Breast Biopsy

breast biopsy

A breast biopsy is performed to remove some cells—either surgically or through a less invasive procedure involving a hollow needle—from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. Image-guided needle biopsy is not designed to remove the entire lesion, but most of a very small lesion may be removed in the process of biopsy. Image-guided biopsy is performed when the abnormal area in the breast is too small to be felt, making it difficult to locate the lesion by hand. There are times when your doctor may decide that image-guidance for biopsy is appropriate even for a mass that can be felt.

A breast biopsy is a minimally invasive outpatient procedure which allows you to return to your normal activities within a few hours after the completion of the procedure. A breast biopsy is often recommended by a radiologist if any abnormalities are detected on your mammogram, ultrasound, MRI, or special mammography views. Your doctor may order a breast biopsy if an abnormality is detected on a physical exam. If a breast biopsy is indicated, there are different methods of obtaining the tissue sample. You can have it performed by doing a stereotactic needle biopsy using mammography guidance, an ultrasound-guided core biopsy, or an MRI-guided biopsy to ascertain whether a malignancy (cancer) is present. The preferred method is determined by which imaging the abnormality is best visualized, the size of the lesion, the location of the lesion in the breast, and the patient’s health status.

Today many suspicious breast abnormalities can be diagnosed without surgery by using needle biopsy. In the past, excisional surgery biopsy was the only option for this purpose.

There are two types of needle biopsies – fine needle aspiration biopsy (FNAB) and core needle biopsy (CNB). FNAB uses a very thin needle to remove fluid and tiny fragments of tissue. CNB uses a slightly larger needle to remove a cylindrical piece of tissue about 1/16 inch in diameter and 2 inches long. CNB is the preferred method because FNAB is difficult due to the small amount of tissue extracted may be inadequate. In our center, the core needle biopsy is the preferred choice.

Even if an abnormality is too small to be felt, FNAB or CNB can still be done using breast imaging methods such as ultrasound, stereotactic mammography, and MRI to guide the needle into the lesion.

What is a Stereotactic Needle Biopsy?
What is an Ultrasound-Guided Breast Biopsy?
What is MRI-Guided Breast Biopsy?
What should I expect when having a breast biopsy?
What do you need to prepare for your Stereotactic or Ultrasound-Guided Breast Biopsy?
What do you need to prepare for your MRI-Guided Breast Biopsy?
What is a Stereotactic Needle Biopsy?

Stereotactic needle biopsy is a method that is useful in some cases in which calcifications or a mass can be seen on a mammogram but cannot be located by touch. Based on mammograms taken from two angles, computerized equipment maps the precise location of the mass or calcifications. The computer guides the placement of the needle for core needle biopsy.

Wire localization is a procedure used to guide a surgical (excisional) breast biopsy of a small lump that is difficult to locate by touch or of areas that look suspicious on the x-ray (due to calcifications, for example) but do not have a distinct lump. After numbing the area with local anesthetic, a hollow needle, thinner than that used for drawing blood, is placed into the breast and x-ray pictures are taken to guide the needle to the suspicious area. A thin wire is inserted 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.

What is an Ultrasound-Guided Breast Biopsy?

Ultrasonography uses sound waves at very high frequency to image internal structures, including those deep within the body. Either pulsed or continuous sound waves are directed at the area of interest using a hand-held device called a transducer. The transducer also receives echoes of the sound waves in a pattern that reflects the outlines of the internal structure mass. The transducer changes electrical signals into ultrasound waves and converts the reflected sound waves back to electrical energy. Unlike radiological procedures, the ultrasound method requires no exposure to x-rays.

What is MRI-Guided Breast Biopsy?

When the breast lesion cannot be seen with mammography or ultrasound, and can only be seen using Magnetic Resonance Imaging (MRI), MRI is used to help guide the radiologist’s instruments to the site of the abnormal growth.

Using MRI guidance to calculate the position of the abnormal tissue and to verify the placement of the needle, the radiologist inserts the biopsy needle through the skin, advances it into the lesion and removes tissue samples. If a surgical biopsy is being performed, MRI may be used to guide a wire into the mass to help the surgeon locate the area for excision.

