductal carcinoma in situ) is discussed in specific topic reviews. (See "Overview of the treatment of newly diagnosed, non-metastatic breast cancer".)


Properly preparing patients for breast biopsy and the potential results can do much to alleviate anxiety. The Breast Imaging Reporting and Data System (BI-RADS) categories 4A, 4B, and 4C identify lesions as having low, moderate, and high likelihood of being associated with a malignancy (table 1). (See "Breast imaging for cancer screening: Mammography and ultrasonography", section on 'The BI-RADS categories'.)

Some facilities premedicate the patient with lorazepam or other short-acting anxiolytics medications. Patients receiving more than just local anesthesia need to make arrangements for transportation and be accompanied home.


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Literature review current through: Sep 2016. | This topic last updated: Oct 3, 2016.
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  1. Gutwein LG, Ang DN, Liu H, et al. Utilization of minimally invasive breast biopsy for the evaluation of suspicious breast lesions. Am J Surg 2011; 202:127.
  2. Melotti MK, Berg WA. Core needle breast biopsy in patients undergoing anticoagulation therapy: preliminary results. AJR Am J Roentgenol 2000; 174:245.
  3. Somerville P, Seifert PJ, Destounis SV, et al. Anticoagulation and bleeding risk after core needle biopsy. AJR Am J Roentgenol 2008; 191:1194.
  4. Harris L, Fritsche H, Mennel R, et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 2007; 25:5287.
  5. Elmore JG, Longton GM, Carney PA, et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA 2015; 313:1122.
  6. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  7. Mannello F, Tonti GA, Papa S. Human gross cyst breast disease and cystic fluid: bio-molecular, morphological, and clinical studies. Breast Cancer Res Treat 2006; 97:115.
  8. Louie L, Velez N, Earnest D, Staren ED. Management of nonpalpable ultrasound-indeterminate breast lesions. Surgery 2003; 134:667.
  9. Gordon PB. Image-directed fine needle aspiration biopsy in nonpalpable breast lesions. Clin Lab Med 2005; 25:655.
  10. Morrow M. The evaluation of common breast problems. Am Fam Physician 2000; 61:2371.
  11. Dixon JM, McDonald C, Elton RA, Miller WR. Risk of breast cancer in women with palpable breast cysts: a prospective study. Edinburgh Breast Group. Lancet 1999; 353:1742.
  12. Parish DC, Ghilchik MW, Day JM, et al. Cytokines in human breast cyst fluid. J Steroid Biochem Mol Biol 2007; 104:241.
  13. Tsung JS, Wang TY, Wang SM, Yang PS. Cytological and biochemical studies of breast cyst fluid. Breast 2005; 14:37.
  14. Pisano ED, Fajardo LL, Caudry DJ, et al. Fine-needle aspiration biopsy of nonpalpable breast lesions in a multicenter clinical trial: results from the radiologic diagnostic oncology group V. Radiology 2001; 219:785.
  15. Scott S, Morrow M. Breast cancer. Making the diagnosis. Surg Clin North Am 1999; 79:991.
  16. Shah VI, Raju U, Chitale D, et al. False-negative core needle biopsies of the breast: an analysis of clinical, radiologic, and pathologic findings in 27 concecutive cases of missed breast cancer. Cancer 2003; 97:1824.
  17. Hoorntje LE, Peeters PH, Mali WP, Borel Rinkes IH. Vacuum-assisted breast biopsy: a critical review. Eur J Cancer 2003; 39:1676.
  18. Kettritz U, Rotter K, Schreer I, et al. Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer 2004; 100:245.
  19. Burbank F. Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy. Radiology 1997; 202:843.
  20. Berg WA, Krebs TL, Campassi C, et al. Evaluation of 14- and 11-gauge directional, vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model. Radiology 1997; 205:203.
  21. Jackman RJ, Marzoni FA Jr, Rosenberg J. False-negative diagnoses at stereotactic vacuum-assisted needle breast biopsy: long-term follow-up of 1,280 lesions and review of the literature. AJR Am J Roentgenol 2009; 192:341.
