Ductal Carcinoma in Situ (DCIS)
Diagnostic tests: biopsy
A biopsy involves taking a small sample of cells or tissue from the breast and looking at the sample under a microscope. The specialist who examines these samples (a pathologist) can see if they are cancerous. There are different ways of taking these biopsies, and here women talk about core biopsies and fine needle aspiration.
Needle (core) biopsy
A needle or core biopsy involves a doctor using a needle to obtain a sample of tissue to further investigate abnormalities found on screening mammograms and to obtain a definite diagnosis. These days, breast needle biopsies are very accurate because they are usually guided by either ultrasound or x-ray imaging and should be virtually pain-free because of the use of local anaesthetic, which is injected into the area first to numb it. Some women feel a little soreness or a sensation of pressure for a short time. Several biopsies are usually taken at the same time. Depending on the number taken, the breast tissue may be quite bruised and sore afterwards, and this may take a couple of weeks to completely disappear. Painkillers can be taken if the area is tender or painful. The tissue samples are sent to a laboratory to be looked at by a pathologist.
A doctor explains what a biopsy can show and what it involves.
A doctor explains what a biopsy can show and what it involves.
Sex: Male
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Why would a woman be given a biopsy and could you also explain what it involves?
Sure. First of all I think we very much understand why women are surprised when we say that there might be something wrong that needs a biopsy at the assessment clinic, because in many cases in screening practice we’re dealing with abnormalities which simply cannot be felt.
The biopsy is necessary because even with the very sophisticated and very high quality imaging that we have in the assessment clinic, we’re still not able in many cases to say exactly what the diagnosis is, and therefore be able to advise whether treatment is needed and, if so, what sort of treatment.
I, of course, understand, as does the team, how anxious an individual will be when they are told that they need a biopsy. However, they should not be concerned that the biopsy is uncomfortable. We use local anaesthetic for all of the biopsies, and that means that the tissue in the area where we put the needle into the breast in order to take the sample, will be numb, and so after the initial slight stinging sensation associated with injecting the local anaesthetic, after that it really should not be uncomfortable. And if there is any discomfort, then the patient must tell us because we can almost always do something about it, for example give a top up of local anaesthetic. So the biopsy procedure itself should not be the cause of too much discomfort.
There are different types of biopsy procedure. And those different procedures vary according to the type of abnormality that we’re looking at, for example can it be seen on ultrasound or can it only be seen on x-ray. And we use slightly different sampling devices in different circumstances. But whichever procedure the particular patient is having, it should be very clearly explained to them what it involves before it’s done.
Thank you. Do hospitals give leaflets out, on what is a biopsy? What it involves? Is that something that’s quite standard?
Yes, I think in routine practice I would hope that most breast units would send out a leaflet explaining in outline what the tests are likely to involve when women come for assessment. And they should receive that leaflet of course when they receive the invitation to come for the assessment clinic, yeah.
This is the needle that is used very commonly in routine practice for taking a core biopsy, and that’s where we obtain a little tissue sample from lumps in the breast, either in a symptomatic clinic or indeed in the assessment clinic. And you can see that it’s got a little, okay I’m going to have to stop and adjust this actually. Alright. There we go.
So you can see it’s got a little notch here and that’s where the specimen is collected. And it works extremely quickly, and makes quite a loud clicking sound, and that’s something that we warn patients about before we do the biopsy. And the breast tissue around where we’re doing the biopsy is completely anaesthetised and it makes a click like so. You can see it works extremely fast and with the local anaesthetic does not cause very much discomfort at all, and that’s something that we’ve studied and we know that the degree of discomfort from this sort of procedure is about the same as either having a blood test, or having your blood pressure taken. And so the vast majority of patients tolerate this extremely well.
Many of the women we interviewed talked about their experiences of having a core biopsy. Some said that, when they were told they needed a biopsy, they weren’t worried because they hadn’t had any lumps or other symptoms. Other women, though, said that it was at this point that they started to worry or realised that things were more serious than they had first suspected. One 72-year-old said she hadn’t expected anything to be wrong but alarm bells started ringing when she had to have a biopsy.
Some woman remembered being given local anaesthetic to numb the area. One woman said she was given more anaesthetic when she said she could feel something. For some, having a biopsy was painless.
