What is a breast biopsy?
Biopsies are the only definitive way to confirm if breast tissue is benign or cancerous. A Needle biopsy is a safe, minimally invasive procedure used to get a sample from an abnormal breast lesion. Small amounts of breast tissue are removed through a needle, and a pathologist will study the tissue under a microscope and provide a diagnosis. There are various methods in which a needle biopsy can be performed.
Ultrasound-guided Biopsy
An ultrasound-guided breast biopsy uses sound waves to locate a lump or abnormality and remove a tissue sample for examination under a microscope. This procedure is less invasive than a surgical biopsy, leaves little to no scarring, and does not involve exposure to ionizing radiation.
3D Tomosynthesis-guided Breast Biopsy
3D Tomosythesis-guided breast biopsies use low-dose x-rays (mammography) to locate a breast abnormality and remove a tissue sample for examination. 3D Tomosynthesis-guided biopsies use 3D images, which may offer improved visualization, especially in dense breast tissue.
3D is less invasive than a surgical biopsy, leaving little to no scarring and is great for evaluating calcium deposits or tiny masses not visible on ultrasound. Tomosynthesis guided biopsies can be performed on mammographic lesions such as calcifications, masses or architectural distortions.
MR-guided Biopsy
An MR-guided breast biopsy uses a powerful magnetic field, radio waves, and a computer to locate a breast lump or abnormality and guide a needle to remove a tissue sample. It does not use ionizing radiation and leaves little to no scarring.
What happens when there’s a cause for concern?
Candidates for breast biopsy fall into two broad categories: Patients who are experiencing physical symptoms with an abnormal imaging finding, and patients whose routine screening shows a possible sign of disease.
The other population of prospective biopsy patients aren’t experiencing symptoms. However, if the radiologist performing their annual mammogram happens to see an abnormality, they may determine that it merits further evaluation.
Regardless of whether the procedure is prompted by symptoms or a screening, The Iowa Clinic radiologist will discuss what’s next.
“A lot of the times we talk with patients about our degree of suspicion,” The Iowa Clinic Radiologist Dr. Kang says. “Some masses are very suspicious — a ‘cancer until proven otherwise’ type of scenario.”
Even if the spot on a mammogram is most likely benign, because there is always a small overlap of cancer and non-cancerous masses in terms of imaging findings, Dr. Kang says many patients appreciate the reassurance of biopsy results to help reach a more certain diagnosis.
“In our clinic, when we’ve had that discussion and the patient's onboard, we typically schedule either within the same week or the following week for another encounter where we are performing a biopsy,” Dr. Kang says.
What should I expect during a breast biopsy?
When you arrive, you will be asked to complete paperwork regarding your history and symptoms. If it makes you feel more comfortable, you may want a relative or friend to join you to lend support and drive you home.
We realize a biopsy may be an emotionally distressful experience. However, patient comfort — in addition to an accurate diagnosis — is our priority. Our radiologists and staff are trained to make this procedure as comfortable and quick as possible. Keep in mind that more than 80 percent of all breast abnormalities are benign or non-cancerous.
A needle biopsy can be performed with local anesthetic and minimal discomfort. With this procedure, no stitches are required and most women can resume normal daily activity immediately.
Please:
- prior to your appointment, let the staff know if you are taking any blood thinners.
- wear a supportive bra to help maintain the post-biopsy dressing.
- wear a two-piece outfit, preferably one that buttons up the front.
- do not change your eating habit.
- do not eat a large meal immediately prior to the exam.
- arrive about 30 minutes before your appointment.
If you have minor claustrophobia or anxiety, you may want to ask your physician for a prescription for a mild sedative. Do not take this medication prior to your arrival or signing paperwork.
Although there are several types of breast biopsy procedures, The Iowa Clinic Radiologists most frequently choose an ultrasound-guided method, which is the simplest and most comfortable. The goal is to use a mammogram and ultrasound image that correlate together to see that area of concern alongside what’s happening in real-time.
What should I expect during an ultrasound guided biopsy?
You will receive a local anesthetic (lidocaine, which blocks signals at the nerve ending of the skin but doesn’t cause unconsciousness) to prevent any sharp pain at the site of a small incision. You should expect to experience tugging sensation during the procedure, though, which happens while you are lying on your back.
