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Breast Imaging

Intervention

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Biopsy

If lumps or abnormalities in the breast are detected through a physical examination, mammography, or other imaging studies, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous. A biopsy is performed to get a sample of cells from a suspicious area and examined to determine diagnosis. There are three main types of biopsy:

  • A fine needle aspiration (FNA), which uses a very small needle to extract fluid or cells from the abnormal area.
  • A core needle (CN) which uses a large hollow needle to remove one sample of breast tissue per insertion.
  • Vacuum-assisted device (VAD) which uses a vacuum powered instrument to collect multiple tissue samples during one needle insertion.

Breast lesion vacuum excision/ biopsy
This is a rather innovate yet well-established technique that spares you the uncertainty and unnecessary surgery. It is used for either accurate sampling of indeterminate or suspicious tissue for pathological analysis, or excision of small non-cancerous abnormalities to avoid surgery and anesthesia. The procedure is done by a special needle in 30 minutes, through a tiny incision, with no post procedure scarring.

Pre-operative Wire Localization

In case of a non palpable abnormality that needs surgery, the surgeon needs guidance before the operation. Guided by an imaging modality such as ultrasound or mammography, the radiologist inserts a wire through a hollow needle to the mass or suspicious area of cells and tissue. The wire then guides the surgeon to the area so that the abnormal tissue can be surgically removed for examination.

Preparation

  • Wear comfortable, loose-fitting clothing for your biopsy procedure. You may need to remove all clothing and jewelry in the area to be examined.
  • Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia.
  • Your physician will advise you to stop taking aspirin or a blood thinner three days before your procedure.
  • Also, inform your doctor about recent illnesses or other medical conditions.

It is advisable to have a relative or friend accompany you and drive you home afterward, especially if a sedative was used.

Procedure
Most areas of the body can be biopsied with a needle device. This is the least invasive option, and usually allows you to return home the same day. Imaging guidance with mammography, ultrasound, or MRI allows for accurate placement of the needle to locate the best place to take a tissue sample.

Image-guided, minimally invasive biopsy procedures are performed by a specially trained radiologist.

Breast biopsies are usually done on an outpatient basis.

In Ultrasound guided biopsy, you will be positioned lying face up on the examination table or turned slightly to the side. Pressing the transducer to the breast, the sonographer or radiologist will locate the lesion.

In Mammographic (stereotactic) guided biopsy, you will be seated next to the stereotactic mammography unit. The breast is compressed and held in position throughout the procedure. Several stereotactic x-ray images are taken.

In MRI guided biopsy, you will lie face down on a moveable exam table and the affected breast or breasts will be positioned into openings in the table. A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm and the contrast material gadolinium will be given intravenously. Your breast will be gently compressed between two compression plates (similar to those used in a diagnostic MRI exam), one of which is marked with a grid structure. Using computer software, the radiologist measures the position of the lesion with respect to the grid and calculates the position and depth of the needle placement.

Whatever imaging method used, a local anesthetic will be injected into the breast to numb it. A very small nick is made in the skin at the site where the biopsy needle is to be inserted.

The radiologist, monitoring the lesion site under imaging, will insert the needle and advance it directly into the mass.

Tissue samples are then removed using one of three methods:

  • In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells. This is used in cyst aspiration.
  • In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with ‘cores’ of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.
  • With a vacuum-assisted device ( eg mammotome or BLES ), vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, eight to 10 samples of tissue are collected from around the lesion.

After this sampling, the needle will be removed.

A small marker may be placed at the site so that it can be located in the future if necessary.

Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.

A mammogram may be performed to confirm that the marker is in the proper position.

This procedure is usually completed within an hour.