Breast Lump Biopsy vs. Excision: What’s the Difference?

Introduction

Breast lumps are tissue growths of various sizes, shapes, and textures that form within one or both breasts. Most of the time, they are not dangerous. Breast lumps can develop due to many reasons and can either be hard or soft. Though having a breast lump doesn’t mean that it is something serious, it is always better to get them examined by a doctor, as rarely they may be indicative of breast cancer or other medical conditions. Treatment for breast lumps always depends on the cause and other individual factors. Let us understand more about their significance, potential causes, symptoms, and treatment options.

Understanding Breast Lumps

Breast lumps are abnormal growths or masses in the breast tissue. They can have various causes and may present with different symptoms. The causes of breast lumps include the following.

• Breast Infection: Any infection in the breast tissue can sometimes harden and form a lump. Sometimes, it may also be filled with fluid/pus and form an Abscess.
• Injury/post surgery: Any serious injury to the breasts or any complication after any surgery to the breasts can also cause lumps.
• Breast Calcifications: Sometimes, benign calcium deposits develop making it feel hard and lumpy.
• Cysts in the Breast: Fluid gets trapped in the milk ducts forming fluid-filled sacs. These are usually common in premenopausal women.
• Fibrocystic changes: These changes make the breast feel lumpy and sometimes tender. They usually occur around your period and get better once you have your period.
• Fibroadenomas: These are benign tumors and are movable under the skin. There are certain causes for these like pregnancy or birth control pills or sometimes around periods.
• Breast Cancer: Cancerous breast lumps are typically hard, irregularly shaped, and may not move freely within the breast tissue. They may or may not be associated with pain.

Symptoms would include mass or lump upon palpation, pain & discomfort, discoloration of breast skin, discharge from nipples, inward turning of nipples, and change in overall size and shape of breasts depending on what type of lump you have. 

Early detection and diagnosis of breast conditions are crucial for appropriate management and treatment. Regular breast self-exams help in the early detection of breast abnormalities. You can do so by standing in front of a mirror and checking for any differences in size, shape, or skin texture. You can also slowly palpitate the breasts with your finger pad to notice any abnormalities or check for any enlarged lymph nodes in your armpit area.

If you notice any change in the changes or lumps, do not panic and visit your doctor for further analysis. On your first visit, the doctor will perform a physical examination by checking the size shape, and location of the lumps and take a thorough medical history. Based on these examinations, they might prescribe further diagnostic procedures like Ultrasound, Mammogram, Fine needle aspiration, or MRI. Sometimes, For the lumps that are painful and are increasing in size, a biopsy can be done for further analysis to understand if it is cancerous.

When to Worry in Case You Have a Breast Lump?

Here are some signs and situations that indicate you should see a doctor for breast lumps:

• A new or persistent breast lump that may or may not be painful.
• Any noticeable changes in the size, shape, or appearance of your breasts.
• Changes in your nipples, such as any discharge, an inversion, or any other unusual changes in the nipple.

Treatment Methods For Breast Lumps

Treatment for these Breast lumps depends on the underlying cause. Some might need intervention whereas some might not need any.

• If the lump is due to a breast infection, you will be prescribed Antibiotics
• For large painful cystic lumps, drainage is the preferred option
• For the lumps that are painful and are increasing in size, a biopsy can be done for further analysis to understand if it is cancerous.
• If the lump is cancerous (breast cancer), it might be treated by surgery, chemotherapy, or radiotherapy.

People often tend to mistake Biopsy and Excision for being the same although they are different. So let us understand more about their differences.

What is a Breast Lump Biopsy?

A breast lump biopsy is a medical procedure to determine the nature of a breast lump. It involves the collection of tissue or fluid samples from the lump to ascertain whether it is benign (non-cancerous) or malignant (cancerous). Common biopsy methods include fine needle aspiration, core needle biopsy, vacuum-assisted biopsy, or surgical biopsy, depending on the lump’s size and characteristics. These samples are examined by a pathologist to provide a definitive diagnosis. The results guide treatment decisions, as benign lumps may require monitoring or removal for symptomatic relief, while malignant lumps often necessitate further cancer treatment, such as surgery, chemotherapy, or radiation therapy. Here’s an overview of the common techniques used:

Fine needle aspiration Biopsy:

This is suggested for the lumps that can be located through physical examination and do not require any further imaging systems. A needle and a syringe will be used to draw some samples of the breast cells or fluid.

Core needle biopsy:

A larger and hollow needle is used to extract the breast tissue that is usually guided by an ultrasound. This can be done to further assess the breast lumps found during physical examination or mammogram or ultrasound.

Vacuum-assisted core biopsy:

This is usually performed under imaging Guidance. A special needle is inserted through an incision that is powered by vacuum to extract a mass of tissue into the needle.

Surgical Biopsy (Excisional or Incisional):

Involves a surgical procedure to remove the entire lump (excisional biopsy) or a portion of it (incisional biopsy). More invasive but necessary when other biopsy methods are inconclusive or if there is a high suspicion of cancer. The excised tissue is sent to a pathologist for examination.

The choice of biopsy method depends on factors like the lump’s size, location, characteristics, and the patient’s medical history. Local anesthesia is typically used to minimize pain or discomfort during the procedure. The collected tissue samples are then sent to a pathology lab, where a pathologist examines them under a microscope to determine whether the lump is benign or malignant. The results of the biopsy play a crucial role in guiding the treatment plan for the patient.

What is Breast Lump Excision?

Breast lump excision is a surgical procedure that involves the removal of a breast lump or mass from the breast tissue. This procedure is typically performed when a lump in the breast is suspicious or when a diagnosis of the lump is needed. There are two main types of breast lump excision:

Excisional Biopsy:

In this procedure, the entire lump or mass is removed. This is often done when a lump is relatively small or when there is a strong suspicion of cancer. The excised tissue is then sent to a pathology laboratory for examination to determine whether the lump is benign or malignant (cancerous).

Lumpectomy:

A lumpectomy is a type of breast lump excision performed as a treatment for breast cancer. In this case, the procedure not only removes the lump but also a margin of surrounding healthy tissue to ensure that all cancerous cells are removed. It is often followed by radiation therapy to further reduce the risk of cancer recurrence.

Breast lump excision is typically done under local or general anesthesia, depending on the extent of the surgery. The choice of excision method and the extent of tissue removal depend on the characteristics of the lump, the patient’s medical history, and whether cancer is suspected. The removed tissue is sent to a pathologist for analysis, and the results guide further treatment decisions. Let’s take a look at the key differences between breast lump excision and biopsy.

Breast Lump Biopsy vs. Excision: Key Differences:

Procedure	Type	Goal	Anesthesia	Tissue Removal	Recovery
Biopsy	Diagnostic Procedure	To detect the type of the lump (Benign or Malignant)	Local Anesthesia	Only sample tissue is removed	1 to 2 days
Excision	Surgical Procedure	To remove the lump entirely	Local/Regional or General anesthesia	Entire lump is removed	4 to 6 weeks

Conclusion

It is important not to panic if you notice any abnormality in your breasts. Remain calm and talk to your doctor about it. Regular self-examinations are very important to detect early signs of abnormalities. Although Biopsy is one of the diagnostic processes to identify if the breast lump is cancerous, it is not advised for all and the same applies to Breast lump excision.

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