Breast Biopsy

About Image Guided Breast Biopsies

Breast biopsies are performed when something suspicious is seen or felt in the breast.

An abnormality may be seen on a mammogram or during a breast ultrasound. You or your physician may feel a lump during a breast exam. When suspicious tissue is seen or felt, a biopsy is often necessary to determine if the tissue is cancerous. Imaging studies alone cannot provide a specific diagnosis on which to base treatment decisions.

On average, one third of women who have a breast biopsy will have cancerous or precancerous tissue and need surgery. In the two thirds of women where this is not the case, no further procedure is necessary to confirm the benign, or noncancerous, diagnosis.

A special automated needle is used for an image guided biopsy. A specialty trained radiologist uses ultrasound, MRI, or mammography to view the breast tissue as he or she carefully guides the needle into the abnormal area. The needle then removes a small amount of tissue from the abnormal area.

These non-surgical biopsies are done in an outpatient center and only require local anesthetic. The specific type of breast biopsy that you receive will depend on the location of the abnormality and other factors.

The tissue is sent to a pathologist for a microscopic evaluation. This tissue analysis is an overnight process.

Image Guided vs. Surgical Breast Biopsy

Radiologists are able to biopsy the abnormal tissue with the same accuracy as a surgical biopsy. They are able to avoid injuring nearby body parts, such as breast implants, while performing the image guided biopsy.

Other reasons for choosing an image guided rather than a surgical biopsy include:

• Smaller incision
• No stitches
• Tiny scar
• Shorter recovery
• No cosmetic disfigurement
• Faster results (usually the next day)

Types of Image Guided Breast Biopsies

Following are the breast biopsies performed at Invision Sally Jobe:

* Needle localization is performed by Radiology Imaging Associates radiologists, but the surgery which follows is not.

Risks Involved in an Image Guided Breast Biopsy

The risks involved in an image guided breast biopsy include the following:

• Bleeding and infection at the puncture site
• Rarely, the pathologist may request that an area be re-biopsied with a needle technique or through surgical excision
• Small risk of rupture in women with implants
• A hematoma or collection of blood may form at the biopsy site
• Infection or abscess

MRI Guided Vacuum Assisted Needle Biopsy

Risks for this biopsy type also include:

• Claustrophobia
• Rare allergic reaction to contrast material
• Degradation of the picture by movement or artifacts from metal implants may decrease the visibility of the area to be biopsied

Scheduling, Insurance and Preparation

Insurance Coverage

Biopsies of the breast are usually covered by insurance when ordered by a physician. Check with your insurance company to be sure. Please bring your insurance card and a photo ID with you to your procedure.

Conditions to Let Us Know About

In advance of your exam, let your scheduler, radiologist, or technologist know if any of the following circumstances apply to you:

• Currently taking blood thinning medication
• Currently pregnant
• Allergic to any medications or anesthetics
• Heart valve replacement
• Mitral valve prolapse
• Joint replacement
• Taking medications regularly
• Taking aspirin or medications that contain aspirin
• Been told that you have a bleeding problem

MRI Guided Intervention

For an MRI Guided Intervention, in addition to the conditions listed above, also let your scheduler, radiologist or technologist know if any of the following apply to you:

• Previous reaction to MRI contrast medium (gadolinium)
• Claustrophobia
• Metallic fragments or splinters in your eye
• Aneurysm clips in the brain
• Any metallic, magnetic, mechanical or electronic devices
• Previous welding or grinding of metal without eye protection
• Weight over 300 lbs.

Preparation Guidelines

Following are the general preparation guidelines for biopsies of the breast. You may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3225 or 720-493-3700 if you have any questions.

• Wear comfortable clothes with a separate top and bottom. The top should be loose fitting.
• Do not wear talcum powder, deodorant, lotion, or perfume at the location of the biopsy.
• Eat and take your prescription medications.
• Remove all jewelry.
• Do not take blood thinning medications, including aspirin, for 3 days prior to the procedure. (Check with your doctor to ensure it’s safe.) Take all other prescribed medications.
• Bring any images and reports you have that were not done at an Invision Sally Jobe center.
• Bring a sports bra or another very supportive bra.

