Stereotactic Vacuum
Assisted Biopsy (Mammographic guidance)
This biopsy method is preferred when an
abnormality is seen well on mammography and cannot be seen under
ultrasound visualization. Most of the time, the abnormality being
biopsied is calcium deposits which are detected on the mammogram. Occasionally,
nodules or small tumors not seen on ultrasound but visible on the
mammogram are removed by this technique. A stereotactically guided
breast biopsy is performed by the breast radiologist. A special vacuum
assisted needle
is used, the mammotome needle, which uses a suction device to remove
large pieces of tissue containing the calcium or nodule. The procedure
is performed quickly and easily and without pain. Whenever possible, the
entire abnormality is removed.
The patient lies prone
(on her stomach) on a special biopsy table with the breast
hanging through an opening in the table. The position may be
uncomfortable, and if you have neck problems, you may want to speak to
your physician and take some muscle relaxant or pain medication prior to
the procedure. The technician will position the breast so that the area
containing the abnormality is compressed by a small breast paddle. This
compression is less uncomfortable than the compression by a regular
mammogram. The paddle contains a small window in which the calcium or
nodule is centered. Computerized digital images are taken which allows
the radiologist to identify the abnormality in 3 planes.
With these coordinates, the Physician
can then locate the abnormality exactly and know precisely where and how
deep to put the biopsy needle. The procedure is performed using sterile
technique so there is no danger of infection. The skin is cleansed with
betadine, anesthetized with a local anesthetic which produces immediate
numbing, and the biopsy procedure is then performed. A small nick is
made within the skin which heals completely within a few weeks. There is
some noise from the suction apparatus, but there is little discomfort
except for the position which must be maintained lying on the table.
Tissue is removed in a quick and painless manner using the vacuum
assisted needle. In most instances, and whenever possible, the entire area of
abnormality is removed.
A small inert titanium clip is inserted
through the needle into the breast to mark the area, in the event that
surgical intervention is required. The tissue is then sent to the pathologist
who renders a complete and accurate diagnosis within 24 hours whenever
possible. Multiple areas may be biopsied in this fashion, although we do
not recommend that they be performed at the same biopsy session, because
of greater discomfort after the procedure.
When the procedure is complete, a small
piece of paper tape is placed over the nick to provide the smallest scar
possible. It is recommended that strenuous physical activity be limited
for the first 24 hours to eliminate the chance of bleeding. Ice is
useful in the immediate post biopsy period to reduce bruising and pain.
Only Tylenol should be used for pain or discomfort.
The results of the biopsy are usually
available 24-48 hours after the procedure and you will be called by one
of the physicians at Promedica. In the event that the diagnosis is
cancer, even though 100% of the abnormal area may have been removed by
this method, a surgical biopsy is still required for definitive
treatment.
Patients who take daily aspirin or
coumadin or anti-inflammatory medication regularly should stop taking
these medications 4-5 days prior to the biopsy - or as recommended by
your physician. They can be resumed 24 hours after the biopsy. Please
inform us if you have any allergies to local anesthetics or betadine.
Core
Biopsy
When a nodule is seen on mammogram, and
the same nodule can be seen on ultrasound, or when a nodule is only
found on ultrasound, an ultrasound guided CORE biopsy is frequently
indicated. The physician scans the breast with the hand held ultrasound
transducer while the biopsy is being performed. This means that there is
direct visualization on the ultrasound screen of the needle as it is
inserted into the breast abnormality to confirm that the needle is being
inserted into the correct spot.
The patient is positioned on her back on the table, and the nodule or
other abnormality is found on ultrasound. A mark is made on the skin
with a pen to indicate the spot for insertion of the needle; the skin is
cleansed with sterile antiseptic solution, and the area is numbed with
local anesthetic. A small nick is made in the skin.
A special needle is used to biopsy the
area. A loud click is heard each time the biopsy is performed, which is
anywhere from 2-5 times. There should be no pain. Small cores of tissue
are removed from the abnormal area and sent to a pathologist for
analysis. Results are available within 24-48 hours. There is usually
minimal post biopsy discomfort. Tylenol is recommended for pain, and
strenuous activity should be avoided for 24 hours.
Patients who take daily aspirin or
coumadin or anti-inflammatory medication regulary should stop taking
these medications 4-5 days prior to the biopsy or as recommended by your
physician. They can be resumed 24 hours after the biopsy. Please inform
us if you have any allergies to local anesthetics or betadine.
Sonotome
(Ultrasound guided Vacuum Assisted Biopsy)
This procedure is similar to the
stereotactic biopsy, except the biopsy is performed with ultrasound guidance
rather than mammographic guidance. The patient lies on her back rather
than lying prone. Unlike a CORE biopsy where the abnormality is only
sampled, as much as 100% of the abnormality can be removed with this
special vacuum assisted 11g needle. The procedure is performed using
sterile technique. Anesthesia or numbing is used, and the mammotome
needle is inserted though a skin nick. There is no pain and minimal
bruising. The procedure usually takes 10-15 minutes. Specimens are sent
to the pathologist and results are available within 24-48 hours.
Strenuous activity should be avoided for 24 hours. At
the conclusion of the biopsy, an inert titanium clip is inserted into
the breast to mark the site of the biopsy, in the event of the need for
subsequent surgery. 2 mammographic views are performed after the biopsy
to confirm that the clip is present in the breast.
Patients who take daily aspirin or
coumadin or anti-inflammatory medication regulary should stop takiing
these medications 4-5 days prior to the biopsy. They can be resumed 24
hours after the biopsy. Please inform us if you have any allergies to
local anesthetics or betadine.
Cyst
Aspiration
This procedure is used for the sole
purpose of removing fluid from a cyst(fluid filled nodule.) A small
needle is inserted into the breast using ultrasound guidance. Local
anesthesia is not routinely used when performing this procedure. The
skin is cleansed. The tip of the needle is placed into the cyst, and the
fluid is withdrawn. Usually the cyst is totally emptied and it collapses
and disappears. The fluid is sent to pathology to confirm that it is
benign. An x-ray after the procedure may be taken if the cyst was seen
on the mammogram to confirm that it is gone. No anesthesia or numbing is
used for this procedure; there are no bandages, and there are no after
effects. The procedure takes less than 5 minutes.
Indications for cyst aspiration include:
painful cyst, palpable lump that is a cyst; a cyst that does not appear
completely benign on ultrasound.
Fine
Needle Aspiration Biopsy
When the physician wants to sample a
mass, but does not wish to use a large needle or anesthesia, this
procedure is chosen. A 22g needle is used. This procedure is
most useful in biopsying very small masses, 3-5mm, but otherwise is used
less and less across the country as it may be of unreliable
accuracy. When it is difficult to determine from the ultrasound
scan whether a nodule is a cyst or a solid mass, this method is selected
to make that determination. Once it is determinted to be solid, a
larger needle might then be used.
