Ultrasound-Guided Breast Biopsy
Ultrasound is an excellent way to evaluate breast abnormalities detected by mammography. In some cases it is not possible to tell from the imaging studies alone whether a growth is benign or cancerous. That is why ultrasound-guided breast biopsy is so effective. It is a highly accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. The procedure prevents the need to remove tissue surgically, and also eliminates the radiation exposure that comes from using x-rays to locate a mass.
Ultrasound-guided biopsy is most useful when there are suspicious changes on the mammogram that can also be seen on an ultrasound exam. After placing an ultrasound probe over the site of the breast lump and using local anesthesia, the radiologist guides a biopsy needle directly into the mass.
A very small nick is made in the skin at the site where the biopsy needle is to be inserted. The radiologist, constantly monitoring the lesion site with the ultrasound probe, guides a biopsy needle or the vacuum assisted needle directly into the mass and obtains specimens. Usually at least five to 10 samples are taken using the core biopsy method.
If you are taking aspirin or a blood thinner, your physician may advise you to stop these medications five days before the procedure. Regular medications should be taken as prescribed by physician. A comfortable two piece garment should be worn. Please avoid using talcum powder or deodorant on the day of your biopsy.
What to Expect
You will be awake during your biopsy, and should have little or no discomfort. Generally the biopsy is completed in less than an hour. It is not necessary to close the tiny skin incision with sutures; a small compression dressing will do. Most patients are able to resume their usual activities later the same day.
A pathologist will examine the tissue specimens after they are processed. A definite diagnosis will be available within a few days. When the final biopsy findings are available, you may have a session with your physician to discuss the results and decide together on the next step. If cancer is diagnosed, you probably will be referred to a tumor specialist or surgeon.
Stereotactic Breast Biopsy
A stereotactic breast biopsy is an alternative to open surgical biopsy. It produces digital images of the breast allowing the radiologist to locate suspicious lesions to the accuracy of one millimeter. It is more cost effective than the surgical biopsy and leaves only a small scar at the site of the incision. Stereotactic core biopsies shorten the time from initial detection of lesions at mammography to final diagnosis and breast conserving therapy. Some indications for a stereotactic breast biopsy are:
- A suspicious mass that cannot be felt on breast exam
- A mammogram showing suspicious clusters of small calcium deposits
- A distorted structure of breast tissue
- A new mass or area of calcium deposits present at a previous surgery site
- The patient or physician strongly prefers a non-surgical method of assessment
Stereotactic breast biopsy provides the same reliability as surgical biopsy, but provides these significant advantages:
- No anesthesia required
- Less time required
- More cost effective
- Much less complicated
Preparation and Special Instructions
The patient should discontinue use of aspirin or blood thinners five days prior to the exam. Regular medications should be taken as prescribed by physician. A comfortable two piece garment should be worn. Please avoid using talcum powder or deodorant on the day of your biopsy.
What to Expect
The patient will lie on a specifically designed table which allows for visualization of the breast. A paddle-shaped instrument compresses the breast during the biopsy. The skin is washed and a local anesthetic is injected. A small incision is made in the skin. The tip of the biopsy needle is then advanced through the incision to the calculated site of the lesion. Stereo images (digital mammography images) are taken to confirm that the needle tip is actually within the lesion. Five to twelve samples are collected and sent to a laboratory for pathology evaluation. A final set of stereo images are obtained and a small clip is placed at the biopsy site so that it can be easily located if the lesion is cancerous.
Most biopsies take about one hour per suspected site. Most women report little or no pain afterward. There may be a small scar from the tiny skin incision. It is not unusual for a small amount of bleeding to occur where the needle was placed. The breast will be bandaged and a cold pack will be applied to relieve swelling and bruising. A non- steroidal pain reliever, such as Tylenol, may be taken as needed.
An MRI-guided biopsy is performed when the suspicious area is not well seen with either x-ray or ultrasound. MRI stands for magnetic resonance imaging and uses a powerful magnet, radio waves and a sophisticated computer to generate highly detailed images of breast tissue.
What to Expect
During the procedure, the patient lies face down on the MRI table which is then slid into position within the machine. The doctor uses the images to determine the position and depth of the abnormality, and to precisely guide the biopsy needle. A small marking “clip” may be placed at the site of the biopsy within the breast. This is so that the site can be easily located if further intervention, such as surgery, is needed.