Breast Biopsy

Breast Biopsy Overview

Breast biopsies are performed to evaluate an area of concern identified on a mammogram, breast ultrasound or breast MRI. Almost all breast biopsies can be performed using minimally invasive biopsy techniques such as core needle biopsy and vacuum-assisted breast biopsy. Open surgical biopsy is reserved for the one to two lesions out of 100, that cannot be biopsied using minimally invasive techniques.

The method of biopsy used depends on how the abnormality is best detected and is determined by the radiologist. Most breast biopsy methods rely on image-guidance such as stereotactic (mammography), ultrasound or MRI (magnetic resonance imaging). These tools allow the radiologist to precisely locate the abnormality within the breast.

Once a sample of breast tissue is removed, it is evaluated by a pathologist. The pathologist is able to tell from the microscopic appearance of the tissue if it is cancerous or benign.

It is normal to feel nervous about having a biopsy.  In spite of a woman’s reservations to have a breast biopsy, the results can provide peace of mind since breast biopsy is generally a definitive method for determining the nature of the abnormality.

Breast Biopsy Preparation

It is important to avoid the following supplements or medications five to ten days before your biopsy:

• Vitamin E
• Omega 3 fatty acids
• Flaxseed oil
• Fish oil
• Aspirin
• NSAIDS such as Advil, Nuprin or Ibuprofen

Consult your prescribing physician regarding discontinuing Coumadin, Plavix, or Lovenox.

Biopsy Procedures

Stereotactic Guided Biopsy

Stereotactic Guided Biopsy is a technique used to obtain samples from an abnormality that cannot be felt during a breast exam, but can be seen on a mammogram.

Digital mammography pinpoints the exact location of a breast lesion by using computer and digital x-ray images taken from two different angles. Using these coordinates, the radiologist inserts a thin hollow biopsy needle through the skin, advances it into the lesion and removes tissue samples. At RAS, image-guided, minimally invasive procedures such as stereotactic guided breast biopsy are performed by a specially trained interventional radiologist and are done on an outpatient basis.

Stereotactic guided biopsy can be a less invasive, good alternative to an open surgical biopsy in determing the diagnosis.

Ultrasound Guided Biopsy

Ultrasound Guided Biopsy allows your physician to identify the exact location of a suspicious lump or lesion for the purpose of biopsy.  This method is often used to locate and biopsy masses that are too small to be felt, but which may be discovered by mammography or ultrasound.

In an ultrasound guided biopsy, an ultrasound machine is used to visualize the exact location of the breast lesion, giving the physician an accurate, picture of the lump or lesion in question, and allowing the radiologist to insert a thin hollow biopsy needle through the skin, into the lesion to remove tissue samples. With continuous ultrasound imaging, the radiologist is able to view the biopsy needle as it advances to the location of the lesion in real-time.

Image-guided, minimally invasive procedures such as ultrasound guided breast biopsy are performed by specially trained interventional radiologists and are done on an outpatient basis.

Breast MRI-Guided Biopsy

MRI Guided Biopsy uses magnetic resonance imaging (MRI) to help guide the radiologist to the site of the abnormality.  Unlike conventional x-ray examinations and computed tomography (CT) scans, MRI does not depend on ionizing radiation. Instead, radio waves are directed at protons, the nuclei of hydrogen atoms, in a strong magnetic field.

The magnetic field produces signals that are detected and processed by a computer into a series of images, each showing a thin slice of the area being examined. The images are used to calculate the exact position of the lump or lesion, and to guide the placement of the needle inserted by the radiologist for the removal of the tissue samples.

Image-guided, minimally invasive procedures such as MRI guided breast biopsy are performed by a specially trained interventional radiologist and are done on an outpatient basis.

Post-Biopsy Instructions

When you leave RAS you'll be wearing a bandage (often this may be an Ace bandage). You will be instructed to wear the bandage for the next 24-48 hours. If you experience bleeding through your bandage, contact the imaging center that provided your service.

For the next 24-48 hours, do not engage in strenuous activities, especially those that involve movement of the chest and arms.

If you need to take pain medicine during the next 48 hours, use acetaminophen products, such as Tylenol. Do not use aspirin or ibuprofen products, such as Advil or Motrin, as it may increase the risk of bleeding; these products can be resumed 48 hours after the procedure.

Do not bathe or shower until the bandage has been removed.

You may shower carefully with the Steri-strips in place;do not remove the Steri-strips – they will lift up and fall off on their own. This could take up to a week.

Over the next few days, if you develop any signs of infection, such as redness, drainage, fever, severe pain or swelling, contact the RAS at the site that provided your service.

If you take anti-anxiety medication prior to your procedure, you must arrange for escorted transportation upon discharge.

Pathology Results

After a breast biopsy a pathologist conducts tests on the tissue submitted for evaluation. The pathologist issues a detailed report of the findings to your physician.

The pathology report helps your physicians determine which treatment options are best for you. Patients may ask for a copy of the pathology report to review or for second opinion consultation.

The pathology report varies, but generally includes information about diagnosis and hormone receptor status. If pathology indicates the cancer is hormone receptor positive, this will help the physician determine whether hormonal therapy may be a beneficial part of  treatment.