Image Guided Breast Biopsy

Breast biopsies are generally performed when an abnormal mass or lump has been found in the breast. A biopsy is the most definitive way to determine if the lump is cancerous, as imaging studies alone cannot provide a specific diagnosis on which to decide treatment options.

During a biopsy, a small amount of tissue is removed from the abnormal area with a needle or similar instrument so a pathologist can examine the material for malignant cells. Radiologists use image guidance (ultrasound, CT, MRI, or mammography) in performing biopsies to obtain tissue from the right spot and to avoid injuring important nearby body parts.

There are several image guided breast biopsy procedures available, most of which can be performed on an outpatient basis using local anesthetic. These procedures allow a radiologist to access the abnormal tissue without surgery, but with the same or even better accuracy than a surgical biopsy. INVISION radiologists have great success in precisely sampling breast lumps and abnormalities that can be visualized with imaging technology. The specific type of biopsy chosen by your doctor will depend on the location of the lump and other circumstances.

This page contains the following information about biopsies:

Reasons for Having an Image Guided Breast Biopsy

A breast biopsy is used to definitively determine if a growth or lump is cancer or not.

Reasons for choosing an image guided rather than a surgical biopsy include:

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Types of Imaging Guided Breast Biopsies

Following are the breast biopsies performed by INVISION radiologists:

Biopsy Type Description
Needle Core
  • Uses ultrasound or CT guidance for accurate placement of the needle
  • A marker is left at the location of the biopsy
Ultrasound Guided Vacuum Assisted
  • Is a type of core biopsy that uses a special needle with a vacuum attachment to extract tissue
  • Uses ultrasound guidance for accurate placement of the needle
  • A marker is left at the location of the biopsy
Stereotactically Guided Vacuum Assisted
  • Is a type of core biopsy that uses a special needle with a vacuum attachment to extract tissue
  • Uses computerized mammography for accurate placement of the needle
  • Used for evaluating calcium deposits seen on mammography and tiny abnormal masses
  • A marker is left at the location of the biopsy
MRI Guided Intervention
  • Requires an MRI exam with contrast injection
  • Used to investigate breast abnormalities seen by MRI that can not be visualized by ultrasound
  • Can perform either a needle localization or a biopsy with a vacuum assisted device
  • A marker is left at the location of the biopsy
Needle Localization for Surgical Excisional Breast Biopsy
  • May be done prior to a surgical biopsy to mark the location of the abnormal tissue for the surgeon
  • Uses ultrasound or x-ray guidance for accurate placement of localization wires
  • Allows the surgeon to more accurately remove a smaller amount of tissue for examination
  • Needle localization is performed by INVISION radiologists, but surgical biopsies are not
Needle Localization for Sentinel Node Breast Biopsy
  • May be done prior to a surgical sentinel node biopsy to mark the location of the sentinel node(s) for the surgeon
  • Allows the surgeon to remove fewer lymph nodes to test for the spread of breast cancer
  • Uses a small amount of radioactive tracer to help identify the sentinel node(s)
  • Uses ultrasound to evaluate the lymph nodes and guide placement of the localization wires
  • Needle localization is performed by INVISION radiologists, but the surgical sentinel node biopsy is performed by the surgeon

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Risks Involved in This Procedure

Since the skin is penetrated during the biopsy, there is a slight risk of bleeding and infection.

A potential risk is that the tissue sample may not be adequate for a diagnosis, requiring additional measures to be taken (i.e. additional sampling or surgical excision). In women with implants, there is a risk of rupture. Both of these risks are very small when imaging guidance is used to collect the specimen.

Other risks vary by biopsy type.

Stereotactically Guided Vacuum Assisted

Additional risks for this biopsy type include:

Ultrasound Guided Vacuum Assisted

Additional risks for this biopsy type include:

MRI Guided Intervention

Since some MRI scanners are enclosed, claustrophobic patients may be uncomfortable. It is possible that any undetected metal implants can be affected by the magnetic field or that they can interfere with the readability of the images. Additionally, a reaction to the contrast medium used for the procedure is possible; however, it is very rare.

Conditions to Let Our Doctor Know About

In advance of your exam, let your INVISION radiologist or technologist know if any of the following circumstances apply to you:

MRI Guided Intervention

For an MRI Guided Intervention, in addition to the conditions listed above, also let your INVISION radiologist or technologist know if any of the following apply to you:

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Insurance Coverage

Biopsies of the breast are usually covered by insurance. Check with your insurance carrier to be sure. Please bring your insurance card with you to your procedure.

Procedure Locations

Breast biopsies are performed at the following INVISION location in the Denver, Colorado area.

Scheduling an Image Guided Breast Biopsy

To schedule a breast biopsy, please call 720-493-3225.

Preparation Guidelines

Following are the preparation guidelines for biopsies of the breast. If you have any questions, please contact us at the same telephone number used to schedule your appointment.