  22. Liberman L, Kaplan JB, Morris EA, et al. To excise or to sample the mammographic target: what is the goal of stereotactic 11-gauge vacuum-assisted breast biopsy? AJR Am J Roentgenol 2002; 179:679.
  23. Pfarl G, Helbich TH, Riedl CC, et al. Stereotactic 11-gauge vacuum-assisted breast biopsy: a validation study. AJR Am J Roentgenol 2002; 179:1503.
  24. Liberman L, Ernberg LA, Heerdt A, et al. Palpable breast masses: is there a role for percutaneous imaging-guided core biopsy? AJR Am J Roentgenol 2000; 175:779.
  25. LaTrenta LR, Menell JH, Morris EA, et al. Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology 2003; 227:856.
  26. Shin JH, Han BK, Choe YH, et al. Targeted ultrasound for MR-detected lesions in breast cancer patients. Korean J Radiol 2007; 8:475.
  27. Linda A, Zuiani C, Londero V, Bazzocchi M. Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: distribution according to patient history of breast cancer and lesion size. Breast 2008; 17:51.
  28. Abe H, Schmidt RA, Shah RN, et al. MR-directed ("Second-Look") ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. AJR Am J Roentgenol 2010; 194:370.
  29. Hollowell L, Price E, Arasu V, et al. Lesion morphology on breast MRI affects targeted ultrasound correlation rate. Eur Radiol 2015; 25:1279.
  30. Price ER. Magnetic resonance imaging-guided biopsy of the breast: fundamentals and finer points. Magn Reson Imaging Clin N Am 2013; 21:571.
  31. Han BK, Schnall MD, Orel SG, Rosen M. Outcome of MRI-guided breast biopsy. AJR Am J Roentgenol 2008; 191:1798.
  32. Heywang-Köbrunner SH, Sinnatamby R, Lebeau A, et al. Interdisciplinary consensus on the uses and technique of MR-guided vacuum-assisted breast biopsy (VAB): results of a European consensus meeting. Eur J Radiol 2009; 72:289.
  33. Daniel BL, Freeman LJ, Pyzoha JM, et al. An MRI-compatible semiautomated vacuum-assisted breast biopsy system: initial feasibility study. J Magn Reson Imaging 2005; 21:637.
  34. Lehman CD, Deperi ER, Peacock S, et al. Clinical experience with MRI-guided vacuum-assisted breast biopsy. AJR Am J Roentgenol 2005; 184:1782.
  35. Liberman L, Bracero N, Morris E, et al. MRI-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience. AJR Am J Roentgenol 2005; 185:183.
  36. Perlet C, Heywang-Kobrunner SH, Heinig A, et al. Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Cancer 2006; 106:982.
  37. Lee JM, Kaplan JB, Murray MP, et al. Imaging histologic discordance at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol 2007; 189:852.
  38. Wallace AM, Daniel BL, Jeffrey SS, et al. Rates of reexcision for breast cancer after magnetic resonance imaging-guided bracket wire localization. J Am Coll Surg 2005; 200:527.
  39. Morris EA, Liberman L, Dershaw DD, et al. Preoperative MR imaging-guided needle localization of breast lesions. AJR Am J Roentgenol 2002; 178:1211.
  40. Esserman LE, Cura MA, DaCosta D. Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy. Radiographics 2004; 24:147.
  41. Guenin MA. Clip placement during sonographically guided large-core breast biopsy for mammographic-sonographic correlation. AJR Am J Roentgenol 2000; 175:1053.
  42. Levin DC, Parker L, Schwartz GF, Rao VM. Percutaneous needle vs surgical breast biopsy: previous allegations of overuse of surgery are in error. J Am Coll Radiol 2012; 9:137.
  43. Svane G, Silfverswärd C. Stereotaxic needle biopsy of non-palpable breast lesions. Cytologic and histopathologic findings. Acta Radiol Diagn (Stockh) 1983; 24:283.
