Needle Biopsy of the Breast

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Biopsies are the only definitive way to confirm if breast tissue is benign or cancerous. Needle biopsy is a minimally invasive procedure used to get a tissue sample from an area of concern in the breast. Small amounts of breast tissue are removed through a needle, and the tissue is studied under a microscope by a pathologist, who will then provide a diagnosis.

There are various methods by which a needle biopsy can be performed.

An ultrasound-guided biopsy is a technique most often used to guide a breast biopsy when a breast abnormality is visible on ultrasound.

A stereotactic breast biopsy allows for a needle biopsy to be performed on lesions which are more conspicuous on mammography than on ultrasound. This type of biopsy utilizes x-ray images (mammograms) of the breast tissue to guide the biopsy needle to the area of interest. Stereotactic biopsies are most commonly performed on tiny breast calcifications; but may also be utilized on breast masses in certain situations.

An MRI-guided biopsy uses real-time magnetic resonance imaging (MRI). It is the latest development and an important advance in diagnosing breast cancer. It is useful when an ultrasound or stereotactic-guided biopsy is not appropriate because the area of concern is not well seen by mammogram or ultrasound, but is discovered or is most conspicuous on MRI.

For more information on this and other radiology procedures, please visit www.radiologyinfo.org.

What Should I Expect

We realize a biopsy may be an emotionally distressful experience. However, patient comfort, in addition to an accurate diagnosis, is our priority. Our radiologists and staff are trained to make this procedure as comfortable and quick as possible. A needle biopsy can be performed with local anesthetic and minimal discomfort. With this procedure, no stitches are required and most women can resume normal daily activity immediately after the procedure. Keep in mind that more than 80% of all suspected breast abnormalities are benign or non-cancerous.

There are several things you can do to prepare for your procedure.

  • A light meal is recommended on the day of the procedure, but do not eat for four hours prior to the procedure. You are encouraged to drink plenty of liquids up until one hour before the procedure.
  • If you take blood thinners (Heparin, Coumadin, Persantine, Plavix, etc.) or other non-steroidal anti-inflammatory medications (such as Advil, Motrin, Aleve, Naproxen Sodium (Naprosyn), Ibuprofen, etc.,) please let us know at time of scheduling. These medications interfere with blood clotting and may increase the chance of significant bruising. Our radiologist may want to check with your physician about these medications before the procedure.
  • Your other regular medications should be taken as prescribed. You may take Tylenol.
  • If you are taking blood pressure medication, make sure you take your prescription the day of your procedure.
  • Wear a comfortable, two piece outfit.
  • Do not use deodorant, powder, perfume, or any lotions on or near your breast on the day of the biopsy. These items can interfere with the interpretation of the images.
  • Your most recent mammogram must be provided to us at least 24 hours in advance.
  • A biopsy is considered to be minor surgical procedure. Please make arrangements for someone to drive you home after the procedure.

ULTRASOUND GUIDED BIOPSY: You will lie on your back or turn slightly to the side. The ultrasound probe is used to locate the lesion. Local anesthetic is injected to ensure that you will be comfortable. The radiologist will then create a small nick in the skin through which the biopsy needle will be inserted, and several samples of tissue will be obtained for evaluation. We will provide you with an ice pack and post biopsy care instructions.

STEREOTACTIC BREAST BIOPSY: Depending on which site you visit, this minimally invasive procedure requires you to either be positioned lying face down on a specially designed table used specifically for breast biopsies, or if in Virginia, in a sitting position utilizing our upright stereotactic biopsy equipment. If you are lying down, your breasts are actually positioned through an opening in the table. For either position, we will then clean the skin and inject a local anesthetic. A tiny incision less than a quarter of an inch is made without causing any significant alteration in the appearance of the breast. The radiologist will remove several samples of tissue through this incision. In certain cases a small, titanium marking clip may be left at the biopsy site so that it can be easily relocated for surgery or follow up, if needed.

MRI-GUIDED BIOPSY: During an MRI-guided biopsy, a local anesthetic is injected to numb the skin and contrast material is given intravenously. You will be positioned face down on your stomach and your breast(s) will be positioned into a cushioned opening containing a special breast-imaging coil. Using computer software, the radiologist determines the position and depth of the lesion for biopsy. When the tissue sampling is complete, a small marking clip may be left at the site of biopsy, so the site can be easily located if surgery becomes necessary.

If you have minor claustrophobia or anxiety, you may want to ask your physician for a prescription for a mild sedative. DO NOT take this medication prior to your arrival or signing paperwork. Avoid eating a large meal immediately prior to the exam.

When you arrive you will be asked to complete paperwork regarding your history and symptoms. You will be asked to remove all jewelry, since these items disturb MRI signals. It is very important that any prior breast films (mammograms, ultrasound or MRI) be available to the radiologist for comparison. If you have had these at a facility other than Radiology Imaging Associates, please bring them with you on the day of your appointment.

MRI uses a very powerful magnet, radio waves and a sophisticated computer system to produce remarkable images without x-ray radiation. Because of the powerful magnet used, certain safety precautions must be observed. Patients may not qualify for MRI if any of the following conditions exist:

  • Cardiac Pacemaker
  • Cochlear implants
  • Artificial heart valves
  • Aneurysm clips
  • Neural stimulator
  • Metal objects (or piercings) embedded in the body
  • Metallic fragments or objects in the eye
  • Permanent make-up (eyeliner, lip liner, eyebrows, etc.)
  • Pregnanacy or IUD

What instructions do I follow after the procedure?

  1. Rest for the remainder of the day.
  2. Resume your usual diet, and take your usual medication as ordered.
  3. Avoid any strenuous activities for 24 hours.
  4. Avoid aspirin products or blood thinners for 24 hours.
  5. If you need medication for discomfort, you may take Tylenol, but avoid nonsteroidal pain medication such as Advil, Motrin, Aleve, Naprosyn and Naproxen Sodium.  For comfort and to reduce swelling, you may use a cold compress as needed the first day after the biopsy.
  6. Keep the biopsy site clean, dry, and covered for 24 hours.  Remove the gauze dressing after 24 hours.  Do not shower or bathe until after the gauze dressing is removed.
  7. You can expect the biopsy site to be tender and perhaps slightly bruised.
  8. Watch for excessive bleeding, pain, or fever. Should any of these occur, contact the radiologist that performed you procedure through our office.

When will I receive results?

Biopsy samples are sent to a pathologist, who will analyze and provide your physician and Radiology Imaging Associates with a diagnosis within 2 -1 10 days.