Biopsy Type Preparation
All Biopsies
  • Wear comfortable clothes with a separate top and bottom.
  • Do not wear talcum powder, deodorant, lotion, or perfume at the location of the biopsy.
  • Remove all jewelry.
  • Do not take blood thinning medications, including aspirin, for 4 days prior to the procedure. (Check with your doctor to ensure it’s safe.)
  • Notify your doctor of any conditions you have under the Conditions to Let Your Doctor Know About section.
  • Bring any images and reports you have that were not done by INVISION.
Needle Core Everything under “All Biopsies” and the following:

  • Bring a sports bra or another very supportive bra.
Ultrasound or Stereotactically Guided Vacuum Assisted Everything under “All Biopsies” and the following:

  • Bring a sports bra or another very supportive bra.
MRI Guided Intervention Everything under “All Biopsies” and the following:

  • Bring a sports bra or another very supportive bra.
  • Take all prescribed medications.
  • Do not wear eye makeup.

For MRI needle localization, obtain additional instructions from your surgeon.
Needle Localization for Surgical Excisional or Sentinel Node Biopsy Obtain preparation instructions from your surgeon.

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What to Expect During Your Procedure

Prior to the date of the procedure, you may have to receive pre-procedure exams, such as an ultrasound, MRI or CT scan.

When you come in for the procedure, a nurse or technologist will answer any questions you have. You will fill out paperwork and consent forms so the radiologist will know your medical history. You may need to change into a gown. The radiologist who will perform the biopsy will then meet you to further discuss the procedure and answer your questions. A technologist will position you on a table in a manner that’s appropriate for the type of biopsy being performed.

Following is additional information for specific breast biopsies:

Needle Core

The radiologist will use ultrasound to locate the abnormal tissue. The site of the biopsy will be cleansed and anesthetized to minimize pain. A small incision, about 1/8 of an inch long, will be made in the skin above the area to be biopsied. While watching the ultrasound monitor, the radiologist will carefully insert a small biopsy needle into the abnormal tissue. A spring-loaded device within the needle will remove a small sample of tissue. The needle will be removed and reinserted from different angles. Altogether, 3-7 samples will be taken, all through the same incision.

The device will make a clicking sound when the sample is taken. You should not feel any pain; just pressure.

A tiny marker (2 mm wide) will be placed at the site where tissue was removed. There may be no visible landmarks left in the breast to identify the problem area, as sometimes most of the abnormal tissue is removed during the biopsy. Before the incision is bandaged, a light touch mammogram will be done to confirm the removal of abnormal tissue and that the marker is visible and in the correct location. The marker cannot be felt, will not set off metal detectors, and is not a problem or contraindication for future MRI exams.

If cancer is found and more tissue must be removed from the breast, the marker will help the surgeon identify the specific area where tissue should be removed. This can minimize the amount of healthy tissue removed from the breast during surgery. If surgery isn’t necessary, the marker will show up on future mammograms to let the radiologist know where the biopsy was done.

The incision will be cleaned and taped and a pressure dressing is applied. You will then change back into your clothes, if necessary.

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Ultrasound Guided Vacuum Assisted

The radiologist will apply gel to the breast and use ultrasound to see a continuous image of the area on an ultrasound monitor. Using the ultrasound image, the radiologist will determine the area that must be biopsied. That area will be cleansed and anesthetized to minimize pain. The radiologist will then make a small incision. While watching the ultrasound image, the radiologist will carefully insert the biopsy needle through the incision until it is next to the abnormal tissue. The biopsy needle will be rotated to sample the tissue and then be removed.

With this type of biopsy, the needle is only inserted once and is directed by the radiologist and ultrasound images to take tissue from the abnormal area. You should not feel any pain; just pressure.

A tiny marker (2 mm wide) will be placed at the site where tissue was removed. There may be no visible landmarks left in the breast to identify the problem area, as sometimes most of the abnormal tissue is removed during the biopsy. Before the incision is bandaged, a light touch mammogram will be done to confirm the removal of abnormal tissue and that the marker is visible and in the correct location. The marker cannot be felt, will not set off metal detectors, and is not a problem or contraindication for future MRI exams.

The incision is then cleaned and taped and a pressure dressing is applied. This procedure generally takes less than an hour.

If cancer is found and more tissue must be removed from the breast, the marker will help the surgeon identify the specific area where tissue should be removed. This can minimize the amount of healthy tissue removed from the breast during surgery. If surgery isn’t necessary, the marker will show up on future mammograms to let the radiologist know where the biopsy was done.

Stereotactically Guided Vacuum Assisted

With this procedure, you must lie on your stomach. Your breast will be positioned through an opening in the table and will be moderately compressed (similarly to a mammogram). A computerized mammography machine will take images from two angles to determine the exact location of the abnormality within the breast. The radiologist uses this information to determine where the biopsy needle should be inserted.

The site of the biopsy will be cleansed and anesthetized to minimize pain. A small incision will be made in the skin. The radiologist will then carefully insert a biopsy needle through the incision until it is next to the abnormal tissue. Additional digital mammograms are taken so the radiologist can check the placement of the needle. It is then rotated to sample the tissue. After enough tissue has been collected, it will be removed.