Jane found having a biopsy quick and painless, and wasn't worried about the little bruising she had afterwards.
Jane found having a biopsy quick and painless, and wasn't worried about the little bruising she had afterwards.
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What they wanted to do was a biopsy, a needle biopsy, which I’ve never had before. But I’m quite relaxed about all these things. So I trotted round to another room and there’s a doctor and a person doing the biopsy. And they weren’t very expert at it. So we had a bit of a laugh really because they would have this exploding needle, as I call it. And they were just saying, “I hope, does this hurt, does this hurt? Sorry to mess you about”, and so on and so forth. But they did that.
The needle biopsy, I think is fine. I’ve got the impression that they were worried that I would be worried by it. But really, it’s so quick. You do have to kind of manoeuvre your breast in position and they do a lot of coordinate reading and so on. So it’s a bit long winded in that you’re sitting there with your breast under a plate and they’re trying to read coordinates so that they know where to take the biopsy exactly. And then they say, “Try not to jump because any minute now the needle will go down.” And of course you do jump [laughs] inevitably, but not badly. I suppose if you jumped a lot then they would have to do it again.
Did you have a local anaesthetic at all? Or it wasn’t …
They did put a local anaesthetic on. I’m not sure whether they actually needed to because it’s so rapid. I know it sounds terrifying having a needle kind of pressed into your breast but it’s just like, it’s fired from a gun and it’s out before it’s in almost. And it is really just, it makes you jump but I couldn’t say that it hurt. It bled a tiny little bit afterwards like you might bleed if you pricked your finger with a pin or something. But it didn’t hurt.
No bruising or anything?
Not seriously, no. They warned me that it might be quite bruised. I think the first one was fine. There was a bit of bruising when I had to have a second one because the first one hadn’t actually done the job and I had to have a second one. And I think probably they were trying to be extra sure on the second one. And there was a little bit of bruising. But again you could bruise yourself falling down in the street or knocking your hip on a wall or anything really. You can easily bruise yourself. So I wasn’t worried by that really.
Pauline describes having a biopsy, which she found painless. She got the results two weeks later.
Pauline describes having a biopsy, which she found painless. She got the results two weeks later.
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You are put in a clamp like a mammogram and then they, first they looked under an x-ray to see where the calcium dots were and then they punched, and it’s more than a needle, it’s thicker, but they punch down on the breast and then this, out it comes and within that tube, it takes a little sort of tube full of tissue and that's what they then analyse.
Was this on local anaesthetic, or?
Yes, yes. You had an injection just to anaesthetise the area. That, I mean some people have found it incredibly painful, I didn’t really find that too bad at all. A tiny little scar from it and that’s all. And that, in fact when they did analyse that, they did find DCIS in the core biopsy.
So did he tell you that there and then?
No because that was analysed; they actually gave me an appointment there and then for the hospital. And so I had that and that was two weeks time and they would either have a result for me then or they would arrange for a further biopsy if the result was clear.
Other, women, however, found having a biopsy uncomfortable or painful. A few said that, despite the discomfort, they just wanted to find out what was wrong. Many recalled how still they had to be during the procedure. One woman said she felt a bit faint but the staff were very caring.
A few women found having a biopsy extremely distressing, and found that their breast ached afterwards and was very bruised. One woman took painkillers to ease the pain. Several said that the core biopsy was actually more distressing than the surgery.
Carol found the biopsy extremely painful. The procedure took some time and left her with a lot of bruising.
Carol found the biopsy extremely painful. The procedure took some time and left her with a lot of bruising.
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I went to the city hospital, had the biopsy and that was a terrible experience. I was forewarned it wasn't all together pleasant and I was sat in the same position for over an hour. And bits of you that you don't think are going to hurt start hurting. For instance, your neck because you're in a particular position and they keep telling you to be very still. And that wasn't straightforward because apparently I've got quite dense breast tissue and the tube where they were taking out samples kept jamming up. So they had to keep removing it from me, flushing it with saline, putting it back in.
I ended up with two quite large-ish holes in my breast. The local anaesthetic kept wearing off because I was in there so long. So they had to keep giving me more. And then I just thought it was over and done with. They took me to a recovery room, apologised for the problems that they’d experienced doing it, and just left me there five minutes, came and put a little dressing on, told me to go home and rest and take paracetamol.