MRI Guided Intervention

Preparation for this biopsy type also includes not wearing eye makeup.

Needle Localization

Preparation for this procedure also includes the surgical preparation instructions you receive from your surgeon.

What to Expect

Before the Procedure

Before your breast biopsy, you may need to have additional pre-procedure exams, such as blood tests, special diagnostic mammogram views, breast ultrasound, or breast MRI. There will also be forms to fill out or a phone questionnaire to complete.

During the Procedure

Breast biopsies vary depending on the type. However, here is generally what will happen:

• A nurse practitioner or technologist will answer any questions you have.
• A nurse practitioner will assess your vital signs and ask you a series of questions. This is to make sure that your procedure can be performed safely and to assure that the correct procedure is being offered to you.
• You will change into a gown.
• You will be taken to the procedure room.
• You will meet the radiologist and staff that will perform your procedure and they will answer any additional questions you may have.

See the specific biopsy types below for additional exam details.

Needle Core Biopsy

Steps for this biopsy type also include:

• The technologist will position you on a padded biopsy table.
• The technologist will use ultrasound to locate the abnormal tissue.
• The area will be cleansed and anesthetized.
• The radiologist will make a small incision, about 1/8 of an inch long, in the skin near the area to be biopsied.
• While watching the ultrasound monitor, the radiologist will carefully insert the spring loaded biopsy needle into the area of the abnormal tissue. You should not feel any pain; just pressure.
• The needle will be activated, making a clicking noise, and a small sample of tissue will be removed. This will be repeated 4-6 times through the same incision, with no further anesthetization necessary.
• A biopsy marker* will be inserted at the biopsy site.
• The incision will be cleaned and closed with a steriip.
• A light touch mammogram will be done to confirm that the marker is visible and in the correct location.
• A pressure dressing will be applied to the biopsy site.
• You will change back into your clothes.

This procedure takes about 30 minutes.

Ultrasound Guided Vacuum Assisted Needle Biopsy

Steps for this biopsy type also include:

• The technologist will position you on a padded biopsy table.
• The technologist will use ultrasound to locate the abnormal tissue.
• The area will be cleansed and anesthetized.
• The radiologist will make a small incision, about 1/4 of an inch long, in the skin near the area to be biopsied.
• While watching the ultrasound monitor, the radiologist will carefully insert a vacuum assisted probe into the area of the abnormal tissue. You should not feel any pain; just pressure.
• The needle will be activated. You may hear the vacuum and feel vibrations. Small samples of tissue will be removed.
• A biopsy marker* will be inserted at the biopsy site.
• The incision will be cleaned and closed with a steriip.
• A light touch mammogram will be done to confirm that the marker is visible and in the correct location.
• A pressure dressing will be applied to the biopsy site.
• You will change back into your clothes.

This procedure takes about 90 minutes. If multiple areas are biopsies, the procedure may take longer.

Stereotactically Guided Vacuum Assisted Needle Biopsy

Steps for this biopsy type also include:

• The technologist will position you on a padded biopsy table. You will lie on your stomach and your breast will be positioned through an opening in the table. Your breast will be compressed similarly to a mammogram.
• A mammography machine will take pictures from three angles to determine the exact location of the abnormality within the breast.
• The area will be cleansed and anesthetized.
• The radiologist will make a small incision in the skin near the area to be biopsied.
• The radiologist will carefully insert the needle and position it near the abnormal tissue. You should not feel any pain; just pressure.
• Additional mammograms will be taken so the radiologist can check the placement of the needle.
• The needle will be activated and rotated to sample the tissue.
• A biopsy marker* will be inserted at the biopsy site.
• The incision will be cleaned and closed with a steriip.
• A light touch mammogram will be done to confirm that the marker is visible and in the correct location.
• A pressure dressing will be applied to the biopsy site.
• You will change back into your clothes.

This procedure takes about 30 minutes.

