Breast Biopsy

Many abnormalities in the breast  are detected by physical breast exam, mammography, breast ultrasound or MRI.  As it not usually possible to tell from these tests whether an abnormality is benign or cancerous, a core biopsy will recommended.  A core biopsy is a test that removes small tissue from the breast to be reviewed by a pathologist under a microscope.  There are different types of core biopsies, click on the links below for more information.

• Stereotactic Breast Biopsy
• Breast Ultrasound Guided Biopsy
• Breast MRI Guided Biopsy
• Needle Localizations 

Stereotactic Breast Biopsy

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.  You will lie on your stomach and your breast will fall through a hole in the table.  The mammo technologist will position you and use compression to immobilize your breast.  Several images will be taken to confirm the location of the site to be sampled.  This is a sterile procedure done using a local anesthetic.  A probe will be inserted into the area to be sampled and several cores samples will be taken out.  A small titanium marker will be left inside your breast to mark the area that is sampled.  This marker will cause no harm or set off any airport alarms.  It is important to have the marker placed for future reference.  After the biopsy is done, the technologist will perform a mammogram and dress the biopsy area and your tissue will be sent to the pathologist for tissue analysis.  You will be given an ice pack. Tylenol is recommended for any post biopsy pain.  You can expect to be at the breast center about 2 hours for each site to be biopsied.

Stereotactic biopsy is recommended in these abnormalities:

• *Calcifications: 
•  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

Stereotactic breast biopsy is often recommended instead of a **surgical breast biopsy because it is less invasive.

*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.  Microcalcifications and Macrocalifications.

Macrocalifications  are radiographically larger calcium deposits and are usually not linked to breast cancer.

Microcalifications are smaller tightly grouped calcifications (clustered)  which can be associated with  abnormal cell growth.  Although 80-85% of microcalicifications   are benign
they may be a sign of early  breast cancer, known as Ductal-Carcinoma-in Situ (DCIS).

Causes of benign microcalcifications :
•  Powers, lotions or deodorants on the skin (these can simulate calcifications)
•  Benign masses
•  Old injury to the breast
•  Collection of calcium in cysts
•  Radiation treatment

Not all microcalicfications will need to be biopsied . The breast radiologist may recommend that you return for a six month follow up diagnostic mammogram to check for stability or evaluate change.

**Surgical breast biopsy is an operation performed in the hospital under general anesthesia.  During an excisional surgical breast biopsy, the surgeon will attempt to completely remove the area of concern, often along with a surrounding margin of normal breast tissue. In young women, if the lesion is palpable (can be felt by clinical examination), excisional biopsy, generally a brief, straightforward surgery performed in an operating room, is often performed.  

Breast Ultrasound Guided Biopsy

Breast Ultrasound  is performed to localize the area of abnormality to be biopsied.  Ultrasound uses soundwaves to image the breast tissue.  Ultrasound biopsy is done as an outpatient procedure and you can expect to be at our center for 1- 1 ½ hours.  During the procedure you will lie on your back and the sonongrapher will locate the area to be biopsied with by placing warm gel and an ultrasound transducer on your breast.  Using standard sterile procedure, the radiologist numbs the area with local anesthetic, and a probe will be inserted into the breast, which removes some of the abnormal breast tissue.  A small titanium marker is placed inside your breast to mark the area that is sampled.  This marker is inert and will cause no harm or set off any airport alarms.  It is important to have the marker placed for future reference.  After the biopsy is done, a mammography technologist will perform a mammogram and dress the biopsy area. The breast tissue is sent to the pathologist for analysis.  You will be given an ice pack. Tylenol is recommended for any post biopsy pain.

You may be recommended to have a Breast Ultrasound Guided Biopsy for abnormalities such as:

• Suspicious solid masses
• Distortion of breast tissue
• Areas of abnormal change of tissue
• Area of abnormality corresponding to abnormal areas seen on Breast MRI 

Breast MRI Guided Biopsy

(MRI) Magnetic Resonance Imaging uses a strong magnetic field to produce images of the breast. The MRI biopsy is done at Vail Valley Medical Center and is done as an outpatient procedure. You can expect to be at the hospital for two hours.  The technologist will insert an IV line into a vein in your arm or hand and   contrast material will be injected.  You will lie face down with the  affected breast   gently compressed between two plates.  A series of MRI images will be taken and computer software will assist the breast radiologist in calculating where the area should be sampled.  Using standard sterile procedure the breast radiologist will use local anesthetic to numb the area to be sampled, and then a probe will be inserted into the breast which removes tissue from the abnormal area.  A small inert titanium marker will be left inside your breast to mark the area that was sampled.  This marker will cause no harm or set off any airport alarms.  It is important to have the marker placed for future reference.  A series of MRI images will be taken to confirm the biopsy area.  The technologist will then clean and dress the area of the biopsy site. Your tissue will be sent to the pathologist for analysis. You will be given an ice pack. Tylenol is recommended for any post biopsy pain. 

You may be recommended to have a MRI Guided Biopsy for abnormalities such as:
• A suspicious mass not seen on other breast imaging test
• An area of distortion
• An area of abnormal tissue change

Needle Localizations

Needle localizations are performed usually after you have had 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 for the initially, either stereotactically or under ultrasound.  The procedure is performed under standard sterile conditions and typically takes about and hour to an hour in a half.  The breast radiologist numbs your breast and inserts a wire (or occasionally two or more wires) in the area to be removed. The mammographic technologist will then perform a mammogram to confirm correct placement of the wire in relation to the area of to be biopsied.  Your images will be printed out and you will take them with you to Vail Valley Medical Center for your surgery.