Ultrasound and Breast Biopsies
Biopsy Site Markers
At the time of the breast biopsy procedures noted, a tiny stainless steel marker or clip may be placed in your breast at the biopsy site.
This is done so that if your biopsy shows cancer cells or precancerous cells, your doctor or surgeon can locate the biopsy area to remove more breast tissue surgically (known as the surgical biopsy).
If your lesion is benign and does not require surgery the marker remains in place and is present on all follow-up imaging showing that it has been previously histologically assessed.
What happens after a biopsy?
With all types of breast biopsies, except a surgical biopsy, you'll go home with only bandages and an ice pack over the biopsy site. Although you should take it easy for the rest of the day, you'll be able to resume your normal activities within a day. Bruising is common after core needle biopsy procedures. To ease pain and discomfort after a breast biopsy, you may take a non-aspirin containing pain reliever and apply an ice pack to reduce swelling.
If you have a surgical biopsy, you'll likely have stitches (sutures) to care for. You will go home the same day of your procedure and you can resume usual activities the next day. Your health care team will tell you how to protect your stitches.
Understanding Ultrasound and Breast Biopsies
Breast Ultrasounds are performed on patients who are 35 and younger for assessing lumps and to determine the nature of the abnormality. Also after a mammogram procedure, if the radiologist is not satisfied with the images, an ultrasound is performed to suppliment the information obtained to provide a holistic understanding of the breast.
Several breast biopsy procedures are used to obtain a tissue sample from the breast. Your doctor may recommend a particular procedure based on the size, location and other characteristics of the breast abnormality. If it's not clear why you're having one type of biopsy instead of another, ask your doctor to explain.
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Different types of breast biopsies include:
Fine-needle aspiration biopsy
This is the simplest type of breast biopsy and may only be used to empty a cyst, obtain pus from an abscess or assess an abnormal lymph node.
The needle is attached to a syringe that can collect the fluid from the cyst. Fine-needle aspiration is a quick procedure
Core needle biopsy
This type of breast biopsy may be used to assess a breast lump that's visible on a mammogram or ultrasound or that your doctor feels (palpates) during a clinical breast exam.
The radiologist uses a thin, hollow needle to remove tissue samples from the breast mass, using sonar guidance.
Several samples, each about the size of 7mm x 1mm, are collected and sent to the pathologist to analyse and identify features indicating the presence of disease.
This type of biopsy uses mammograms to pinpoint the location of suspicious areas within the breast. For this procedure, you generally lie facedown on a padded biopsy table with one of your breasts positioned in a hole in the table.
You may need to remain in this position for 30 minutes to one hour.
The table is raised several feet, and the equipment used by the radiologist is positioned beneath the table. Your breast is firmly compressed between two plates while mammograms are taken to show the radiologist the exact location of the area for biopsy. The radiologist makes a 4mm incision into your breast.
She then inserts a vacuum-powered probe and removes several samples of tissue. The samples are sent to a lab for analysis.
MRI-guided core needle biopsy
This type of core needle biopsy is done under guidance of an MRI — an imaging technique that captures multiple cross-sectional images of your breast and combines them, using a computer, to generate detailed 3-D pictures. During this procedure, you lie facedown on a padded scanning table.
Your breasts fit into a hollow depression in the table. The MRI machine provides images that help determine the exact location for the biopsy.
A small incision about 1/4-inch long (about 6 millimeters) is made to allow the core needle to be inserted. Several samples of tissue are taken and sent to a lab for analysis.
Surgical biopsy with hook wire localisation
During a surgical biopsy, a portion of the breast mass containing the relevant mass is removed. A surgical biopsy is usually done in an operating room using sedation given through a vein in your hand or arm (intravenously) and a local anesthetic to numb your breast. If the breast mass can't be felt, your radiologist may use a technique called wire localization to map the route to the mass for the surgeon. During wire localization, the tip of a thin wire is positioned within the breast mass or just through it. This is usually done right before surgery.
During surgery, the surgeon will attempt to remove the entire breast mass along with the wire. To help ensure that the entire mass has been removed, the tissue is sent to the hospital lab to confirm whether breast cancer has been detected and if so, the edges (margins) of the mass are evaluated to determine whether cancer cells are present in the margins (positive margins). If cancer cells are present at the margins, you will be scheduled for another surgery so more tissue can be removed. If the margins are clear (negative margins), then the cancer has been removed adequately.