With an ultrasound probe, your radiologist can look at the mass and the needle in real-time and make sure that the needle is in the mass. They then can take samples and look for any potential complications in real-time. If there's any bleeding from the mass that's forming a hematoma, they are able to see them readily with an ultrasound and deal with that.
If the finding on a mammogram (such as a calcification or architectural distortion) doesn’t correlate with an ultrasound, the physician will use the mammographic images to guide a needle to a target area. In this stereotactic or tomosynthesis guided biopsy method, you would be seated in a special mammographic chair while your breast is in compression.
Occasionally, a physician will select a third method—an MRI guided biopsy—to sample the area of concern, if ultrasound or mammography aren’t correlating.
What should I expect during a MR-guided biopsy?
During an MR-guided biopsy, you will be positioned face down on your stomach and your breast(s) will be positioned into a cushioned opening containing a special breast-imaging coil, with a targeting grid placed at either the lateral or medial side of the breast, depending on the location of the target. Both non-contrast and contrast enhanced MR images will be acquired prior to targeting.
Using computer software, the radiologist determines the appropriate position and depth of the lesion for biopsy. A local anesthetic is injected into the breast at the level of the target to numb it. An introducer is placed through the skin, and appropriate positioning is confirmed on additional MRI images. Then, a needle device is inserted through the introducer, and sampling is performed. When the tissue sampling is complete, a small marking clip is left at the site of biopsy, so it can be easily located on a mammogram for future follow up if surgery becomes necessary.
You will be asked to remove all jewelry, since these items disturb MRI signals. It is very important that any prior breast films (mammograms, ultrasound or MRI) be available to the radiologist for comparison. If you have had these at a facility other than Iowa Clinic Medical Imaging, please let us know so we may obtain the films for comparison or bring them with you on the day of your appointment.
Many of the following items are contraindications to having an MRI as they are not compatible with the magnetic field present around all MRI machines. If you have any of the items listed below, call 515.875.9740 so we can make arrangements for you before your appointment.
- Cardiac Pacemaker
- Artificial heart valve prostheses
- Aneurysm clips
- Eye implants or metal ear implants or any metal implants activated electronically, magnetically or mechanically
- Copper 7 IUD
- Shrapnel or non-removed bullet
- Pregnancy
- Weight over 350 lbs
- Claustrophobia
- Any metal puncture(s) or fragment(s) in eye
What should I expect during a stereotactic breast biopsy?
This minimally invasive procedure requires you to be positioned upright, typically on a special chair. We will clean the skin and inject a local anesthetic. A tiny incision less than a quarter of an inch is made without causing any significant alteration in the appearance of the breast. The radiologist will remove several samples of tissue through this incision. When the tissue sampling is complete, a small marking clip will be left at the site of biopsy, so it can be easily located for future follow up if surgery becomes necessary.
What happens after a breast biopsy?
Following the procedure, patients typically experience a little soreness at the site. But you shouldn’t have to wait long for results. Typically, the pathology results come back within around 24 hours. So, if you have a biopsy in late morning, your results should come back by the following afternoon.
Then, your patient navigator or radiologist will call with the biopsy results, to check-in on healing and outline next steps. Less than two percent of patients experience any complications (which might be an infection of hematoma); most are just anxious to have a diagnosis.
Your biopsy results should fall into one of three categories: benign, benign but high risk, cancer, or discordant.
For benign results, Radiologist will most likely recommend that you return to your normal yearly screening mammogram schedule but could alternately recommend a short term 6-month mammogram follow up.
For patients who receive a high risk but benign diagnosis (e.g. radial scar or complex sclerosing lesion), we will refer those patients to our surgeons for further consultation to see if surgical excision of the lesion is appropriate. Otherwise, these patients may return to annual screening or return in 6 months for a short term short-term follow-up.
For patients who receive a malignant diagnosis, we will refer those patients to our surgeons for consultation. These patients may under breast MRI to evaluate for extent of disease. These patients may also be referred to medical oncology and/or radiation oncology if appropriate for their treatment.
Discordant result is when a diagnosis does not match up with what we expect on the imaging. For instance, if a pathology result of a biopsy of a highly suspicious mass is benign, we might call this discordant. Patients with discordant results will be refer to our surgeons to further discuss the case, and to consider surgical excision for a more definitive diagnosis.
Because early detection is key for breast cancer survival, scheduling regular screenings and quick follow-up can put you on track for treatment. Schedule your mammogram appointment today by calling 515.875.9740.