While surgical breast biopsy is still necessary for some breast abnormalities, many breast lesions can now be biopsied percutaneously (through the skin). Percutaneous biopsy eliminates the general anesthetic risk, resultant breast deformity and scarring, post biopsy mammographic distortion and the several weeks post operative recovery period frequently associated with surgical biopsies. Risks of percutaneous biopsy are minimal-pain, bleeding, infection, and failure to diagnose.
Percutaneous biopsies can be performed using mammographic or ultrasonographic guidance. When possible mammographic guidance is preferred because the breast is better stabilized and better tissue samples are usually obtained. Some lesions, however are mammographicly not apparent, and thus ultrasound guidance is employed.
Patients undergoing percutaneous biopsy should discontinue any medications, which might slow blood clotting (aspirin, some other anti-inflammatory medications, and anticoagulants) for at least one week prior to the biopsy. Do not discontinue any prescribed medication, however, without first discussing it with your physician. Your physician will also usually obtain several blood tests to assure that you do not have a problem that might potentiate excessive bleeding at the time of the biopsy. We do occasionally perform biopsies of patients on anticoagulants or without obtaining clotting studies in special circumstances.
It is not necessary (in fact, it is not recommended) to fast prior to the biopsy. Wear comfortable clothing on the day of the biopsy. On arrival, you will be asked to remove your clothing from the waist up and put on a mammography gown. The technologist will then discuss the biopsy with you, ask pertinent questions, and answer any questions you might have and will have you sign a consent form. Please inform the technician if you have had a prior allergic reaction to xylocaine (a local anesthetic).
The technologist will then begin the (sometimes tedious and uncomfortable) task of positioning you for the examination. This frequently requires repositioning you several times and obtaining numerous mammographic images.
Once you are optimally positioned, things begin to move quickly. The radiologist and technologist will use the computer to document the biopsy site. A felt tip marker will be used to mark the site. The skin will be cleaned with an antiseptic called Betadine. The radiologist will then infiltrate the skin with local anesthetic and will sometimes anesthetize the deeper breast tissues (unless you have a very small lesion that might be displaced or obscured by the local anesthetic). Discomfort associated with the biopsies varies markedly from patient to patient, but usually the mammographic positioning is more uncomfortable than the actual biopsies.
A small skin incision will then be made and our biopsy device will be placed. Repeat mammographic images will be obtained with the device in place and adjustments may or may not be necessary. It is very important that you do not move at all during this period of time as even minimal motion may necessitate starting the procedure over again from the point of initial mammographic positioning.
Once positioning is optimal, the radiologist will obtain several biopsies. Images both of your breast and of the biopsy specimens will then be made and the radiologist will decide whether or not more biopsies are needed.
When the lesion has been well sampled, you will be released from the mammographic position and pressure will be applied to your breast. You will be given an ice pack to apply to your breast and will be observed in your physician’s office or in our department for approximately l hour.
You may have breast bruising or discomfort for the next several days (most patients report only minimal discomfort). You may apply ice or take Tylenol for the discomfort, but do not take any aspirin or other medication which might slow blood clotting, such as Ibuprofen, Naproxen, Coumadin, Ticlid for three (3) days after the procedure. Please call your physician if you have any marked discomfort or significant bleeding after the biopsy. Your physician should have a pathologic diagnosis for you approximately two (2) working days after the biopsy (or on Monday, if the biopsy is performed on Friday).
In rare circumstances, a surgical biopsy may be necessary after a percutaneous biopsy. A pathologic diagnosis of atypical hyperplasia is a “marker” for malignancy and surgical biopsy will often be recommended in this circumstance to make certain that no malignant cells are seen in the surrounding breast tissues. A subsequent surgical biopsy or repeat stereotactic biopsy might also be necessary if the pathologic diagnosis is not compatible with the mammographic appearance of a lesion.
In summary, percutaneous biopsies are frequently a great alternative to surgical biopsy and even when a malignant lesion is diagnosed, assist in preoperative planning.
Please feel free to contact us with any questions prior to your biopsy.
Authored by: Christin Dickerson, M.D., Elisabeth Uebershar, M.D. and Joe Wilson, M.D.