Is an excisional breast biopsy necessary?

I think the reason that an excisional biopsy is deemed the next step here is because sometimes cancer cells or a tumor may be hiding near cells that are found to be atypical.  The core needle biopsy can only sample a small area.  An excisional biopsy is needed to remove a piece of tissue so the whole thing can be dissected in the path lab.

I just had an excisional biopsy 3 months ago.  I was urged to skip the core needle biopsy altogether by my breast surgeon and head right to the excisional.  The surgeon explained that the core needle might not get the "bad" parts of my lump, and then I'd need the excisional afterwards anyway.  Or, if my lump grew, I'd need another biopsy even if the core needle was negative.  Also, my lump was quite large, so he said the core needle wouldn't be able to sample all parts of it.  To me, this made sense, because I didn't want to end up with two procedures if I could just skip to the excisional which is the gold standard for diagnosis.

The excisional biopsy wasn't bad at all.  It wasn't a long procedure--maybe one hour total but I think the actual biopsy only took 30 minutes and the rest was prep work.  Personally, I don't think the excisional biopsy is any worse than the core needle biopsy, and in fact I would skip the core needle and head right to the excisional again so that I could avoid a second procedure, and also because you get anesthesia with the excisional, and none (except local) with the core needle.

 I don't see it as permanently altering my breast.  I have a small, one-inch scar that is barely noticeable.  No distortions of the breast, and I have a small B cup, and my lump was 2 cm. and even more tissue than that was removed.  I was actually surprised by how large a chunk they removed.  And you would not be able to tell I had anything removed if it weren't for the scar, because there is no denting or any other changes.  In fact, I will say that the excisional biopsy made things better for me because the lump that was removed was always hurting, so now that it's completely gone the pain is gone too, so I'm glad I had the excisional.  I had no complications at all from the procedure.  I went home after the surgery, took a short nap, and then was out with my husband that night for dinner, feeling completely fine. 

I opted for an excisional biopsy...the core biopsies missed the canceer..

Hi,

I had a needle biopsy and they found a lot of aytpical cells, and I'm now headed for an excisional biopsy and lymph node sampling (I think the latter is because my lump, which is palpable, is in the breast tail nearer the armpit). I think it's pretty standard to go to wide excision after finding atypical cells from what I understand.

 For you ladies who found the cancer after excisional (and only found atypical cells at the earlier biopsy), did any of you have palpable lumps? Did anyone have a lump in the breast tail?

For bluestocking, wish you all the best and that things turn out ok for you.

As the others have said, yes, an excisional biopsy is necessary.  The atypical cells that were found in your needle biopsy are not a problem and don't need to be removed, but in about 20% - 25% of cases, atypical cells are found to be mixed in with some cancer cells.  Since a needle biopsy only pulls up a few small samples, once atypical cells are found, the entire area that appears suspicious needs to be removed and all the suspicious breast tissue needs to be examined under a microscope, in order to ensure that nothing more serious than atypical cells are in there. 

I'm one who fell into the 20% - 25% group.  I had two areas of calcifications in my breast (and no palpable lump).  A stereotactic biopsy of both areas showed only ADH (atypical ductal hyperplasia).  Once I had the excisional biopsy, DCIS was found in both areas and in one of the areas, a small microinvasion of invasive cancer was also found. 

Keep in mind that because this is a breast cancer discussion board, most of the women here who've faced a situation like yours are the ones who fell into the 20% - 25% group - we were diagnosed with BC.  Most of the other women - the 75% - 80% who were found to having nothing more serious than atypical cells - don't stick around for long once they get the good news (kibbles, it's good that you are here!).  

As the others have said, having an excisional biopsy really isn't a big deal.  Yes, you will have a scar but it will fade in time.  And with the discovery of atypical cells, what's more important is being absolutely sure that you don't have breast cancer, or if you do have BC, catching it as early as possible. 

I am recovering now from an excisional biopsy on a mass that was not palpable (pretty deep in dense tissue) and was increasing in size.  I first had a core needle biopsy at the end of April, and I have to say that I experienced more pain and bruising from that than from the excisional--both were performed by the same surgeon.  Plus, I now have peace of mind, as I've received my pathology reports that the mass was benign.  Had the results revealed cancer, I would have wanted to know that as well. 

 P.S. I'm checking in on this board from time to time because I have, according to my gynecologist, the worst case of fibrocystic condition she's ever seen, and so I'm screened regularly and am finding that I'm now receiving some sort of "call back" each 6 mos.

Absolutley you need an open biopsy, needle biopsy does not always get enough tissue.  You do not want to let any potential cancer grow another six months, or wait till it develops new calcifications on mammogram.  I was diagnosed at age 45 with no family history, thank heavens my cancer was found early.  I had an open biopsy before mastectomy, the scar from the biopsy was about 3/4 of an inch along the side of my aerola, and was not bad, my small breast did not change in size form the biopsy.  The needle localization prior to biopsy is not fun, but you will survive.  Good luck, hopefully you will not have cancer.

