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What is a core needle biopsy?
A core needle biopsy is a method of obtaining core shaped samples of a lesion through a needle. These samples are then sent to a pathology lab to obtain a diagnosis.
Why has my doctor ordered a needle biopsy rather than taking the whole lesion out?
Tissue samples may be obtained using different methods:
They may be surgically biopsied, where a larger section of breast tissue is removed in the operating room. This is usually done through day surgery, and requires more recovery time than the other methods.
A fine needle biopsy may be performed. This method is usually used to aspirate fluid from a cyst to be sent for a pathologic analysis. This method may at times be used to obtain cells from a more solid mass; however, it is often difficult to obtain an adequate sample.
With the advancement of new technology, core biopsies have become increasingly more popular. This type of biopsy uses a somewhat larger needle with a cutting action. With improved methods of visualization, localization, and retrieval, we are able to accurately obtain tissue samples in a relatively quick and easy manner for diagnosis. This is performed on an out-patient basis and recovery is minimal.
The main advantages to having a core biopsy are:
- It allows patients with benign lesions (non-cancerous) to avoid surgery and its slightly greater risks.
- It provides the surgeon with information to better plan your surgery if the lesion is breast cancer, (or other challenging pathology), and to arrange for additional treatments that may be required, such as chemotherapy.
If the abnormality is shown to be malignant or have atypical cells (pre-cancerous), or the results are inconclusive, you may require surgery.
How is it done?
Prior to your scheduled appointment, a radiologist has reviewed your previous films and reports and has planned the best approach to perform your core biopsy. Your biopsy may be done under ultrasound guidance or mammographic guidance depending on the modality it is best seen on.
Ultrasound guidance
Just before the biopsy, an ultrasound technologist will perform a preliminary scan to find the lesion for the radiologist. A small pen marking may be made on the skin. The radiologist will explain the procedure, answer any questions you may have, and obtain your consent to proceed.
Your skin will be cleansed with an antiseptic solution, and local anesthetic will be given. The radiologist will make a very small incision in your breast to ease introduction of the needle.
The needle is imaged with ultrasound to ensure it is in the proper location for sampling. The radiologist usually takes about 5 samples (sometimes more or less, depending on your particular case). You will hear a snapping sound as the biopsy apparatus is obtaining the samples - you will be told when to expect it so you will not be startled.
After the samples are obtained, some firm pressure is placed over the site for a few minutes to stop any bleeding. The technologist will then place a small ice pack over the area to minimize any bruising or swelling. This pack will be sent home with you.
Mammography guidance (stereotactic method)
Abnormalities seen only by mammography, such as microcalcifications, architectural distortion, or asymmetric densities, will most likely be biopsied by this method.
Before your biopsy, the radiologist will explain the procedure to you, answer any questions you may have, and obtain your consent to proceed.
For this type of biopsy, a special table is used where you will be asked to lie on your stomach. This table has an opening in it where only the breast of interest will go through. The technologists will do their best to make you as comfortable as possible before they begin as it is crucial that you hold quite still during the procedure. The table will be raised from the floor so the radiologist and technologists can work beneath you. Your breast will be slightly compressed as the technologist positions your breast to locate the lesion and will remain in the compression throughout the procedure. (It will not be as tight as for a regular mammogram). Images from two different angles (stereo views) will be taken, which the biopsy unit uses to accurately calculate the exact location and depth of the lesion.
The radiologist will cleanse your skin with antiseptic solution, administer local anesthetic (freezing), and make a small incision in your breast (approximately 1 cm). He/she will insert the needle into your breast near the lesion. You may feel some pressure at this time. Because breast tissue can be very dense and fibrous, the final placement of the needle must be inserted very quickly (fired) to place it in the exact location. The device used to do this makes a snapping sound - we will tell you beforehand so you will not be startled and move. You should not feel any pain. Stereo images are taken to confirm our location before we proceed with the tissue sampling.
The biopsy apparatus uses a slight vacuum to draw in the samples; therefore, you will hear the buzzing of the equipment during the biopsy. The actual biopsy time is less than a minute. The radiologist will take a variable number of samples – usually 6 or more, depending on the circumstances. As each sample is taken, local anesthetic is drawn in through the biopsy needle. If you are feeling any pain, please let us know. After the samples are obtained, they will be x-rayed in another room to confirm we have the calcifications within our cores. (This will be done while you are still on the table).
At the completion of the biopsy, the radiologist will likely leave a metal marker in your breast at the biopsy site. This is necessary, as we may remove the complete visible portion of the lesion. If the pathology results lead to surgery, we must know the exact location of the biopsy site.
This sterile titanium marker is inserted through the needle while it is still in your breast. You will not feel anything. The needle is then removed, the compression released and some firm hand pressure placed on your breast for 5-10 minutes. Because the incision is so small, all that will be required is some sterile tapes across the cut to aid the healing and minimize any scarring – you will receive no stitches.
Following the procedure, a mammogram will be done on the biopsied breast to review its appearance and the placement of the titanium marker. The compression will not be as firm as for your standard mammogram.
After the mammogram, a small ice pack will be put over the biopsy site to minimize any swelling, bruising and discomfort.
Will the metal clip just stay in my breast?
The titanium clip will remain in your breast if the lesion is shown to be benign and you require no surgery. It should not give you any problems, as it is very tiny (approximately 3 mm). However, if you are known to have an allergy to titanium, please inform the radiologist. The clip will not cause you to set off any alarms when going through an airport metal detector and it will not prevent you from having an MRI scan if you require one in the future.
Is there any preparation before the biopsy?
There is no preparation prior to your biopsy. You may eat and take your medications as normal.
If you are on prescribed blood thinners such as: warfarin (Coumadin), Aggrenox, Plavix, or Ticlid, we ask that you inform the radiologist at the time of your appointment. If you are a patient in the hospital on heparin, your doctor will arrange to have this discontinued prior to your biopsy.
Please also inform the radiologist if you have an allergy to freezing or usually require quite a bit of time for freezing to take effect when having dental work done.
What can I expect after the biopsy?
Following your biopsy, we ask you to take it easy for the next 48 hours. This means no heavy lifting or physical exertion. You may want to just rest for a few hours following the procedure. We recommend you take the remainder of the day off of work and possibly the next day, depending on the physical nature of your job. We suggest this to prevent any bleeding or discomfort. You will be sent home with a little ice pack with which you should ice your breast for 20 minutes every hour for the next 24 hours. You may have a bit of bleeding the day of the biopsy – this is managed by sitting or lying still and applying firm pressure on your breast for 5 to 10 minutes.
Any pain or discomfort should be managed with Tylenol – do not take aspirin or ibuprofen for the next 48 hours as this affects the clotting process.
You will be sent home with a written sheet of post biopsy instructions and the doctor or technologist will go over them with you.
How long does the procedure take?
The biopsy procedure itself does not take very long, however,
You can expect to be here approximately an hour. This allows time for the radiologist to explain everything to you before the biopsy and to review the post biopsy care instructions following the procedure. If using metered parking, we recommend you to allow for 2 hours as there may be unexpected delays.
How long does it take to get the results?
Most times it takes between 7 to 10 days to get your results. They will be sent to your physician or surgeon. We ask you to phone their office to get the results as we do not disclose them from our office. If you have not heard anything from your doctor for 2 weeks, you may contact us and we will check to see what the delay may be.
Questions
If you have any questions or concerns you may contact us at 306-655-8686. Our office is opened Monday to Friday 7:30 am to 4:00 pm.
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