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Breast Biopsy

Percutaneous breast biopsies are procedures used to sample suspicious breast tissue so it can be examined by a pathologist for the presence of cancer. Biopsies can be performed using Ultrasound, Stereotactic (Mammographic) or MRI guidance. Either method is a quick, non-surgical office based procedure. The ease and safety of these procedures, typically performed during a brief office visit, are well-documented. These modern procedures provide the same reliability as the more complicated surgical biopsy, but provide these significant advantages:

  • Does not require general anesthesia
  • Requires less time
  • More cost effective
  • Less complicated

Ultrasound Guided PROCEDURES

Ultrasound-guided breast procedures are an accurate way of sampling breast tissue or cells from suspicious or indeterminate breast abnormalities that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. With an ultrasound-guided biopsy there is no radiation exposure from using x-rays. A single site or multiple sites may be sampled. There are several types of ultrasound-guided breast sampling procedures: core needle biopsies, fine needle aspirations and cyst aspirations.

Core Needle Biopsy
If a suspicious or indeterminate area is found in the breast by ultrasound, the radiologist will place an ultrasound probe over the site and sterilize the overlying skin with iodine-based soap. Local anesthesia will be administered with a small needle, a small nick will be made in the skin and a biopsy needle will be inserted directly into the mass. Tissue specimens are then taken using either a spring-loaded or vacuum-assisted device. A tiny titanium clip will be inserted into the biopsy area to show from where the tissue was sampled in case further future surgery is needed (if the tissue is cancerous) or to prevent repeat unnecessary biopsies (if the tissue is not cancerous). You may experience some pressure or mild discomfort during the exam, and afterward as the local anesthesia wears off. There is no suturing needed after a percutaneous breast biopsy because the incision is so small. The tissue samples that were removed will be assessed in a pathology lab, where a pathologist will look at the samples under a microscope and create a pathology report. Information such as the location of each biopsy, the tissue diagnosis and whether or not the tissue is cancerous are included in this report.

At the end of the procedure, pressure will be applied to the site to curtail any excessive bleeding. Bandages and an ice pack are placed over the affected area. Shortly afterward, you will be sent home. The remainder of the day should be spent refraining from any strenuous activity and for the next 48 hours. Bruising and discomfort may occur after a breast biopsy; Tylenol is usually sufficient to alleviate any residual aches or tenderness.

To prepare for a core needle biopsy, wear a two-piece outfit and a good support bra. There are no restrictions on eating, and you can drive yourself to and from the procedure. Do not use powder, perfume or deodorant under your arms or on your breasts. Avoid aspirin, ibuprofen (i.e. Advil, Motrin, Aleve), fish oil and Vitamin E products for approximately 1 week prior to the procedure. You may take Tylenol and any other medication as you normally do.

Fine Needle Aspirations (FNA)
If a suspicious or indeterminate area is found in the axilla (armpit) or in a technically challenging area in the breast by ultrasound, the radiologist will place the ultrasound probe over the site and sterilize the overlying skin with iodine-based soap. Local anesthesia will be administered with a small needle. A tiny needle will then be inserted into the area and agitated to dislodge cells into a syringe. The cells will be smeared onto a microscope slide(s) and sent to a pathology lab, where a pathologist will assess the cells under a microscope and create a pathology report. Unlike a core needle biopsy, a fine needle aspiration will not give a tissue diagnosis, it can only tell whether or not cells obtained are cancerous. A limitation of this procedure is the high rate of insufficient sampling in which case not enough cells were obtained to assess whether or not they are cancerous.

At the end of the procedure, a band-aid will be placed over the area and you will be sent home. You can resume normal activities immediately. Slight bruising and discomfort may occur; Tylenol is usually sufficient to alleviate any residual aches or tenderness.

To prepare for a fine needle aspiration, wear a two-piece outfit and a good support bra. There are no restrictions on eating, and you can drive yourself to and from the procedure. Do not use powder, perfume or deodorant under your arms or on your breasts. You may take any medication as you normally do.

Cyst Aspirations
Cysts are benign fluid collections that many women have in their breasts. They are not cancer. Sometimes they can cause discomfort and be painful to the patient and sometimes they can have some indeterminate features on ultrasound. If either of these is the case, the radiologist will recommend a cyst aspiration. The radiologist will place the ultrasound probe over the site and sterilize the overlying skin with iodine-based soap. Local anesthesia will be administered with a small needle. A tiny needle will then be inserted into the cyst and the fluid will be drained into a syringe. The fluid will only be sent to a pathologist if it looks suspicious.

At the end of the procedure, a band-aid will be placed over the area and you will be sent home. You can resume normal activities immediately. Slight bruising and discomfort may occur; Tylenol is usually sufficient to alleviate any residual aches or tenderness.

