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Biopsies: Why And What To Expect.

Suspicious areas detected on mammography or ultrasound may require a biopsy to determine if the lesion is benign (not cancer) or cancerous. Biopsies can be performed by surgical or non-surgical approaches. Non-surgical approaches are also called core biopsies and are less invasive than surgical approaches. For this reason, the core biopsy procedure is the preferred method of choice.

The results of the biopsy can not be determined at the time of the biopsy. Once the tissue is removed, the sample(s) are sent to the pathology department to classify and characterize the tissue.

What is an ultrasound guided cyst aspiration?

When a complex cyst is identified within the breast at the time of ultrasonographic evaluation then further evaluation with a cyst aspiration may be warranted. During the cyst aspiration procedure, the patient will lie on her back, the breast will be cleansed and a small amount of local anesthesia administered. Then, a small needle will be introduced into the the breast to remove the fluid within the complex cyst. If the fluid is unable to be removed or the fluid removed has a concerning appearance, then further evaluation with an ultrasound guided core biopsy would be performed. If the fluid drained from the cyst has a suspicious appearance, then further characterization of the fluid from the cytology lab may be indicated.

What is an ultrasound guided breast biopsy?

When a suspicious abnormality is best seen on ultrasound, then further evaluation with an ultrasound guided core biopsy is often recommended. The core biopsy technique uses a small hollow needle to take samples of the breast while using ultrasound to identify the target and provide guidance during the procedure.  During the ultrasound core biopsy, patients lie on their back; after cleansing the breast, a small amount of local anesthesia is administered to minimize any discomfort. A small hollow needle is then placed into the breast with ultrasound guidance and a few samples of breast tissue are retrieved and sent to the pathology lab for further characterization.

What is Stereotactic guided breast biopsy?

If a finding is best seen on mammography and is found to be approachable with a needle biopsy then further characterization of the lesion with a stereotactic biopsy may be recommended. This is commonly performed to evaluate developing clusters of microcalcifications but can also be performed for other findings.

During a stereotactic breast biopsy, a specially designed examination table will allow the patient to lie face down with her breast hanging freely through an opening in the table. The table is then raised and the biopsy procedure is performed beneath the table. The breast will be cleansed and a small amount of local anesthesia delivered to minimize discomfort. A special mammography machine uses x-rays to pinpoint the area of concern in all three dimensions. The radiologist is then able to target the area of concern with a hollow needle and remove small samples of tissue.

Stereotactic biopsies can be limited when lesions are found in areas of the breast which are not approachable or if the breast tissue size and contour are not adequate. At NCWIC, we use the state of the art Hologic Eviva device which quickly removes tissue and often allows for core biopsies to be performed in women with smaller breasts who traditionally, would require surgical excision. 

What is Wire localization?

When an area of concern is not approachable by core biopsy or when there is a high risk lesion or cancer identified on core biopsy, then further surgical evaluation may be indicated. The surgical evaluation is often preceded with placement of a thin wire into the breast by the radiologist to target the breast tissue requiring surgical intervention. During surgery, the wire guides the surgeon to the exact site of the abnormality allowing for removal of only the breast tissue in the indicated area of concern.

Needle localization can be mammographically or ultrasonographically guided depending on the characteristics of the finding. During the mammographic guided needle localization procedure, the patient is typically lying on her stomach and the breast is compressed. Whereas during ultrasonographic guidance, the patient is lying on her back and the breast is not compressed. Whether mammographic or ultrasonographic,  imaging is used to guide the placement of the wire. Prior to placement, the breast will be cleaned and local anesthetic will be administered to minimize any discomfort.  Documentation of accurate needle placement is confirmed by imaging and a thin wire is placed through the needle into the breast. The needle is then removed leaving the wire secure within the breast.

How do I prepare?

Before the procedure:

We request that you discontinue any "over the counter" blood thinners (including aspirin or ibuprofen products such as Bayer aspirin and Advil) one week prior to the biopsy. If you are routinely prescribed blood thinners such as coumadin for other known health conditions, please consult with the prescribing physician prior to the biopsy and inform the NCWIC staff. Additionally, please let us know if you have any known allergies or reactions to medications or anesthesia.

Eat and drink as you normally would.* Wear comfortable clothing. Inform the breast center if you have excessive coughing or other reasons why it would be difficult for you to remain recumbent and still during the procedure.

After the procedure: 

You should avoid strenuous activity for 24 hours after returning home, but then usually you will be able to resume normal activities.

You should contact your physician if you experience excessive swelling, bleeding, drainage, redness or heat in the breast.

*These guidelines are specifically for radiologic procedures. Please speak to your surgeon regarding preparation for any surgical procedures.

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