Minimally Invasive Breast Biopsy

Indications: To obtain a diagnosis of a breast lesion that is seen on mammogram, US, MRI  or is palpable on breast exam. (2009 Consensus Statement "Best Practice" for diagnosing breast lesions)

Benefits:Can be performed in the doctors office or out patient imaging facility

• Out patient
• Local Anesthesia
• Choice of incision placement
• Precise targeting of the lesion
• No radiation exposure
• Minimal disruption to normal tissue
• More rapid pathology reporting
• Less time away from work and play

Risks:

• Bleeding, Hematoma (blood collection)
• Pain
• Infection
• Skin dimpling from the incision
• Marker palpable after the procedure
• Biopsy of the incorrect area
• Neck stiffness
• Loss of nipple sensation (if the lesion is near the nipple)
• Mondor's disease (Thrombosis of a superficial vein in the breast)

Alternatives:

• Open Surgical biopsy
• Short term radiologic follow up Birads-3 lesions<Lesions felt to be likely noncancerous)

Associated Factors: You are awake for the procedure and will be made as comfortable as possible.

Stereotactic Breast Biopsy - With this type of biopsy, the mammogram is used as our guide to obtain the specific tissue that we need to sample. You are placed face down on the table and by gravity, your breast hangs through a hole in the table. Your breast is then imaged with a low dose digital x-ray to identify the density or area of calcifications. Once the area is identified, the computer helps to determine the appropriate placement of the biopsy device. Once images are confirmed, the breast is cleansed and local anesthesia (lidocaine) is placed. After a tiny nick is made in the skin, the device is positioned and a digital image checked. The area is further infiltrated with Lidocaine to numb or deaden the area. The samples are then taken and an x-ray confirms the presence of the calcifications in the specimens. At the completion of the procedure, a radiologic marker is placed to mark the area for future reference. The marker may be made of titanium or surgical steel and often has a material that makes it visible under ultrasound as well. Don’t worry; they will not set off the metal detectors in the airport! This marker allows us to know where to return to if further surgery is needed, and it also allows the radiologist in the future know that you did indeed have a biopsy of that area. When the procedure is completed, the technologist will initially hold pressure on the area and they apply steri-strips or surgical glue. An outer dressing is placed. Many time an ace wrap or tube top type wrap is placed to add additional pressure over the biopsy site. You may have a regular mammogram immediately after the procedure if one is necessary to confirm that the appropriate area has been biopsied. 

Ultrasound Guided Vacuum Assisted Biopsy-This procedure is performed when there is either an ultrasound abnormality or a palpable mass in the breast. You are placed on the table lying on your back and your arm is usually over your head. Once the breast is scanned with the ultrasound machine, the area for biopsy is marked with a surgical marker. The breast is then cleansed with an antiseptic and the area is made numb with Lidocaine. The incision is made as a tiny nick in the skin. A larger needle is then used to assure the area is completely numb. Once the Lidocaine is allowed to work, the biopsy devise is inserted under ultrasound guidance. Once position is checked, the area is sampled. If all image evidence of the lesion is to be removed, the procedure is continued until the ultrasound image of the density confirms the removal. A tiny marker is then placed for future reference. Pressure is held over the biopsy cavity and then steri-strips and sterile dressings are placed. A mammogram may be performed if confirmation of a Mammographic lesion is necessary.

MRI Guided Biopsy - When an abnormality is identified on MRI and it is the only modality that identified the lesion, a biopsy may require MRI guidance. Your biopsy will be performed using a breast MRI scanner. After an initial scan, an injection of gadolinium ( a contrast material that enhances the image) will allow our radiologist and/or surgeon to identify the abnormality; sophisticiated software is then used to localize the lesion. Once the lesion is localized, you will have your breast cleansed, after which local anesthesia is administered. The biopsy device is placed, and an additional scan confirms that we are in the appropriate position. When the position is confirmed, the biopsy is performed, and a marker is placed to identify the biopsy site in the event that a cancer or atypical lesion is found. The final scan confirms the placement of the marker, and steri-strips are placed, as is an ace wrap, which helps prevent bleeding.

Core Needle Biopsy - A biopsy performed in the doctor’s office to make a diagnosis of a breast problem. When the patient and the doctor feel a lesion, a core biopsy can be used to confirm a diagnosis and/or to rule out a cancer. This procedure can be performed with or without ultrasound guidance. The procedure involves the cleansing and numbing of the skin. A small nick is then made in the skin and the core needle device is repeatedly placed in the breast fired and removed, until adequate samples are obtained. With this biopsy technique the area is not removed, just sampled. A marker can be placed to mark the area or the physician may choose not to mark the lesion. No sutures are needed, just steri-strips to approximate the skin.

Fine Needle Aspiration - A procedure that is performed to sample cells from a solid lesion or to confirm that a mass is a fluid filled cyst. A skinny needle is inserted into the breast without anesthesia. This may be done with or without ultrasound guidance. If your pathologist is not specially trained in FNA cytology readings, then a core biopsy would be a better choice. The results of the cytology are only as good as the pathologist reading the slides. If fluid is obtained, it may be discarded or tested based upon its consistency. Further biopsies may be required if the mass is solid.