At this point you have completed a diagnostic examination and the findings led the radiologist to recommend a biopsy. A diagnostic work up may entail any of the modalities: mammogram, ultrasound, and/or MRI. Generally, lesions should be biopsied under the modality where they are best visualized, particularly for subtle lesions. That being said I will only be describing stereotactic and ultrasound guided breast biopsies. I may cover MR guided breast biopsies and wire localization for surgical excision in a later post.
The stereotactic guided biopsy device has improved over the past decade. Before women would always have to lie on their chests and stomachs allowing their breasts to hang through two round cut outs in the table. Now most women are laying comfortably on their sides with pillows for neck, shoulder, and back support when needed. We also provide an eye mask in an attempt to reduce anxiety, and even music upon request.
For all biopsies, the lesion/site is identified, the patients skin sterilized, numbed locally, a really small incision is made that does not require stitches, and the biopsy device is passed. In breast, as well as some other tissues, a marker made of titanium being about 1 mm is implanted to show the surgeon where the sample was taken.
Ultrasound guided biopsies are my absolute preference, including wire localization and MR guided biopsies. These I feel are the most well-tolerated by the patient. First, the patient is generally laying on their back or elevated a little bit to a side. The needle is the smallest available for performing breast biopsies. I can visualize my needle in the lesion with each biopsy pass. I generally take three core biopsies. In actuality, the titanium marker delivery device is larger than the biopsy needle. Clips have improved and our practice uses titanium clips with a capsule coating like a gelatin capsule for vitamins or advil and the like. This capsule makes it also visible on ultrasound for approximately the next 3-6 months, but the titanium is visible for life on mammogram.
Should you get the titanium marker? Absolutely! It marks the lesion so if it is a cancer, then a surgeon knows exactly where to go to perform a lumpectomy. If it is benign and negative for cancer, then it will forever mark the site and when a future radiologist reads your mammogram they will know it has been biopsied and was presumably benign. The markers do not set off metal detectors at airports, so you will not be issued a medical card. They will not prevent you from having an MRI in the future. It is so small that it would seem exceedingly rare for someone to be able to feel it in their breast.
Well, I hope that will alleviate some wonderful lady’s anxiety out their going into one of these procedures. I have no doubt that the procedure has fear associated with it, and the wait for the biopsy results can be extremely stressful. I hope your radiologist and healthcare staff provide you with as much warmth and compassion in your time of need as you deserve.
Let me know how I can be of anymore help in the comments below.