Excisional Biopsy

An excisional biopsy is a surgical procedure that involves removing a small tumor or another abnormality from a breast for evaluation. When breast cancer is suspected, many patients turn to Tampa General Hospital for the peace of mind of a conclusive diagnosis and, if necessary, definitive next steps.

Tampa General Hospital’s Cancer Institute ranks among the top 10% of hospitals in the nation and is one of Florida’s few cancer centers backed by academic medicine. As a national and global leader in cancer care, TGH is accredited by the Commission on Cancer (CoC), a quality program established by the American College of Surgeons (ACS). Our Breast Cancer Program is home to a team of world-renowned surgeons who have decades of experience in performing advanced diagnostic and treatment procedures, including excisional biopsies.

When Is an Excisional Biopsy Considered?

In years past, an excisional biopsy was considered to be the gold standard for conclusively diagnosing breast masses that could be felt and suspicious lesions that could be seen in a mammogram. Today, however, a less invasive image-guided core needle biopsy is the preferred diagnostic approach in most cases. If a core needle biopsy is not possible or produces an inconclusive result, an excisional biopsy may be a good option for further evaluating the breast abnormality.

What Does an Excisional Biopsy Involve?

Usually, an excisional biopsy is an outpatient procedure performed in a hospital or surgical center. If the breast abnormality cannot be felt or is difficult to find, a preoperative localization procedure may be performed to guide the surgeon. One option is a wire localization. After the breast is numbed, a physician uses ultrasound or mammogram imaging to precisely insert a thin, hollow needle into the suspicious tissue. Once the tip of the needle is properly positioned, the physician inserts a wire through the center of the needle. The guidewire is left in place during the excisional biopsy.

Other localization procedures use tiny magnetic or radioactive seeds or radiofrequency reflectors, which are placed completely inside the breast. When performing the excisional biopsy, the surgeon can then locate the abnormality by using a handheld detector.

During an excisional biopsy, the patient is moderately sedated and a local anesthetic is administered to numb the surgical site. After making a small incision in the breast, the surgeon removes the suspicious tissue. Using X-ray or ultrasound imaging, the surgeon confirms that the removed tissue contains the abnormality, then removes any localization markers, closes with incision with tape or stitches and covers it with a sterile dressing.

The tissue removed during the excisional biopsy is sent to a lab, where it is microscopically examined by a pathologist. If the pathologist finds cancerous cells, they will further study the tissue to determine whether it is surrounded by a sufficient rim of healthy tissue. If so, the tumor has likely been completely removed.

What to Expect With an Excisional Biopsy

Most patients go home on the same day as their surgery with detailed instructions from their treatment team on how to manage any discomfort, how to care for the incision site and when to resume their daily activities. Any pain or tenderness should resolve within a week and any bruising should gradually fade over two weeks, but the swelling can last for up to eight weeks.

If the incision was closed with tape strips, the strips should be left in place until they fall off. If the incision was closed with stitches, a physician will remove them during a follow-up appointment, usually within one week.

How Effective Is an Excisional Biopsy?

The main goal of an excisional biopsy is to conclusively rule out or diagnose breast cancer. In many cases, however, the breast cancer surgeon can remove the entire tumor—especially if it is small—and eliminate the need for further treatment. As such, an excisional biopsy can be a highly effective treatment for early-stage breast cancer.

Benefit From World-Class Care at TGH

At TGH, our patients have access to a full complement of the latest breast health services, including excisional biopsy and preoperative localization procedures. If you would like to explore your diagnostic and treatment options for a breast abnormality, contact us at (800) 844-4554 to request an appointment with an expert on our team.