What to expect at breast biopsy

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.

Stereo Biopsy Device
Hologic Tomosynthesis Sterotactic Guidance Biopsy Table

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.

US biopsy device
Left: formalin for core biopsy specimen collection; Right Top: marker; Middle: core biopsy device; Bottom: lidocaine for local anesthetic

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.

us-biopsy-e1531711308556.png
Left: needle against lesion; Right: needle deployed into lesion

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.

Thanks,

Ron

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I am an American Board of Radiology certified Diagnostic Radiologist with a certificate of additional qualification in Neuroradiology. I absolutely love my job. I have learned a tremendous amount about the human body, including its’ expected complications given our extraordinary complexity, and get to use that knowledge to help people. I personally have experienced emotional devastation and loss, which has made me compassionate and empathetic. I really care about people, and I hope I can use this site to help you. I graduated medical school in 2004 from New York Medical College. My wife and I had our first son in NY where we bought our 900 sf two bedroom one bath starter home. I stayed at Westchester Medical Center for radiology residency, where we had our second son. I obtained a neuroradiology fellowship position at Yale New Haven Medical Center commuting about an hour and a half each way for a year while we had our third boy. Upon graduation I was fortunate to return to Westchester Medical Center to work in Neuroradiology, Body Imaging, and Women’s Imaging departments, a rarity in academic medicine. Almost a decade later and I am living in a larger home in Reno working in a private practice community based outpatient radiology group which contracts with a rural hospital in Elko, Nevada. My wife and I now have four boys and gave up on the girl. We also have a male Bernese mountain Dog named Helmut and female Newfoundland named Lucy. Despite all its hardships and tremendous struggles, I have an absolutely amazing life, which is a gift I cherish. It’s down to my philosophy. I am a firm believer in teamwork. So much comes down to communication. When healthcare providers talk to each other one-on-one, the patient care is always improved, every time! We might not find an answer to your problem, but our collective knowledge sure can help improve your chances. At Yale the best conference I ever regularly attended was a head and neck tumor board. The head and neck surgeon (otolaryngologist = ENT) presented the patient’s clinical history, the radiologist showed the images, the oncologist discussed the tumor and chemotherapy options, and the patient came to the conference and we all did a physical exam looking into their mouth to directly visualize a tumor. It was incredible! Patients came from far and wide to see this highly trained, world-renowned, humble, Japanese, gentleman surgeon. It was also an epiphany. I found that when I see the patient, talk to them, listen to their story, examine them and discuss the patient with my colleagues, the patient felt better and I had a lot of fun. It’s weird but reminds me of seeing a comedy where it is always funnier in a packed theater with everyone laughing. Knowledge and compassion are both infectious and contagious. My greatest days are helping patients deal with some of their most difficult days, and I am good at it.

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