A tiny marker (2 mm wide) will be placed at the site where tissue was removed. There may be no visible landmarks left in the breast to identify the problem area, as sometimes most of the abnormal tissue is removed during the biopsy. Before the incision is bandaged, a light touch mammogram will be done to confirm the removal of abnormal tissue and that the marker is visible and in the correct location. The marker cannot be felt, will not set off metal detectors, and is not a problem or contraindication for future MRI exams.

The incision is then cleaned and taped and a pressure dressing is applied. This procedure generally takes 30-60 minutes.

If cancer is found and more tissue must be removed from the breast, the marker will help the surgeon identify the specific area where tissue should be removed. This can minimize the amount of healthy tissue removed from the breast during surgery. If surgery isn’t necessary, the marker will show up on future mammograms to let the radiologist know where the biopsy was done.

MRI Guided Intervention

With this procedure, you must lie on your stomach. Your breast will be positioned through an opening in the table and will be moderately compressed (similarly to a mammogram). The table will slide into an MRI scanner and several images will be taken to determine the exact location of the abnormality within the breast. The radiologist uses this information to determine where the biopsy needle should be inserted.

The site of the biopsy will be cleansed and anesthetized to minimize pain. A small incision will be made in the skin. The radiologist will then carefully insert a biopsy needle through the incision until it is next to the abnormal tissue. Additional MRI images are taken so the radiologist can check the placement of the needle. It is then rotated to sample the tissue. After enough tissue has been collected, it will be removed.

A tiny marker (2 mm wide) will be placed at the site where tissue was removed. There may be no visible landmarks left in the breast to identify the problem area, as sometimes most of the abnormal tissue is removed during the biopsy. Before the incision is bandaged, a light touch mammogram will be done to confirm the removal of abnormal tissue and that the marker is visible and in the correct location. The marker cannot be felt, will not set off metal detectors, and is not a problem or contraindication for future MRI exams.

The incision is then cleaned and taped and a pressure dressing is applied. This procedure generally takes 30-60 minutes.

If cancer is found and more tissue must be removed from the breast, the marker will help the surgeon identify the specific area where tissue should be removed. This can minimize the amount of healthy tissue removed from the breast during surgery. If surgery isn’t necessary, the marker will show up on future mammograms to let the radiologist know where the biopsy was done.

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Needle Localization for Surgical Excisional Breast Biopsy

Needle localization may be done at a Sally Jobe/INVISION location or in the outpatient facility of an RIA partner hospital just prior to surgery. The area to be localized will be cleansed and anesthetized. The radiologist will use ultrasound or mammography images to carefully place a wire through the skin into the abnormal tissue. You should not feel any pain.

The radiologist will take a mammogram to ensure the wire is properly placed. A bandage will be loosely taped over the area.

You will then go the operating room where the surgeon will perform the surgical biopsy.

Needle Localization for Sentinel Node Breast Biopsy

Needle localization for a sentinel node biopsy may be done at an INVISION Breast Network location or in the outpatient facility of an RIA partner hospital. This process begins approximately three hours before the scheduled surgery time.

The skin over the area to be localized will be cleansed and anesthetized. A solution containing a radioactive tracer will be injected near the lump. You will wait an hour for the solution to enter your lymph system. You will then undergo lymphoscintigraphy. With this exam, a gamma camera (similar to a Geiger counter) is passed over the skin to identify the areas of the lymph system where the most radioactive tracer is located. These areas are likely to be the sentinel nodes that first receive drainage from the tumor and are most likely to contain malignant cells if the cancer has spread. The skin over these areas is marked.

The radiologist will use the gamma camera and ultrasound to locate the lymph nodes under the marked areas. Using ultrasound guidance, he or she will carefully insert localization wires through the affected lymph nodes.

You will then go the operating room where the surgeon will perform the surgical sentinel node biopsy.

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Recovering from Your Procedure

The bandage over the biopsy site should remain in place and dry for 24 hours. After that you can bathe or shower as usual. Avoid heavy lifting and other strenuous activities for 24 hours. You may then resume your normal activities.

You may experience soreness at the site of the incision, but it should quickly improve. You can take over the counter pain relievers or use ice packs to minimize any discomfort.

Getting Your Procedure Results

Your tissue sample will be sent to a laboratory so a pathologist can examine it. The results will be available the next business day and will be reported to your physician. You can get your results from your physician or from the Sally Jobe or INVISION facility where the procedure was performed. During the biopsy, our radiologists and technologists will be happy to answer questions about the procedure; however, they will not be able to give you the results until the following business day.

Additional Information

The information on this page was taken in part from the following sources. Review these web sites or articles for additional information on imaging guided biopsies.

Sources

A biopsy is the most definitive way to determine if a breast lump is malignant. During a breast biopsy, a small amount of tissue is removed from the abnormal area with a needle so a pathologist can examine the tissue for malignant cells.