When a mammogram or ultrasound shows an abnormality that is either suspicious for cancer or is not clearly benign, a biopsy may need to be performed. A biopsy may be needed for one of the following reasons:
- A mammogram or ultrasound shows a suspicious mass that may or may not be felt by physical breast examination
- A mammogram shows a suspicious cluster of small calcium deposits
- The structure of your breast tissue is distorted or has changed unexpectedly
- A new mass or area of calcium deposits is present at a previous surgery site
- A lymph node is abnormal
We offer minimally invasive, image-guided core biopsies using stereotactic mammography, sonography, and magnetic resonance imaging (MRI) to guide the sampling of tissue, making the process faster and more accurate. As their names suggest, the major difference between the diagnostic biopsies is the method of imaging used to target the area of concern.
A pathologist evaluates these tissue samples to determine the type of tissue in the abnormality and, if needed, diagnose the type of breast cancer. Radiologists dedicated to breast imaging and breast care perform all diagnostic biopsies.
Before imaging technology was available, patients with abnormal mammograms were sent to a surgeon for a surgical biopsy. Surgical biopsy requires a larger incision and removes a greater amount of tissue than stereotactic, ultrasound-guided, and MRI-guided core biopsies. Today surgical biopsy is used primarily to treat women whose diagnostic biopsies show cancer in the breast.
Sterotactic or X -ray-guided biopsies are performed when the abnormality is unable to be visualized on ultrasound. In a stereotactic biopsy, you lay on your stomach with your breast hanging through a hole while multiple mammograms are taken from different angles to visualize the abnormal area. Computer imaging uses different angles to target the exact site of the abnormalities. Throughout your procedure, additional views are taken to ensure the correct location is sampled.
In ultrasound imaging, also called ultrasound scanning or sonography, high-frequency sound waves produce real-time pictures of your breast tissue. Ultrasound exams do not use ionizing radiation (X -ray). Ultrasound images are captured in real-time, so they can show the structure and movement of your body tissue as well as blood flowing through your vessels. In an ultrasound-guided biopsy, you lay on your back while your radiologist uses these real-time images to guide the probe to the abnormality.
Magnetic resonance imaging (MRI) is the newest and most advanced type of breast imaging. MRI uses a combination of magnetic and radio waves to create three dimensional images of your breast. MRI-guided biopsies are performed when you are lying on your stomach with your breast hanging next to a grid. After the MRI scan is obtained, your radiologist uses the grid in the image to locate and biopsy the area in question. Because your radiologist uses the MRI scan as a guide, you must lie entirely still for both the scan and biopsy procedure. This combined procedure can last up to two hours.
Preparing for a Biopsy Exam
If you are having a breast biopsy, please arrive 30 minutes before your appointment time. Bring your insurance or welfare identification cards. You will be asked to undress from the waist up, so you may feel more comfortable in a two-piece outfit. While there is no extensive preparation necessary for the procedure, please be sure to eat a good breakfast before you arrive. If you are taking Aspirin, may be asked to stop taking it a few days before the procedure because it’s a blood thinner.The biopsy itself takes about 20 minutes, but if you add in the preparation time and post-procedure care, it can take a little more than an hour.
During the procedure, your radiologist will numb the area with an anesthetic. The radiologist will then make a small incision in your skin and (using imaging as a guide) insert the probe into your breast. Once the probe is in place, a vacuum attached to the probe will suck a small piece of tissue into the probe. The probe will then core out a small piece of tissue. The probe can rotate automatically and take tissue samples from different areas without having to be reinserted with another incision.
At the end of the procedure, the radiologist may insert a tiny titanium or stainless steel marker to identify the exact biopsy location for future imaging. This marker is too tiny to be felt and can only be detected by mammogram.
Your radiologist may also order a mammogram at the end of the procedure. This is to ensure that correct area was sampled and to check for internal bleeding.
After the procedure, you can drive yourself home or back to work. While you can return to work if your job is not strenuous, it is not recommended. For 24 hours after the procedure, limit strenuous activities such as heavy lifting or pulling. Keep the area of your incision clean and dry and apply ice to your breast for the rest of the day. Our team will wrap your entire chest with a tight bandage called Coban to limit tissue movement and minimize pain and bruising. Take acetaminophen (Tylenol®) or pain-relievers other than aspirin for any pain or discomfort. Our experienced breast coordinator will give you detailed, written care information after the procedure.
The results of your biopsy will be available within 24 to 48 hours of the procedure. Either the radiologist or breast-care coordinator will notify you of your results.
Six months after your procedure you will be called back for a follow-up mammogram. This mammogram, taken after your breast is fully healed, establishes a new baseline and will be used as a comparison for future screenings.