That night I was in total agony, really, really bad pain. I went to bed but I had to get up, I couldn't lie down, it was throbbing, terrible pain. Ended up sitting in the chair in the living room trying to get comfortable, and I was actually awake all night. The following day I was quite concerned about it because I'd been told to go home and take paracetamol so I thought, “This isn't right, something’s not right.” And I actually rang one of the Breast Cancer UK nurses on-line, explained to her and she actually told me that with that kind of a biopsy some ladies even are given morphine for the pain because they know it's so painful. Why was I sent home and told to take paracetamol then? But anyway, that was that and that was over and done with.
A few women said they felt ‘like a piece of meat’ when they were having a core biopsy. One said she and her husband spent seven hours in the hospital while different tests were carried out. She said she found having the biopsy undignified but knew that the doctors were only trying to find out what was wrong. Several women noted that, although they found the procedure uncomfortable, worrying or painful, the staff had been friendly and caring and had explained everything during the procedure. A few felt that staff could have been more sensitive when moving them into the correct position or could have explained the procedure and why they needed it in more detail.
Ann felt uncomfortable and vulnerable having a biopsy. Having her husband with her helped.
Ann felt uncomfortable and vulnerable having a biopsy. Having her husband with her helped.
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I went into the room for the … not really knowing even what the procedure was. But maybe, I don’t know, looking back maybe I would’ve been on the floor if I’d known what the procedure was. So maybe it was a good thing. And again I remember talking presumably to the radiologist that does that. But I didn’t know all these terms at the time and I remember asking directly, “Well, you know, when you do these things, how often do you find anything?” And again he didn’t look me in the eye. I didn’t, that really. ahh, and that’s when I began to feel that, you know, but he did say something like 80% I think not finding anything, so I suppose, again you know my brain was saying, “Oh it’s going to be all right.”
So we went ahead, and I must admit I didn’t know what, I hadn’t even, no concept of what the procedure would be. I don’t know if I need to talk about that particularly but it is a bit [sighs] …
You can if it was something that was important to you at that stage, or …?
I just remember thinking, “Oh what,.” I mean, the way you have to lie on the table and you have to put your breast through it. I found that quite, I am, you know, I know I’m very touchy about hospitals and medical things but I did find that, I don’t know how you would describe it. I suppose it was frightening and a bit sort of, well it’s such an unusual position to be in. It makes you feel almost not like a person, I felt very vulnerable, anyway, it’s fine. They went ahead all right and, as I said, they were very kind and everyone was, you know, talking to me and all that. So I think it went all right.
I mean, the procedure itself, they do make sure everything is numb and, as I say, once it was over, I felt the positive relief in the room. Everyone seemed relieved that they’d finished. Anyway, OK, so that was that. And, as I say, I did find that quite, I did come out shaking a bit out of that. I was feeling a little bit, so I was very pleased that my husband was there. Anyway, so we waited a few minutes I think and then someone said, “Oh well, you’ll come back and see Mr so-and-so.”
Maisie knew the doctors were doing tests for her own good but would have liked the results sooner.
Maisie knew the doctors were doing tests for her own good but would have liked the results sooner.
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I had to go back and I had to, there is this flat table, that is so embarrassing. I was a bit chubbier than this I must say, and you had to lie down on the table like a piece of meat and your breasts went through this hole. And then the doctor’s went “Well, …” maybe they had a crooked back by the time he was finished, because he was under the table putting the needles in to find it. But, you know, I lied down patiently and I know I keep saying but during all this they were just doing it because they know what they are looking for and they are trying to help you. You know, so that they then can give you the treatment and stuff and things like that.
So I went there on the day on Wednesday, I think it was in October or November, I can’t remember when it is. My husband and I went. And they said, “Well …” They still couldn’t find it any way because it was way back over there. And we spent about seven hours in hospital and they looked for it. But it was all right because it was for my own good and, as I said, they were doing something to help me. So we stayed and we waited patiently. And eventually they found what they wanted. And the most crappy thing is they said, “We won’t know until two weeks”. I’m thinking, “What the hell.” They have found something and I know I keep saying hell a lot [laughs]. They found something. They knew what they were looking for. You know, why not say, “Come back in about a week”, instead of two weeks. That two weeks is a hell of a lot of time.