I agree with the others that it's important to have the surgical biopsy.  My mammogram showed microcalcifications, I had a stereotactic needle biopsy and the result was "atypical" cells.  They referred me to a breast surgeon who did an excisional biopsy to be sure it was only atypical cells.  Unfortunately, the path report came back stating that I had 5-6 tumors (all quite small) of ILC.  She told me this type of cancer is hard to find, and it normally doesn't show up on mammograms or the needle biopsies.  I'm so glad I had the excisional biopsy and the cancer was caught early.  Like Beesie said, most women who post here are the smaller pecentage group who have been diagnosed with BC.  Regarding the procedure, the needle biopsy was so much worse for me -- laying on my stomach for almost two hours with my necked cranked is not my idea of a fun time (not that any of these procedures or treatments are fun).  The surgical biopsy was much easier because I was under anesthesia and my recovery was just a few days.  My scar was small and there wasn't really a noticeable difference in the shape of my breast.  Good luck and hope you find a decent doc for your second opinion.

Thank you for posting!!  I'm about to have this procedure and I made the mistake of doing an image search of "lumpectomy" as well as excisional biopsy and I almost threw up!!  I'm grateful to you and the other ladies who have posted, as it is helping to settle me down a bit.

yes, You should have the biopsy. I had atypical cells also, and when the doctor did the incision biopsy it turned out my breast was full of cancer...I never had a lump, and had a normal ultrasound and mammogram.

Doctors have their reasons when the word atypical comes up.

Stay strong. And sure, a place that mixes up records soulds like a place to avoid!

What stage were u when diagnoaed

Without my excisional biopsy, I never would have known I had LCIS.  Long story short I now have a choice to decrease my risk of developing invasive breast cancer.

hi

Today I had a exicsional biopsy after 2 mamo's and one ultrasound which calcification followed by a stereotactic biopsy which resulted ALH. I just turned 52. I read that risk of been in 20-25% pool for LCIS gets lesser with increased in age number? any thoughts. Ofcourse im scared.

First of all oneL, I sent you a private message. You should post this in the "Not diagnsoed but worried area" and start a new thread.

It is always scary when we have a lump or something on a mammo that is not normal. As for the difference between LCIS and DCIS, there are threads with those exact names here to look through as well as lots of information in the other areas of BCO, not here in the discussion boards area.

As a quick primer, LCIS is Lobular Carcinoma In Situ and is considered a pre-cancerous condition with a higher chance of developing BC in the future. DCIS is Ductal Carcinom in Situ is considered Stage 0 cancer. It is confined to the ducts ony and is considered a  little bit more serious than LCIS. If left untreated, this often results in invasive breast cancer or IDC. Please look at the areas that explain all of this here in Breast Cancer.org. They have excellent things to help you to understand. Look at the top of the page next to where it says Log in and go to Breast Cancer.org and there is a ton you can read there.

. Hoping that answers your questions. As for the lump and what is going on, only a biopsy can answer that question. Sometimes they don't send your films and reports to your doctor unless they have the doctor on file as the one to send the report to.

Best to you!

Thank you for all your info. So now that I am at the excisional bx stage i feel a little bit more comfortable. But funny how all women who have atypical cells they get results as breast ca?? It seems like a bit of a monopoly, or a money making scam. If peop walking around who never had a mammo or bx never get diagnosed with ca but are probably living to 89 and never know!! So the people who get treated have to go thru all the torture, for atypical cells? What if we have atypical cells in our leg, toe, intestine but you never know?? So I have to ask what is the percentage of peop, after an excisional biopsy done, end up having breast cancer? Probably more than less. I think they will keep digging until something is found. Does anyone know the ratio of atypical cells being benign or malignant? I am a nurse too but i am very skeptical about the health system right now.

Michele, the answer to your question is 20%.  Approx. 20% of women who have a needle biopsy that shows ADH or ALH are found to have breast cancer in the excisional biopsy pathology. 

If you read this board - or any other breast cancer discussion board - it will look like the percentage is closer to 100%.  That's because it's mostly people who are diagnosed with breast cancer who tend to stick around on these boards.  I've been here for 7 years and I've seen lots of women who've had excisional biopsies end up with nothing more than the original diagnosis of ADH or ALH.  Most of those women leave the board and don't continue to post here.  

Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications.  "...One pathologist performed a blinded review of the results of procedures performed to assess for calcifications and confirmed ADH in 101 cases with subsequent surgical excision....Upgrade to malignancy occurred in 20 (19.8%) of the 101 cases."

Frequency and Upgrade Rates of Atypical Ductal Hyperplasia Diagnosed at Stereotactic Vacuum-Assisted Breast Biopsy   "One hundred forty-one of 991 (14.2%) lesions yielded a diagnosis of ADH at 9- or 11-gauge stereotactic vacuum-assisted breast biopsy. Upgrade to ductal carcinoma in situ or invasive carcinoma occurred in 26 of 123 (21.1%) patients."