What is it?

Your attending physician has requested a breast biopsy. This is because they have found a change in the breast tissue on a previous mammography or ultrasound. Other possible reasons for this procedure are a post-operative check-up or familial predisposition.

The radiologist uses a special needle to remove tissue fragments. They then examine the lesion or suspicious tissue with a microscope to determine if it is benign or malignant. The procedure is performed under a local anaesthetic and is virtually pain-free.

Types of breast biopsy

Core needle biopsy

The radiologist uses a special needle that moves quickly through the lesion. A tissue sample is collected through a special notch on the needle. This sample is examined under the microscope later. This technique can be deployed under mammographic guidance or ultrasound guidance, depending on the lesion.

Fine-needle aspiration biopsy

This biopsy is also known as a puncture. The radiologist uses a needle to extract cells from a fluid-filled, suspicious lump. The pathologist then examines the collected cells. The fine-needle aspiration biopsy is performed in the same way as a core needle biopsy. It is usually done under ultrasound guidance. The radiologist uses this procedure to distinguish cysts (fluid-filled cavities) from tumours (that may be malignant).

Test procedure

Before the procedure

  • Are you pregnant? Be sure to report this to the nurse. In some cases, the radiologist will postpone or adjust the test. They want to avoid the risk of exposing your unborn child to the risk of radiation.
  • Do you take blood thinners or any other medication? Inform your attending physician before the appointment. To avoid complications, you must stop taking medication such as blood thinners, at least one week before the biopsy.
  • Do not use any body lotion or gel on the day of the test. These will make the breast slippery and hamper the procedure.
  • Wear comfortable clothing and make sure that you are able to easily remove your upper clothing.
  • You can eat and drink as normal on the day of the biopsy. Fasting is not required.

Procedure

Core needle biopsies and fine-needle aspiration biopsies follow a similar process. The radiologist decides whether to perform the procedure under mammographic or ultrasound guidance. Fine-needle aspiration biopsies are more frequently performed under ultrasound guidance. Your physician will inform you in advance.

Procedure under mammographic guidance

  1. Take place on the chair
  2. The nurse places your breast on the support plate of the mammography device.
  3. The exact location of the suspicious lesion is determined, your breast is disinfected (orange) and you are given a local anaesthetic.
  4. The needle is placed, which you will not feel due to the anaesthetic.
  5. Afterwards, control photographs are taken to check the position of the needle.
  6. Once the needle is correctly placed, the radiologist will place the device on the needle to collect the tissue. You will hear a clicking noise. Then, the radiologist removes the needle from your breast. While the nurse covers the needle puncture, the radiologist collects the removed tissue in a sterile pot. The radiologist may have to repeat this process once or twice.
  7. After this, the radiologist takes a photograph of your breast to check that the correct tissue sample has been removed. They bring the tissue to the laboratory for further tests.

Procedure under ultrasound guidance

  1. You will be lying on your back on the table
  2. Your breasts will be covered and you will place your hands next to your head.
  3. The radiologist will apply a cold gel on your breast and place a device against your breast that emits sound waves. He or she will move this until a clear image of the lesion is visible.
  4. The radiologist will mark the skin with a black marker to indicate where to puncture the skin. The radiologist will wipe off the gel, disinfect the skin and administer a local anaesthetic.
  5. He or she will make a small incision (a few millimetres) where the skin has been marked and place the biopsy needle in this incision. On the other hand, the radiologist will hold the ultrasound device transducer near the incision. This way, the radiologist can see exactly where they are taking the sample from.
  6. When the radiologist takes a sample, you will hear a clicking sample. It is important that you do not move.
  7. After this sound, the radiologist will remove the needle and place the sample in a small sterile container. This process will be repeated until a sufficient number of samples has been collected.
  8. On completion, the radiologist will take the samples to the laboratory for further testing.

What will you feel or experience?

Both procedures are virtually pain free. You will not feel the incision because a local anaesthetic will be applied to your breast(s). The pressure on your breast may feel uncomfortable.

After the procedure

The nurse applies pressure for a few minutes to where the skin was punctured and thoroughly disinfects the wound. He or she will cover it with special plasters that must stay in place for five days. No sutures are involved. The plasters will be covered with a bandage that you can shower with. You will be given covering bandages to take home with you.

Then the nurse or medical imaging professional will take you back to the dressing room. The procedure is finished and you may go home.

Results

The radiologist will not be able to let you know the results of the procedure straight away. The sample must be examined by the laboratory first. Discuss with the radiologist when you will get the results or when you can telephone about them. This usually takes five working days.

Your attending physician will automatically receive the results of the biopsy.

Centres and specialist areas

Breast Centre
Integrated Cancer Centre in Ghent
Radiology

Latest publication date: 05/02/2021
Supervising author: Dr Elzo Kraemer Ximena, Dr Schoofs Christophe