Many women said that they had not known what to expect of the core biopsy beforehand and would have liked more information. Others, though, felt that information beforehand would have just made them more anxious. One woman said, because she was given no information about the biopsy, she postponed having it for several months. She was busy with work and was shocked that doctors had not told her that they would be looking for DCIS.
Rachel didn't know until afterwards what type of biopsy she'd had and would have liked more information beforehand.
Rachel didn't know until afterwards what type of biopsy she'd had and would have liked more information beforehand.
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He mentioned biopsy, he said, and then, "I can do that now". He went through the procedure with the needle just so that I would hear the click at the end and how they did it and said "now don't worry and once it does that, we will give you a local anaesthetic, if you feel any pain whatsoever we can give you more". And then, I thought well, I don't like needles particularly, so I didn't know what to expect and so I thought, I'll let them get on with it [laughs]. So I'm a bit of a coward, so I wasn't watching at the beginning, and then and I thought 'I think I'll have a look at this.' It was quite fascinating [laughs] because I could see the needle going in but I did think that five samples did seem a lot.
Yeah. So did he click five times?
Yeah. So did he click five times?
Oh yes it went in five times. Yeah, yeah. And I think I looked after about the third. And I was amazed at how long it was. And that you could see it actually moving round inside you, it was.
On the screen?
Yeah. Quite fascinating really [laughs]. And then it was, they just, I'd got to wait outside until the bleeding had stopped a little bit and then went to the desk to make an appointment for the following week.
When I get the results. And they gave me a piece of paper and that's when I knew I'd had a core biopsy. Didn't even know, they say 'have you got any questions?' but you need some input to ask questions. And I hadn't anything to, no guidelines whatsoever so, nothing to go on. So, that was where we were from there.
When you would get the results?
When I get the results. And they gave me a piece of paper and that's when I knew I'd had a core biopsy. Didn't even know, they say 'have you got any questions?' but you need some input to ask questions. And I hadn't anything to, no guidelines whatsoever so, nothing to go on. So, that was where we were from there.
Rachel didn't know until afterwards what type of biopsy she'd had and would have liked more information beforehand.
Rachel didn't know until afterwards what type of biopsy she'd had and would have liked more information beforehand.
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I had no sense whatsoever that these white spots could really be cancer. I just was left with the impression that there was something that they had to investigate. I suppose, looking with hindsight, why didn't I think or ask if it might be cancer, but I didn't. It just didn't occur to me. I was alerted to the fact that this procedure [biopsy] was unpleasant, and could have rather a bad effect on me, and so - I was extremely busy at the time, and I rang up subsequently and said could I leave this 'til after Christmas, because I thought it could take a couple of days out of my week recovering from the effects, and I just couldn't afford that. "Oh, no problem whatsoever", they said. So again I felt that it was nothing to do with cancer, because all the understanding about cancer I have is that if you have cancer everything moves into a fast gear.
So after Christmas I rang and said, "Look I've still not got over the hump" - I was writing something and I really couldn't be interrupted. "Okay, no problem, just tell us when you're ready", and so I finished the important piece of work I was doing during February and so I rang up and fixed my appointment to go for this exploration, some form of biopsy, I think they called it.
I went and that was when I discovered quite what the procedure was - which was unpleasant, and while I was just waiting for them to set up all the machines and equipment, a doctor, a radiologist doctor was present, a woman, who said something about ductal carcinoma in situ, which I'd never heard before, and it was - I think she said - I just remember the words, she might have said, "Well we're looking to see whether or not it is", or "It looks like it is" or something, and I had no idea what it was.
I don't recall at the time even asking her what it was, because I was just absorbing this new name. My recollection is rather vague at this point because it's now nineteen or twenty months since then. But I had to go back about eight or nine days later for the results, or maybe six or seven days later for the results. But in the intervening period I can recall looking up on the web about this ductal carcinoma in situ, and discovering to my horror that it was actually breast cancer. And I was shocked that I had gone from the November, and this was now the beginning of March completely ignorant about what it was that they might be looking for. I was reeling with shock and by then of course I was really very worried.
Some women had a biopsy on the same day as other tests, while others had to come back to have it on another day. A few were shocked to have all the tests on the same day because it wasn’t what they were expecting at the recall appointment. Many of those who did have to come back at a later date took someone with them, though a few said they preferred to go alone.
