Most breast abnormalities in the breast are detected by a physical breast exam, mammogram, breast ultrasound or breast MRI. As it is not usually possible to tell from these tests whether an abnormality is benign or cancerous, a core biopsy is often recommended. A biopsy is a test that removes small tissue from the area in question to be reviewed by a pathologist under a microscope. There are different types of core biopsies, which are described below.
Stereotactic Breast Biopsy
A stereotactic breast biopsy is an outpatient procedure that uses a special X-ray machine to help guide the breast radiologist to the site of abnormality. The patient lies on the stomach and the breast falls through a hole in the table. The mammo technologist positions the patient and uses compression to immobilize the breast. Several images are taken to confirm the location of the site to be sampled. This is a sterile procedure performed using a local anesthetic.
A needle is inserted into the area to be sampled, and several core samples are taken. A small titanium marker is left inside the breast to mark the area that is sampled. This marker causes no harm. It is important to have the marker placed for future reference. After the biopsy is completed, the technologist performs a mammogram and dresses the biopsy area. The tissue is then sent to a pathologist for analysis. The patient is given an ice pack, and Tylenol is recommended for any post-biopsy pain. Patients can expect to be at the Breast Center for about two hours for each site to be biopsied.
Stereotactic breast biopsy is often recommended instead of a surgical breast biopsy because it is less invasive. Surgical breast biopsy is an operation performed in the hospital under general anesthesia. During an excisional surgical breast biopsy, the surgeon attempts to completely remove the area of concern, often along with a surrounding margin of normal breast tissue.
Stereotactic biopsy is recommended for the following abnormalities:
- Calcifications (please see the description of calcifications below)
- A suspicious mass or other abnormalities not seen with breast ultrasound
- Distortion of the breast
- History of breast cancer to map out further treatment options
Calcifications are tiny deposits of calcium that may appear in breast tissue. They are seen best on mammography images and are divided into two types of calcifications: micro calcifications and macro calcifications. Macro calcifications are radiographically larger calcium deposits and are usually not linked to breast cancer. Micro calcifications are smaller, tightly grouped (clustered) calcifications, which can be associated with abnormal cell growth. Although 80 to 85 percent of micro calcifications are benign, they may be a sign of early breast cancer, known as ductal carcinoma in situ (DCIS).
Not all micro calcifications need to be biopsied. A breast radiologist may recommend that the patient return for a six-month follow-up diagnostic mammogram to check for stability or evaluate change.
Breast Ultrasound Guided Biopsy
Breast ultrasound is performed to localize the area of abnormality to be biopsied. Ultrasound uses sound waves to image the breast tissue. Ultrasound biopsy is performed as an outpatient procedure, and patients can expect to be at the Breast Center for 1 to 1½ hours. During the procedure, the patient lies on his/her back, and the sonographer locates the area to be biopsied by placing warm gel and an ultrasound transducer on the breast.
The radiologist then numbs the area with local anesthetic, and a probe is inserted into the breast, which removes some of the abnormal breast tissue. A small titanium marker is placed inside the breast to mark the area that is sampled. This marker is inert and causes no harm, nor does it set off any airport alarms. It is important to have the marker placed for future reference. After the biopsy is completed, a mammography technologist performs a mammogram and dresses the biopsy area. The breast tissue is sent to the pathologist for analysis. The patient is given an ice pack, and Tylenol is recommended for any post-biopsy pain.
A breast ultrasound guided biopsy is recommended for abnormalities such as:
- Suspicious solid masses
- Distortion of breast tissue
- Areas of abnormal change of tissue
- Areas of abnormality corresponding to abnormal areas seen on a Breast MRI
Breast MRI Guided Biopsy
Magnetic Resonance Imaging (MRI) uses a strong magnetic field to produce images of the breast. The MRI biopsy is performed at Vail Valley Medical Center as an outpatient procedure. The patient can expect to be at the hospital for two hours. The technologist inserts an IV line into a vein in the patient's arm or hand, and contrast material is injected. The patient lies face down with the affected breast gently compressed between two plates. A series of MRI images are taken, and computer software assists the breast radiologist in calculating where the area should be sampled.
The breast radiologist uses local anesthetic to numb the area to be sampled, and then a probe is inserted into the breast, which removes tissue from the abnormal area. A small inert titanium marker is left inside the breast to mark the area that was sampled. This marker causes no harm, nor does it set off any airport alarms. It is important to have the marker placed for future reference. A series of MRI images are taken to confirm the biopsy area. The technologist then cleans and dresses the area of the biopsy site, and the tissue is sent to the pathologist for analysis. The patient is given an ice pack, and Tylenol is recommended for any post-biopsy pain.
MRI-guided biopsies are recommended for abnormalities such as:
- A suspicious mass not seen on another breast imaging test
- An area of distortion
- An area of abnormal tissue change
Needle localizations are usually performed after the patient has received a breast biopsy in which the results were indeterminate or positive. Needle localizations are scheduled at the Breast Center prior to surgical breast biopsy. The method of localization depends on the core biopsy type that was performed initially, either stereotactically or under ultrasound. The procedure is performed under standard sterile conditions and typically takes about 1 to 1½ hours.
The breast radiologist numbs the patient's breast and inserts a wire (or occasionally two or more wires) in the area to be removed. The mammographic technologist then performs a mammogram to confirm correct placement of the wire in relation to the area to be biopsied. The patient's images are printed out for the surgeon performing the breast biopsy.