To prepare for a cyst aspiration, wear a two-piece outfit and a good support bra. There are no restrictions on eating, and you can drive yourself to and from the procedure. Do not use powder, perfume or deodorant under your arms or on your breasts. You may take any medication as you normally do.

Stereotactic-Guided Core Needle Breast Biopsies

 

Hartsdale Imaging Breast Biopsy

Stereotactic (mammographic)-guided breast procedures are an accurate way of sampling breast tissue from suspicious or indeterminate breast abnormalities that are visible on a mammogram, whether or not they can be felt on breast self-examination or clinical examination. There is a small amount of radiation exposure from using x-rays. A single site or multiple sites may be sampled.

You will be positioned as comfortable as possible on your abdomen on a special mammogram table. When you are lying down, your breast will be gently placed through an opening in the table. Once you are in position, your breast will be held in place with light compression. It is VERY IMPORTANT that you REMAIN STILL once you are in position. Any movement may cause the radiologist to miss the area in question. You will be asked to hold your breath as X-ray/mammogram pictures are taken. This is to verify the location of the area to be sampled. The radiologist will review the images and a computer will be used to locate the precise area of your breast tissue to be sampled. Again it is VERY IMPORTANT that you REMAIN STILL during the procedure. The radiologist will sterilize the overlying skin with an iodine-based soap and will administer local anesthesia with a small needle. A small nick will be made in the skin and the biopsy device will be inserted. Several more X-ray/mammogram pictures will be taken, and then when the biopsy is ready to begin, you will hear the sound of a little motor (like the sound of an electric toothbrush) as the samples are being removed. Tissue specimens are taken using vacuum pressure without having to remove the biopsy needle after each specimen. You may feel some slight pressure during this time, but it is important to relax, as it is rarely painful. Once the breast tissue samples are obtained, they may be X-rayed to determine adequacy. If the samples are deemed adequate, a tiny titanium clip will be inserted into the biopsy area to show from where the tissue was sampled in case further future surgery is needed (if the tissue is cancerous) or to prevent repeat unnecessary biopsies (if the tissue is not cancerous). At this point, a final X-ray/mammogram will be taken while you are still on the table. You may experience some pressure or mild discomfort during the exam, and afterward as the local anesthesia wears off. There is no suturing needed after a percutaneous breast biopsy because the incision is so small. The tissue samples that were removed will be assessed in a pathology lab, where a pathologist will assess the samples under a microscope and create a pathology report. Information such as the location of each biopsy, the tissue diagnosis and whether or not the tissue is cancerous are included in this report.

At the end of the procedure, pressure will be applied to the site to curtail any excessive bleeding. Bandages and an ice pack are placed over the affected area. You will receive one more mammogram for a final check to make sure the correct site was sampled and the clip is where it is supposed to be. Shortly afterward, you will be sent home. The remainder of the day should be spent refraining from any strenuous activity and for the next 48 hours. Bruising and discomfort may occur after a breast biopsy; Tylenol is usually sufficient to alleviate any residual aches or tenderness.

To prepare for a core needle biopsy, wear a two-piece outfit and a good support bra. There are no restrictions on eating, and you can drive yourself to and from the procedure. Do not use powder, perfume or deodorant under your arms or on your breasts. Avoid aspirin, ibuprofen (i.e. Advil, Motrin, Aleve), fish oil and Vitamin E products for approximately 1 week prior to the procedure. You may take Tylenol and any other medication as you normally do.

Breast MRI

Breast MRI is the most sensitive breast cancer screening tool currently available. It offers valuable information about many breast conditions that cannot be obtained by other imaging modalities, such as mammography or ultrasound without using radiation or breast compression.

It may be used for the following indications:

  • For women at high risk for breast cancer, typically because of family history
  • Patients diagnosed with new breast cancer to determine how large the cancer is, whether it has spread to the lymph nodes, and to check the other breast
  • Tumor characterization when mammography and ultrasound are inconclusive
  • Evaluating scars tissue after breast surgery
  • To determine the effectiveness of chemotherapy
  • To screen patients with breast implants for rupture

MRI Guided Breast Biopsy

Sometimes breast MRI finds lesions not visible on mammography or ultrasound. If suspicious, a needle biopsy is needed to make a diagnosis, and MRI is used to guide the needle to the lesion.

Patients are awake during the procedure and usually have very little discomfort. A local anesthetic is injected to numb the area of the breast. A small incision is made in the skin. MRI imaging is performed while inserting a vacuum powered biopsy instrument into the breast. Samples of tissue are removed through the inside of the needle. At the end of the procedure, a tiny metal marker is placed at the biopsy site in the breast for future reference. The marker will not cause any pain, disfigurement or harm and it is MRI compatible and will not cause metal detectors to go off. The procedure is usually completed in under an hour with little or no scarring. We recommend avoiding strenuous activities for 24 hours after the procedure.

Breast Biopsy | Yonkers