A few women explained that they had to come back for a biopsy on another day because the machine had broken down on the day of their appointment. This meant even more waiting to find out if anything was wrong and was often difficult. Other women said they had to have several biopsies either on the same day or later because the ones they had were inconclusive. Two of these women went on to have surgery to remove a larger piece of tissue, called an excision biopsy, before doctors could tell them whether anything was wrong (see Wide local excision for DCIS: The operation). Another woman, who had private health insurance, said she had to wait several weeks for a biopsy because the doctor she wanted to be seen by was on holiday.
Hilary had a biopsy on three different occasions but didn't mind. The staff were friendly and apologetic every time.
Hilary had a biopsy on three different occasions but didn't mind. The staff were friendly and apologetic every time.
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They also did an ultrasound on my breast, also on my left breast. There’s nothing at all on my left breast. And they said they would do a biopsy. And I innocently thought, “Oh, I’ll be called back later.” But no they did it that day. But I was quite comfortable. Everybody was fine. And it was quite almost a social thing because we chatted and everything.
Two days later I went back for the results. And I was told unfortunately I’d have to have another biopsy because it wasn’t quite, because it was deep they wanted to find more information. So I had another one done again. And in another couple of days I went back and again unfortunately I had to have a third one. They were most apologetic about it. It wasn’t their fault I know. Again it was quite a comfortable thing.
Pam's biopsy was delayed because she wanted to see a doctor privately that she had been treated by before but he was away.
Pam's biopsy was delayed because she wanted to see a doctor privately that she had been treated by before but he was away.
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I remember, you know, he [doctor] said, “Well we’ll have to get the biopsies, the next stage.” He said, “We take these things in stages.” And he explained the various stages and the next step is the biopsies to find out exactly what we’re dealing with. And though he was a doctor, it’s a surgeon that authorises the biopsy. And my surgeon that I wanted to see, the man that I’d seen with the mastalgia and liked, was away on holiday and wouldn’t be back for about a week. So what was suggested to me was that I come back and see my GP and see if the GP could do anything to get the ball rolling, the idea being that it would be done and on the surgeon’s desk for when he came back off holiday.
So my husband drove me back home and we went straight round to the doctor’s. Luckily a surgery was on, and by then I was in tears, it was just starting to kick in. And I saw the receptionist and she said, “Oh, for something like this obviously you’ll have an emergency appointment, we’ll see you tonight.” And she offered me a choice of, my usual doctor wasn’t around but there was a lady doctor available, there was a male doctor available. I just opted for the male doctor, I wasn’t bothered. I just wanted to see somebody.
So saw the GP anyway that evening and he said, “Right, well, what we’ll do”, he said, “I will fax the hospital.” Bearing in mind nobody had got any notes or anything to refer to. Now he was going purely on what we told him. He said, “I will fax the hospital and see if we can’t get a consultant to authorise the biopsy.”
He [consultant] said, “As your other consultant” – the man I wanted to see – “is on holiday”, he said, “really, you know, he ought to be part of this meeting and he won’t be here.” He said, “So, you know, are you going to stick with this other consultant?” And I said, “Well yes I want to go to him” because I knew him a little bit and I wanted to go to the other hospital because I’d been there before. So it basically came down to him sort of saying, “Well I can’t help you then.” He wanted to be the consultant, he wanted me to have it done there either NHS or privately there, and he wasn’t prepared to just rubber stamp the biopsy. If he got involved, he said, it’s most sort of irregular to have two consultants involved with one patient, you know. It’s only sort of on very serious sorts of cases, something nobody’d ever heard of or seen of before when you get two consultants treating one patient. And, of course we didn’t know the protocol or anything then. And I’ve never been in hospital for anything at all, major or anything, then we didn’t know what the protocol was. And, I think I came and upset the doctor a little bit because he was kind of, you know, “If you want me to do this you come to me. You know, if you want to go with the other person that’s where you have to go.”
So I said, “Well, I’ll wait then,” because this doctor would be back in a week’s time. And it was a bit scary because knowing you’ve got cancer in you, you want it dealt with promptly. But I thought, well a week, and they are saying it’s something minor, you know. So I said I would wait.
