Image Guided Biopsy

Lumps or abnormalities in the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous. A breast biopsy is performed to remove some cells from a suspicious area in the breast and examine them under a microscope to determine a diagnosis.

What are some common uses for Image Guided Biopsy?

An image-guided breast biopsy can be performed when previous imaging has shown shown an abnormality such as:

• a suspicious solid mass
• a distortion in the structure of the breast tissue
• an area of abnormal tissue change

Ultrasound-Guided Breast Biopsy

An ultrasound-guided breast biopsy uses sound waves to help locate a lump or abnormality and remove a tissue sample for examination under a microscope. It is less invasive than surgical biopsy, leaves little to no scarring and does not involve exposure to ionizing radiation.

How an Ultrasound Breast Biopsy performed?

You will be positioned lying face up on the examination table or turned slightly to the side. The radiologist will inject a local anesthetic into the skin and more deeply into the breast to numb it. Using the transducer to the breast, the technologist / sonographer will locate the lesion. The radiologist will then make a very small nick in the skin at the site where they will insert the biopsy needle. Monitoring the lesion site with the ultrasound probe, they will insert the needle and advance it directly into the mass.

The radiologist removes tissue samples using one of three methods:

• In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
• In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with “cores” of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. The doctor repeats this process three to six times.
• With a vacuum-assisted device (VAD), vacuum pressure pulls tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, the doctor will collect eight to 10 samples of tissue from around the lesion.

MRI Breast Biopsy

Using the powerful magnetic field of MRI, radio waves and a computer to help locate a breast lump or abnormality and guide a needle to remove a tissue sample for examination under a microscope. It does not use ionizing radiation and leaves little to no scarring.

How is MRI Breast Biopsy performed?

You will be positioned lie face down on the MRI exam table. The technologist will position the affected breast into an opening in the table and insert an intravenous (IV) line into a vein in your hand or arm for the contrast. Your breast will be gently compressed between two compression plates, one of which is marked with a grid structure.

Using computer software, the radiologist measures the position of the lesion with respect to the grid and calculates the position and depth of the needle placement. A local anesthetic will be injected into the skin and more deeply into the breast to numb it. Then a very small nick will be made in the skin at the site where the radiologist will insert the biopsy needle.

The radiologist then inserts the needle, advances it to the location of the abnormality and MR imaging is performed to verify its position. Depending on the type of MRI unit being used, you may remain in place or be moved out of the center or bore of the MRI scanner.

If a surgical biopsy is to be performed, the radiologist may insert a wire into the suspicious area as a guide for the surgeon or a small marker may be placed at the biopsy site it can be located it in the future, if necessary.

Once the biopsy is complete, pressure will be applied and the biopsy site will be covered. No sutures are needed. Post-procedure Mammography may be used to confirm that the marker is in the proper position.

Stereotactic Breast Biopsy

Stereotactic breast biopsy uses mammography – a specific type of breast imaging that uses low-dose x-rays – to help locate a breast lump or abnormality and remove a tissue sample for examination under a microscope. It’s less invasive than surgical biopsy, leaves little to no scarring and can be an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound. 

How Stereotactic Breast Biopsy performed?

You will lie face down on a moveable exam table. The technologist will position the affected breast into an opening in the table. The table is raised and the procedure is then performed beneath it. The breast is compressed and held in position throughout the procedure.

Preliminary stereotactic mammogram images are taken and reviewed by the radiologist. Once the radiologist identifies the abnormality on imaging, the computer will generate coordinate information and send it to the biopsy device.

The radiologist will inject a local anesthetic into the skin and more deeply into the breast to numb it and make a very small nick in the skin at the site where they will insert the biopsy needle. The needle is then inserted and advanced it to the location of the abnormality using the mammogram and computer generated coordinates. Mammogram images are again obtained to confirm that the needle is within the lesion prior to sampling.

Tissue samples are then removed, generally using a vacuum-assisted device. After the sampling is complete, the needle will be removed from the breast. A final set of images will be taken. The radiologist may place a small marker at the biopsy site so they can locate it in the future if necessary.

Once the biopsy is complete, the technologist will apply pressure to stop any bleeding. The biopsy site will be covered with bandage, but no sutures are needed. Post-procedure mammogram may be used to confirm that the marker is in the proper position.

View our Stereotactic Breast Biopsy Preparation Video below.