Before the Procedure

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It is important to notify the department or radiology practice:

If you are taking any blood-thinning medication (e.g. Warfarin).

 

The radiologist performing the procedure may need to liaise with your other doctors to determine if it is safe or necessary to temporarily discontinue your medication.  If you are taking aspirin, usually this can be continued, however, the risk of bruising is moderately increased.

If you are, or could be, pregnant.

 

A small dose of radiation (X-ray) is used in the mammogram taking images for the biopsy. Whilst this is very unlikely to cause damage to a developing baby (or foetus), it is useful to discuss these low risks with your referring doctor and radiologist. It is important to take any previous breast imaging (e.g. mammogram, ultrasound, MRI) to the hospital department or radiology practice before the day of your procedure. This ensures that. the mammographer, who will take the images throughout the procedure, and the radiologist, have all the images they need to perform the vacuum-assisted core biopsy procedure.

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On the day of the Procedure

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Avoid deodorant. If the biopsy is to be performed under mammogram (X-ray) guidance, deodorant can mimic or imitate the calcium spots in the breast that are to be biopsied, which makes it harder for the radiologist to identify the abnormality that requires biopsy. Wear a two piece, comfortable outfit as you will need to remove the clothing on your upper body. Usually, you will be given a gown to wear during the procedure.

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The majority of breast abnormalities (small calcium spots or small masses) that will require a vacuum-assisted core biopsy, are only visible on a mammogram. To be able to perform the biopsy procedure, a special mammogram machine will be used to locate the area of abnormality within the breast.

In the procedure room you will usually be asked to lie on a stereotactic prone table, on your stomach. The table has a hole through which the breast is placed. The table will be raised as underneath this table is a special mammogram machine and biopsy device. This allows the radiologist and mammographer to comfortably work below the table.

Occasionally, this procedure may be performed using an “upright” mammogram unit. This requires you to sit in a chair. Whether you are lying down or sitting, the breast will be placed between the two compression plates of the mammogram unit (just like a normal mammogram) and a series of X-rays will be taken to locate the area of abnormality.

Once you are positioned and the area of abnormality is located, you will be asked not to move, as even slight movement (e.g. turning your head) can move the area where the abnormality has been found out of the biopsy field or view. 

 

After some initial images have been taken, the overlying skin will be cleansed with antiseptic. A local anaesthetic will be injected into the skin and breast tissue. This may cause a stinging sensation which can last for a few seconds. Following this, you may feel the radiologist touching the breast and a pushing sensation. This is normal and you should not feel significant pain.

Repeat pictures or images are taken at this stage (and at other stages) of the procedure to confirm the correct positioning of the biopsy site and needle. A small (3-4 mm) incision is made in the anaesthetised skin and the needle inserted. When the needle takes the tissue samples it may make a “whirring” or “clicking” sound.

When the radiologist is satisfied that enough samples have been taken, a small titanium (strong, lightweight metal) marker clip (2 mm) may be inserted into the breast via the biopsy needle. This is done so that the area of abnormality can be located at a later date if surgery is required. If inserted, the clip is safe, cannot be felt, and does not need to be removed. Once the needle is removed, a sterile dressing will be applied to the breast. Usually, no stitches are required. Instructions on when to remove the dressing will be given to you before you leave.

Vacuum-assisted core biopsies may be performed under ultrasound guidance, instead of a mammogram. This procedure is the same as described above, except that you will be required to lie on your back on an ultrasound bed. The breast will not be placed between mammogram compression plates.

Vacuum-assisted core biopsies can also be performed under MRI guidance. A needle will be placed into your arm and a liquid dye or contrast medium may be injected during the scan. You will be asked to lie on your stomach in the MRI scanner and your breast will be lightly compressed between two plates (similar to a mammogram). The remainder of the procedure will be similar to that described above.

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