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 biopsy is a technique most often used to guide a breast biopsy when a breast abnormality is visible on ultrasound. It is the simplest and most comfortable form of breast biopsy.
Stereotactic Breast Biopsy
A stereotactic breast biopsy allows for a needle biopsy to be performed on lesions which are more conspicuous on mammography than on ultrasound. This type of biopsy utilizes x-ray images (mammograms) of the breast tissue to guide the biopsy needle to the area of interest. Stereotactic biopsies are most commonly performed on tiny breast calcifications but may also be utilized on breast masses in certain situations.
MR-guided Biopsy
An MR-guided biopsy is the latest development and an important advance in diagnosing breast cancer. It is most useful when an ultrasound or stereotactic-guided biopsy is not appropriate because the area of concern is not well seen by mammogram or ultrasound but is discovered or is most conspicuous on MRI.
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, a local anesthetic is injected into the breast to numb it and contrast material is given intravenously. 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. Using computer software, the radiologist determines the position and depth of the lesion for biopsy. When the tissue sampling is complete, a small marking clip may be left at the site of biopsy, so it can be easily located 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 lying face down on a specially designed table used specifically for breast biopsies. Your breasts are actually positioned through an opening in the table. We will then 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 may 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 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, 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 or malignant diagnosis, they may require a breast MRI to evaluate for extended disease. They’ll also get connected with an oncology patient navigator who will take care of treatment referrals.
Because early detection is key for breast cancer survival, scheduling regular screenings and quick follow-up can put you on track for treatment. Schedule an appointment today for a mammogram.