  44. Phillips SW, Gabriel H, Comstock CE, Venta LA. Sonographically guided metallic clip placement after core needle biopsy of the breast. AJR Am J Roentgenol 2000; 175:1353.
  45. Margolin FR, Jacobs RP, Denny SR, Schrumpf JD. Clip placement after sonographically guided percutaneous breast biopsy. Breast J 2003; 9:226.
  46. Patterson SK, Joe A, Helvie MA. Sonographically-guided metallic marker placement at time of wire localization for intraductal or cystic lesions: a method to verify lesion retrieval. Acad Radiol 2008; 15:1316.
  47. Cox CE, Garcia-Henriquez N, Glancy MJ, et al. Pilot Study of a New Nonradioactive Surgical Guidance Technology for Locating Nonpalpable Breast Lesions. Ann Surg Oncol 2016; 23:1824.
  48. Dauphine C, Reicher JJ, Reicher MA, et al. A prospective clinical study to evaluate the safety and performance of wireless localization of nonpalpable breast lesions using radiofrequency identification technology. AJR Am J Roentgenol 2015; 204:W720.
  49. Goudreau SH, Joseph JP, Seiler SJ. Preoperative Radioactive Seed Localization for Nonpalpable Breast Lesions: Technique, Pitfalls, and Solutions. Radiographics 2015; 35:1319.
  50. Sharek D, Zuley ML, Zhang JY, et al. Radioactive seed localization versus wire localization for lumpectomies: a comparison of outcomes. AJR Am J Roentgenol 2015; 204:872.
  51. Ahmed M, Anninga B, Goyal S, et al. Magnetic sentinel node and occult lesion localization in breast cancer (MagSNOLL Trial). Br J Surg 2015; 102:646.
  52. Kopans DB, Lindfors K, McCarthy KA, Meyer JE. Spring hookwire breast lesion localizer: use with rigid-compression mammographic systems. Radiology 1985; 157:537.
  53. White RR, Halperin TJ, Olson JA Jr, et al. Impact of core-needle breast biopsy on the surgical management of mammographic abnormalities. Ann Surg 2001; 233:769.
  54. Stomper PC, Winston PS, Proulx GM, et al. Mammographic detection and staging of ductal carcinoma in situ: mammographic-pathologic correlation. Semin Breast Dis 2000; 3:1.
  55. D'Orsi CJ. Management of the breast specimen. Radiology 1995; 194:297.
  56. McCormick JT, Keleher AJ, Tikhomirov VB, et al. Analysis of the use of specimen mammography in breast conservation therapy. Am J Surg 2004; 188:433.
  57. NCCN Guidelines Breast Screening and Diagnosis, NCCN Clinical Practice Guidelines in Oncology, 2016. www.nccn.org (Accessed on March 04, 2016).
  58. Ljung BM, Drejet A, Chiampi N, et al. Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer 2001; 93:263.
  59. Verkooijen HM, Core Biopsy After Radiological Localisation (COBRA) Study Group. Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicenter prospective study with 95% surgical confirmation. Int J Cancer 2002; 99:853.
  60. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013; 310:1455.
  61. Caudle AS, Yang WT, Mittendorf EA, et al. Selective surgical localization of axillary lymph nodes containing metastases in patients with breast cancer: a prospective feasibility trial. JAMA Surg 2015; 150:137.
  62. Caudle AS, Yang WT, Krishnamurthy S, et al. Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol 2016; 34:1072.
  63. Boughey JC, Ballman KV, Le-Petross HT, et al. Identification and Resection of Clipped Node Decreases the False-negative Rate of Sentinel Lymph Node Surgery in Patients Presenting With Node-positive Breast Cancer (T0-T4, N1-N2) Who Receive Neoadjuvant Chemotherapy: Results From ACOSOG Z1071 (Alliance). Ann Surg 2016; 263:802.