The choice of which type of breast biopsy to use will depend on each patient’s situation, which modality the lesion is best seen, as well as their needs. Some of the factors to consider include how suspicious the lesion appears, how large it is, where in the breast it is located, the lesion type, how many lesions are present, other medical problems the patient may have, and personal preferences. Patients are encouraged to discuss the advantages and disadvantages of different biopsy types with their doctors.

What should I expect when having a breast biopsy?

When you arrive we will give you a detailed explanation specific to your procedure, and we will ask you to sign a consent form. You will be asked to change into a gown. Once you are in the proper position, your skin will be cleaned and numbed. The specific methods of obtaining a biopsy differ somewhat between each modality. We are happy to answer any questions you may have prior to, or during the procedure.

When the biopsy is over, the technologist will hold pressure on the biopsy site for 10 minutes to stop any bleeding. The site will be dressed with gauze and surgical tape, and an ice pack will be placed on it to reduce swelling and bruising.

We then send the tissue sample to the pathologist who will issue a report to us and to your doctor, usually within 24 hours.

What do you need to prepare for your Stereotactic or Ultrasound-Guided Breast Biopsy?

For the stereotactic or ultrasound-guided breast biopsy procedure, you will be asked to remove some or all of your clothes and to wear a gown during the exam. A comfortable two-piece outfit is preferred. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician if there is any possibility that they are pregnant. Some procedures using image-guidance are typically not performed during pregnancy because radiation can be harmful to the fetus.

You should not wear deodorant, powder, lotion or perfume under your arms or on your breasts on the day of the exam.

Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia. Your physician will advise you to stop taking aspirin or a blood thinner two days before your procedure.

Also, inform your doctor about recent illnesses or other medical conditions.

You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you have been sedated.

What do you need to prepare for your MRI-Guided Breast Biopsy?

Please do not bring hearing aids, credit cards, jewelry and watches, eyeglasses, pens, removable dental work, and anything that’s magnetic near the MRI machine.

The technologist will review the procedure with you, answer any questions, and have you sign a consent form.

You’ll be asked to fill out a screening form before having your MRI-Guided Breast Biopsy. The form may ask whether you have had previous surgeries, have any metal objects in your body, or have any medical devices (like a cardiac pacemaker) surgically implanted in your body.

Most, but not all, implanted medical devices are allowed near the MRI machine. Talk to your doctor or the technologist operating the machine if you have concerns about any implanted devices or conditions that may interfere with the MRI.

MRI can seriously affect some types of implanted medical devices. Implanted cardiac pacemakers and defibrillators can malfunction. Cochlear (inner-ear) implants can be damaged. Cochlear implants are small electronic devices that help people who are deaf or who can’t hear well understand speech and the sounds around them. Brain aneurysm clips can move due to MRI’s strong magnetic field. This can cause severe injury. Your doctor will let you know if you shouldn’t have the MRI-Guided Breast Biopsy because of a medical device. If this happens, consider wearing a medical ID bracelet or necklace or carrying a medical alert card that states that you shouldn’t have an MRI.

Some MRI examinations may require the patient to receive an injection of contrast material into the bloodstream. The radiologist or technologist may ask if you have allergies of any kind, such as allergy to iodine or x-ray contrast material, drugs, food, the environment, or asthma. However, the contrast material most commonly used for an MRI exam, called gadolinium, does not contain iodine and is less likely to cause side effects or an allergic reaction.

The radiologist should also know if you have any serious health problems or if you have recently had surgery. Some conditions, such as severe kidney disease may prevent you from being given contrast material for an MRI. If there is a history of kidney disease, it may be necessary to perform a blood test to determine whether the kidneys are functioning adequately.

Women should always inform their physician or technologist if there is any possibility that they are pregnant. MRI has been used for scanning patients since the 1980s with no reports of any ill effects on pregnant women or their babies. However, because the baby will be in a strong magnetic field, pregnant women should not have this exam unless the potential benefit from the MRI exam is assumed to outweigh the potential risks. Pregnant women should not receive injections of contrast material

Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia. Your physician will advise you to stop taking aspirin or a blood thinner two days before your procedure.

Also, inform your doctor about recent illnesses or other medical conditions.

Tell your doctor if being in a fairly tight or confined space causes you anxiety or fear. This fear is called claustrophobia. If you have this condition, your doctor might give you medicine to help you relax. Your doctor may ask you to fast (not eat) for 6 hours before you take this medicine on the day of the test.

You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you have been sedated.

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