MRI Guided Vacuum Assisted Needle Biopsy

Steps for this biopsy type also include:

• The technologist will place a small IV in your hand for the contrast.
• The technologist will position you on a padded biopsy table. You will lie on your stomach and your breast will be positioned through an opening in the coil. Your breast will be compressed similarly to a mammogram.
• The table will slide into the MRI scanner and several images will be taken to determine the exact location of the abnormality within the breast.
• The area will be cleansed and anesthetized.
• The radiologist will make a small incision in the skin near the area to be biopsied.
• The radiologist will carefully insert the needle and position it near the abnormal tissue. You should not feel any pain; just pressure.
• Additional MRI images will be taken so the radiologist can check the placement of the needle.
• The needle will be activated and rotated to sample the tissue.
• A biopsy marker* will be inserted at the biopsy site.
• The incision will be cleaned and closed with a steriip.
• A light touch mammogram will be done to confirm that the marker is visible and in the correct location.
• A pressure dressing will be applied to the biopsy site.
• You will change back into your clothes.

This procedure takes 30-60 minutes.

Needle Localization for Surgical Excisional Breast Biopsy

Needle localization may be done at an Invision Sally Jobe location or in the outpatient facility of an RIA partner hospital just prior to surgery. The area to be localized will be cleansed and anesthetized. The radiologist will use ultrasound or mammography images to carefully place a wire through the skin into the abnormal tissue. You should not feel any pain.

The radiologist will take a mammogram to ensure the wire is properly placed. A bandage will be loosely taped over the area.

You will then go the operating room where the surgeon will perform the surgical biopsy.

Needle Localization for Sentinel Node Breast Biopsy

Needle localization for a sentinel node biopsy may be done at an Invision Sally Jobe location or in the outpatient facility of an RIA partner hospital. This process begins approximately three to four hours before the scheduled surgery time.

The skin over the area to be localized will be cleansed and anesthetized. A solution containing a radioactive tracer will be injected near the lump. You will wait an hour for the solution to enter your lymph system. You will then undergo lymphoscintigraphy. With this exam, a gamma camera (similar to a Geiger counter) is passed over the skin to identify the areas of the lymph system where the most radioactive tracer is located. These areas are likely to be the sentinel nodes that first receive drainage from the tumor and are most likely to contain malignant cells if the cancer has spread. The skin over these areas is marked.

The radiologist will use the gamma camera and breast ultrasound to locate the lymph nodes under the marked areas. Using ultrasound guidance, he or she will carefully insert localization wires through the affected lymph nodes.

You will then go the operating room where the surgeon will perform the surgical sentinel node biopsy.

* Biopsy Markers

A biopsy marker is a pin head sized metal marker made of surgical stainless steel or titanium with small re-absorbable pellets that can be seen by ultrasound. This marker will be placed at the site where tissue was removed during the biopsy. You will not be able to feel the marker. It will not set off metal detectors, does not contain electronic devices, and does not pose a problem for future MRI exams.

If cancer is found and more tissue must be removed from the breast, the marker will help the surgeon identify the specific area where tissue should be removed. This can minimize the amount of healthy tissue removed from the breast during surgery. If surgery isn’t necessary, the marker will show up on future mammograms to let the radiologist know where the biopsy was done.

After the Procedure

Recovery

You may experience soreness at the site of the biopsy, but it should quickly improve. Follow these instructions to help with your recovery:

• Leave the pressure dressing in place and keep it dry for 10-12 hours.
• Leave the steriip in place for 14 days.
• No lifting over 10 pounds and no strenuous exercise for 3-4 days.
• Do not take a bath, go in a hot tub, or swim for two weeks. You may shower.
• Resume any medications that were stopped after checking with your physician.
• Use ice packs or over the counter pain relievers to minimize discomfort.

Procedure Results

Your tissue sample will be sent to a laboratory so a pathologist can examine it. The results are usually available the next business day and will be reported to your physician. You can get your results from your physician or from the Invision Sally Jobe facility where the biopsy was performed.

During the biopsy, our radiologists and technologists will be happy to answer questions about the procedure itself; however, they will not be able to give you the results until the pathologist provides them.

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