  64. Houssami N, Abraham LA, Onega T, et al. Accuracy of screening mammography in women with a history of lobular carcinoma in situ or atypical hyperplasia of the breast. Breast Cancer Res Treat 2014; 145:765.
  65. Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst 2013; 105:701.
  66. Esserman LJ, Thompson IM Jr, Reid B. Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA 2013; 310:797.
  67. Esserman LJ, Thompson IM, Reid B, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol 2014; 15:e234.
  68. Elmore JG, Nelson HD, Pepe MS, et al. Variability in Pathologists' Interpretations of Individual Breast Biopsy Slides: A Population Perspective. Ann Intern Med 2016; 164:649.
  69. Masood S. Fine needle aspiration biopsy of nonpalpable breast lesions. In: Cytopathology Annual 1993, Schmidt W (Ed), Williams and Wilkins, Baltimore 1994.
  70. Masood S. Occult breast lesions and aspiration biopsy: a new challenge. Diagn Cytopathol 1993; 9:613.
  71. Hall FM, Storella JM, Silverstone DZ, Wyshak G. Nonpalpable breast lesions: recommendations for biopsy based on suspicion of carcinoma at mammography. Radiology 1988; 167:353.
  72. Löfgren M, Andersson I, Bondeson L, Lindholm K. X-ray guided fine-needle aspiration for the cytologic diagnosis of nonpalpable breast lesions. Cancer 1988; 61:1032.
  73. Chae BJ, Lee A, Song BJ, Jung SS. Predictive factors for breast cancer in patients diagnosed atypical ductal hyperplasia at core needle biopsy. World J Surg Oncol 2009; 7:77.
  74. Elsheikh TM, Silverman JF. Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature. Am J Surg Pathol 2005; 29:534.
  75. Anderson BO, Calhoun KE, Rosen EL. Evolving concepts in the management of lobular neoplasia. J Natl Compr Canc Netw 2006; 4:511.
  76. Margenthaler JA, Duke D, Monsees BS, et al. Correlation between core biopsy and excisional biopsy in breast high-risk lesions. Am J Surg 2006; 192:534.
  77. Lally BE, Haffty BG, Moran MS, et al. Management of suspicious or indeterminate calcifications and impact on local control. Cancer 2005; 103:2236.
  78. Aref A, Youssef E, Washington T, et al. The value of postlumpectomy mammogram in the management of breast cancer patients presenting with suspiciouis microcalcifications. Cancer J Sci Am 2000; 6:25.
  79. Waddell BE, Stomper PC, DeFazio JL, et al. Postexcision mammography is indicated after resection of ductal carcinoma-in-situ of the breast. Ann Surg Oncol 2000; 7:665.
  80. Bruening W, Fontanarosa J, Tipton K, et al. Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med 2010; 152:238.
  81. Winchester DP, Strom EA. Standards for diagnosis and management of ductal carcinoma in situ (DCIS) of the breast. American College of Radiology. American College of Surgeons. College of American Pathologists. Society of Surgical Oncology. CA Cancer J Clin 1998; 48:108.
  82. Meissnitzer M, Dershaw DD, Lee CH, Morris EA. Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol 2009; 193:1025.
  83. National Comprehensive Cancer Network. NCCN guidelines, version 2: Breast cancer screening and diagnosis. 2013. National Comprehensive Cancer Network. NCCN guidelines, (Accessed on September 26, 2013).
  84. Salkowski LR, Fowler AM, Burnside ES, Sisney GA. Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology 2011; 258:380.
  85. Shaylor SD, Heller SL, Melsaether AN, et al. Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy--is it worthwhile? Eur Radiol 2014; 24:1176.
  86. Manjoros DT, Collett AE, Alberty-Oller JJ, et al. The value of 6-month interval imaging after benign radiologic-pathologic concordant minimally invasive breast biopsy. Ann Surg Oncol 2013; 20:3163.
  87. Johnson JM, Johnson AK, O'Meara ES, et al. Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology 2015; 275:54.