Two women were offered the choice of having a biopsy on the same day as other tests or a mammogram a year later because the doctor was concerned that there could be a problem developing. One of these women declined because she’d had no symptoms and felt there wouldn’t be anything wrong. She had another mammogram a year later and was diagnosed with DCIS. Another chose to have the biopsy there and then.
Sue had a biopsy because she wanted to know whether the calcifications found on her mammogram were serious.
Sue had a biopsy because she wanted to know whether the calcifications found on her mammogram were serious.
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I went on the Friday and saw a doctor who showed me under a magnifying glass that I had got calcium deposits and this could mean there were changes in the breast tissue that could possibly mean in future, it could turn out to be that I may in fact have breast cancer in the future. She did give me the choice that I could go for a mammogram next year, have the mammograms compared to see whether the calcium deposits had changed or got larger or smaller etc, or whether more had come. Or, if I wanted, I could have a biopsy done that day.
I opted to have the biopsy done that day. The biopsy involved another mammogram and put into a mammogram machine, given some local anaesthetic and the biopsies were taken. I think there were six or seven taken. They were just like tiny little splinters and put on glass. And the results were available for me the next week.
When I went back the following week for the results, I did take my husband with me. And when the nurse called me in and said would I like to take my husband with me, I obviously knew then there was some sort of problem. And the doctor was brilliant. He drew everything out for me. And he said what they had found was that I had DCIS.
Fine needle aspiration
A fine needle aspiration (FNA) is a quick, simple procedure where cells are drawn off using a fine needle and syringe. The sample is sent to the laboratory where it is looked at under a microscope to see if any cancer cells are present. As the breast is sensitive, the needle aspiration may be quite uncomfortable and the breast may be bruised for a week or so afterwards.
A doctor explains why some women are given a fine needle aspiration at the hospital.
A doctor explains why some women are given a fine needle aspiration at the hospital.
Sex: Male
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Some women, a few, less than, but some were given a fine needle aspiration. Can you example why they might have that and what that would show? And what it would involve?
Sure, a fine needle aspiration refers to using a fine or very thin needle, which is about the same size as the needle used for doing a blood test for example. And it simply takes a little bit of fluid from where the abnormality is in the breast, and that fluid contains cells which are spread on the microscope slide and then looked at under the microscope.
It is still used in some circumstances, but most clinics in the United Kingdom are now using what is known as a Core Biopsy, and that refers to a slightly different, it’s a slightly, actually a slightly wider needle which takes a core of tissue to be looked at under the microscope. We know from very extensive studies that have been done over the last ten years or so that the core needle biopsy is actually more accurate and gives us more information than the fine needle aspiration, in most circumstances. But both methods are used.
This bit of very simple apparatus is what we use for fine needle cytology, where the needle which is the same sort of needle as used for a blood test, is simply inserted into the lump in the breast usually done by ultrasound guidance to make sure that its absolutely accurate, and the needle is moved around within the lump at the same time exerting some suction on the syringe to provide a negative pressure and cells are pulled into the needle, and are then delivered onto microscope slides and then go to the laboratory to be looked at under the microscope.
So this is used for some lumps in the breast. It’s also used particularly in patients where we think that there is a cancer present in order to sample the lymph glands in the axilla or the armpit because it’s very important that we have information as to whether there are any cancer cells in the lymph nodes, in order to plan appropriate treatment.
Kath had all her tests on the same day and was diagnosed with DCIS after a fine needle aspiration.
Kath had all her tests on the same day and was diagnosed with DCIS after a fine needle aspiration.
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So I got the fine needle aspirations done, which was an awful experience because the guy was speaking about rectal examinations as if I wasn’t there. And why I didn’t say anything at the time I don’t know, but it was pretty awful. And they did the ultrasound thing and I could actually see the thing. I did some nursing early on, it was my first career. Too soft to carry it on [laughs]. So I kind of knew what I was looking at. And I thought, “No, there is something there.” So I’d already started preparing myself for, “Well it’s at least a cyst, or something”, you know. Because you do keep telling yourself everything’s all right, you know.
They did everything that day apart from the mammogram.
And told you there and then?
Yes, not from the biopsy, from the fine needle aspirations they can tell how active the cells are. And he thought it was moving fast. It was very active, he said, then. You know.
And that it’s DCIS.
Waiting for test results can be difficult and many women talked about how they felt during this time (see Waiting for results).
Last reviewed July 2017.
Last updated October 2013.
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