Fine needle aspiration (FNA) is a percutaneous (through the skin) procedure that uses a fine gauge needle (22 or 25 gauge) and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass. With FNA, the cellular material taken from the breast is usually sent to the pathology laboratory for analysis. The needle used during FNA is smaller than a needle that is normally used to draw blood. If the radiologist or surgeon just drains fluid from a cyst and does not send the sample to the pathology laboratory for analysis, the procedure is simply called cyst aspiration.

A core needle biopsy is a percutaneous procedure that involves removing small samples of breast tissue using a hollow 'core' needle. For palpable (able to be felt) lesions, this is accomplished by fixing the lesion with one hand and performing a freehand needle biopsy with the other. In the case of non-palpable lesions (those unable to be felt), stereotactic mammography or ultrasound image guidance is used.

Stereotactic mammography involves using computers to pinpoint the exact location of a breast mass based on mammograms (x-rays) taken from two different angles. The computer coordinates will help the physician to guide the needle to the correct area in the breast. With ultrasound, the radiologist or surgeon will watch the needle on the ultrasound monitor to help guide it to the area of concern.

The needle used during core needle biopsy is larger than the needle used with FNA (usually a 16, 14, or 11 gauge needle is used with the core needle biopsy procedure). The core needle biopsy needle also has a special cutting edge.

The vacuum-assisted breast biopsy is a percutaneous procedure that relies on stereotactic mammography or ultrasound imaging. Stereotactic mammography involves using computers to pinpoint the exact location of a breast mass based on mammograms taken from two different angles. The computer coordinates will help the physician to guide the needle to the correct area in the breast. With ultrasound, the radiologist or surgeon will watch the needle on the ultrasound monitor to help guide it to the area of concern. The patient will either by positioned in the upright or prone (face down) position for a vacuum-assisted biopsy.

Vacuum-assisted biopsy is a minimally invasive procedure that allows for the removal of multiple tissue samples. However, unlike core needle biopsy, which involves several separate needle insertions to acquire multiple samples, the special biopsy probe used during vacuum-assisted biopsy is inserted only once into the breast through a small skin nick made in the skin of the patient's breast.

Large core breast biopsy is a surgical technique that involves removing an entire intact breast lesion (abnormality) under image guidance. Large core biopsy requires the use of a prone biopsy table (the patient lies face down) and stereotactic mammography imaging equipment. Stereotactic mammography involves using computers to pinpoint the exact location of a breast mass based on mammograms taken from two different angles. The computer coordinates will help the physician to guide the large core sampling device to the correct area of the breast. Large core biopsy can remove 5 millimeters (mm) to 20 mm of breast tissue. The procedure also allows the radiologist or surgeon to remove the entire lesion in one non-fragmented piece.

Punch Biopsy is typically used by surgeons to sample skin rashes. After a local anesthetic is injected, a biopsy punch, which is similar in function to a small (3 mm to 4 mm or 0.15 inch in diameter) version of a cookie cutter, is used to cut out a cylindrical piece of skin. The opening is typically closed with a suture (small stitches) and heals with minimal scarring.

Surface Biopsy involves sampling or scraping the surface of a sore or tumor to remove cells for pathologic testing. Surface biopsy is often performed by surgeons to remove a small piece of skin to test for carcinoma (cancerous tissue).

Surgical biopsy can be excisional (removal of an entire lesion) or incisional (removal of a piece of a lesion). In the past, most biopsies performed were open surgical procedures. However, surgical biopsy is less common now. Surgical biopsies can be performed on abnormalities that can be seen or felt by the surgeon or pre-operative imaging can help provide a road map to the lesion.

In cases of non-palpable breast lesions, a percutaneous wire can be placed in or near the lesion using mammogram or ultrasound for guidance. This marker wire provides a target for the surgeon. A surgical biopsy requires a 1.5 to 2.0 inch incision (approximately 3.8 centimeters to 5.1 centimeters) in the breast. The removed tissue is then histologically analyzed by a pathologist (a special laboratory physician uses microscopic analysis of the tissue to determine its type).

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