Imaging-Guided Breast Biopsies

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When an abnormality is seen on a mammogram or using another technology, a tissue sample is needed to determine whether the growth is benign or cancerous. At Lahey, minimally invasive imaging-guided breast biopsies are performed using a digital mammogram (stereotactic core needle biopsy), ultrasound, or MRI guidance, depending on the case.

Stereotactic Core Breast Biopsy

One alternative to open surgical biopsy, or removing an entire breast lump for analysis, is the stereotactic core breast biopsy. A much less invasive procedure than open biopsy, a stereotactic breast biopsy involves inserting a hollow needle into a suspicious lesion and, with the help of special breast X-rays, removing a small sample of breast tissue for further analysis.

A stereotactic breast biopsy is most useful when a mass, a cluster of microcalcifications (tiny calcium deposits that are closely grouped together), or an area of abnormal tissue change shows up on a woman’s mammogram, though no lump can be felt during a clinical breast exam.

How It Works

The patient lies prone on the imaging table with her breast falling through a hole in the table. The procedure is actually done below the table after raising it to gain access to the breast. The technology team and the radiologist then work together to ensure that the abnormality to be biopsied is in the field of view and, once achieved, the breast is prepared with betadyne wash. A local anesthetic is then applied to take away any painful sensation. Most of our patients have commented that they were surprised at how little discomfort they experienced during the procedure. However, the radiologist is always willing to give more medicine if necessary and works closely with each patient during the procedure to keep her comfortable.

Imaging is obtained at multiple steps during the procedure to confirm that the correct area is still within the biopsy field. Once the anesthetic is administered, an incision is made and the biopsy needle is advanced into the breast tissue. After confirming positioning, the needle is further advanced into the biopsy site. Then samples are taken. Anywhere from one to twelve samples are taken.

At the end of the procedure, a tiny surgical clip (about the size of a sesame seed) is placed at the biopsy site to mark the location that tissue was taken from. The clip itself is small enough that a woman cannot feel it in her breast tissue. A mammogram is also performed at the end of the procedure to confirm the position of the clip marker and document the appearance of the breast.

Although the typical biopsy is short, to be safe, each patient should allow a few hours to have a biopsy performed in our Breast Imaging Department. Our patients are most satisfied if they plan to allow 3-4 hours for their procedure. We care about our patients and do not mind taking more time to have the best, most comfortable, safest and most accurate biopsy possible.

Results are sent from pathology to the surgery group within three to five business days of the procedure. Someone from the Breast Center surgery group will give you the results at that time and/ or during your follow up appointment.

Ultrasound-Guided Breast Biopsy

Ultrasound guided breast biopsy is similar to stereotactic core breast biopsy except the abnormality is localized with ultrasound imaging instead of X-ray technology, and the patient lies on her back rather than her front. A patient would have an ultrasound guided breast biopsy instead of a stereotactic biopsy if her abnormality is best seen by ultrasound. The procedure follows closely the steps outlined in stereotactic core breast biopsy above.

During an ultrasound guided breast biopsy, anywhere from one to twelve samples are taken. At the end of the procedure, a tiny surgical clip (about the size of a sesame seed) is placed at the biopsy site to mark the location that tissue was taken from. The clip itself is small enough that a woman cannot feel it in her breast tissue. A mammogram is also performed at the end of the procedure to confirm the position of the clip marker and document the appearance of the breast.

Although the typical biopsy is short, to be safe, each patient should allow a few hours to have a biopsy performed in our Breast Imaging Department. Our patients are most satisfied if they plan to allow 3-4 hours for their procedure. We care about our patients and do not mind taking more time to have the best, most comfortable, safest and most accurate biopsy possible.

Results are sent from pathology to the surgery group within three to five business days of the procedure. Someone from the Breast Center surgery group will give you the results at that time and/ or during your follow up appointment.

MRI-Guided Core Breast Biopsy

Magnetic resonance imaging (MRI)-guided core breast biopsy is performed when an abnormality is seen best by breast MRI. The patient is positioned feet first, lying facedown, with her head facing out of the scanner—a position that lessens feelings of claustrophobia. An anesthetic is injected into the deeper tissue of the breast to be examined, and a biopsy device designed specifically for this procedure is then inserted into the breast by the radiologist. Approximately four small tissue samples are obtained and, at the end of the procedure, a tiny clip marker is placed at the site of the biopsy. A mammogram is also obtained to document the clip’s location. The entire procedure takes approximately 60 to 90 minutes. Results are available within three to five business days.

Frequently Asked Questions about Breast Biopsies

How long will my biopsy take?

The length of each biopsy differs, depending upon the unique circumstances of each patient. For example, the smaller the area to be biopsied the more technically challenging the procedure. Also, if a lesion is located close to vital structures, the physician will need to use an approach that minimizes the risk to the patient, although it will extend the duration of the procedure. In some instances, the physical needs or physical characteristics of a particular patient make the case more challenging.

Although the typical biopsy takes only a short time, to be safe, each patient should allow three to four hours for the procedure. We care about our patients and prefer to take additional time to ensure the safest, most accurate and most comfortable biopsy possible.

What should I expect after the procedure?

Every woman is different, and while some women bruise extensively, others bruise very little. It is impossible for the radiologist to predict. After a biopsy, it is normal to feel sore and to bruise to some degree. We recommend applying a cold compress to the area. Rarely, more extensive bleeding occurs or a hematoma (abnormal localized collection of blood) forms. A hematoma will heal, but it may take more time to resolve.

It is recommended that anyone having a biopsy limits physical activity and lifting for the remainder of the day. Most women can return to normal activity the next day or within several days, as they feel up to it. Women who are very athletic may want to consider avoiding a strenuous workout schedule for an extra day or so to reduce the chances of rebleeding. Avoiding swimming for approximately 48 hours is helpful, although showering the next day is okay. The incision site will heal like any cut would, and keeping it clean is important.

We are happy to answer any questions our patients may have at any step of the process. Please do not hesitate to ask.

Further Information

For more information on imaging-guided breast biopsies, talk to your doctor or visit our Health Encyclopedia.