Frequently Asked Questions About Breast Biopsies

What are the different types of breast biopsies examined by the pathologists at SCMC?

A breast lesion can be sampled by a variety of techniques, depending on the size, location and character of the lesion. Surgeons can perform a fine needle aspiration of a larger palpable breast lesion using a thin needle to gently dislodge the cells from the lesion. Radiologists using fine needle aspiration techniques guided by ultrasound may obtain diagnostic tissue from very small nonpalpable lesions. Radiologists can also obtain thin cores of tissue (core biopsies) from small lesions by using ultrasound or stereo tactic guidance. A pathologist usually helps assist the surgeon or radiologist in the preparation of the specimen in order to insure an adequate sample. Surgery is usually necessary to remove larger and more complex breast lesions. This may be in the form of an excisional biopsy or lumpectomy, which may be first localized by a wire guide in radiology, prior to its removal by the surgeon. All breast tissue submitted to pathology for microscopic examination is reviewed by at least two surgical pathologists.

How will the microscopic examination of my breast biopsy at South Coast Medical Center differ from that of most institutions?

All breast tissue submitted to pathology for examination is reviewed by at least two pathologists. This includes fine needle aspirations, core biopsies, excisional biopsies and final therapeutic specimens such a lumpectomies. Although there are some institutions that require two pathologists to agree upon the diagnosis of breast carcinoma, at SCMC all benign, indeterminate, or malignant breast lesions are reviewed by at least two surgical pathologists.

Why go through the added work of having two pathologists review all breast biopsies?

We consider breast biopsy to be an important component of breast care. The biopsy is telling us a part of your “breast history” and we want to be sure that two pathologists agree upon the microscopic findings of the biopsy and the implications of the diagnosis that is rendered. In the case of a breast biopsy, two independent examinations of the same biopsy increase the sensitivity and accuracy of the diagnosis. False negative (missing cancer) and false positive (mistakenly diagnosing a cancer) are significantly reduced by the use of two pathologists.

What happens if the two pathologists are uncertain about the breast lesion that they are examining?

If the breast lesion is difficult to classify because of its complexity or if it appears to be a rare and unusual lesion, the pathologists at SCMC will send the entire biopsy out to a nationally respected institution. We utilize the pathologists at Stanford Medical Center, because we believe they have an excellent pathology department and are academic experts in breast pathology.