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• Mammotome - During a Mammotome biopsy, also called a vacuum-assisted biopsy, a surgeon inserts a small tube into the breast tissue (under local anesthesia) and uses suction to draw a cylinder of breast tissue into the tube, and a small rotating knife cuts and removes the tissue (cores) for examination.

• Advanced Breast Biopsy Instrument (ABBI) uses a rotating circular knife to remove a larger cylinder of tissue for examination. The ABBI procedure removes more tissue than FNAB, CNB, or the Mammotome.

Surgical biopsy - In some cases, surgery may be needed to remove all or part of the lump for examination under a microscope. An excisional biopsy is used to remove the whole lesion (breast abnormality such as a lump or area containing calcifications) as well as a surrounding margin of normal appearing breast tissue. This biopsy can be done in the hospital outpatient department with local anesthesia or sometimes in your doctor's office.

Wire Localization may be utilized during an excisional breast biopsy of a small lump that is hard to locate by touch or in area that looks suspicious on the mammogram but does not have a distinct lump. After numbing the area with local anesthesia, a thin hollow needle is placed into the breast and x-ray pictures are taken to guide the needle to the suspicious area. A thin wire is placed through the center of the needle. A small hook at the end of the wire keeps it in place. The hollow needle is then removed, and the surgeon uses the wire as a guide to locate the abnormal area to be removed.

Axillary Node Dissection - The axillary lymph nodes are located under the arm. Axillary node dissection is performed to determine if cancer has spread beyond the breast. This procedure may be done at the same time as a lumpectomy or a mastectomy or may be scheduled following a positive biopsy. Axillary node dissection is performed under general anesthesia and requires an incision under the arm for removal of fatty tissue in which 10 to 20 lymph nodes are embedded. The incision is sutured and a drain may be put in to remove excess fluid. The procedure takes between 1 and 2 hours and usually requires at least one night in the hospital. Side effects may include pain, nerve damage, and lymphedema (swelling of the arm on the affected side).

Sentinel Lymph Node Biopsy - The sentinel node is the first lymph node that filters fluid from the breast. It is believed that malignant cells reach the sentinel node first and that this lymph node is more likely to contain cancer cells if the cancer has spread. Sentinel node biopsy involves injecting a radioactive tracer and/or blue dye into and around the tumor. With a small, hand-held Geiger counter, the surgeon tracks the path the tracer takes as it travels away from the breast and under the arm to the first lymph node. Once located, the sentinel node is removed through a small incision and sent to the laboratory for diagnosis.