Ultrasound-Guided Breast Biopsy
An ultrasound-guided breast biopsy is a procedure in which ultrasound waves are used in order to find lumps or other abnormalities in the breasts so that doctors can take tissue samples for analysis. This type of biopsy is a minor procedure that is more precise than regular biopsies.
This type of procedure is useful for doctors because while mammograms can detect the existence of lumps or other abnormalities, they often cannot tell exactly what the abnormality is or if it is cancerous. In order to determine what the abnormality is, a needle sample of the tissue needs to be extracted for testing.
How Does Ultrasound-Guided Breast Biopsy Work?
Ultrasound-Guided biopsies are a great alternative to surgical biopsies because they are less invasive and oftentimes will only require a local anesthetic for doctors to extract the breast tissue needed.
The procedure begins with a radiologist using an ultrasound probe to detect the site of the breast abnormality. Then they will apply local anesthetic to the site.
First, the doctor will make a small cut on the skin where they will insert the biopsy needle. Monitoring the site with the ultrasound probe, the doctor will then insert a hollow needle into the mass to extract the breast tissue with the guidance of the ultrasound picture.
In order to extract the breast tissue the doctor will then use one of the following instruments:
- A fine needle attached to a syringe, smaller than needles typically used to draw blood.
- A core needle, also called an automatic, spring-loaded needle, which consists of an inner needle connected to a trough, or shallow receptacle, covered by a sheath and attached to a spring-loaded mechanism.
- A vacuum-assisted device (VAD), an instrument that uses pressure to pull tissue into the needle.
After the sample has been extracted the needle is removed and the wound is dressed. With this method, the scarring and recovery is very minimal for the patient.
How Do I Prepare?
Medical history and medications being taken should always be discussed with your doctor before a procedure like this. Since local anesthesia is used for this procedure it is important to alert your doctor if you have any allergies to this as well.
In addition to local anesthesia, the procedure may cause some bleeding so patients may be advised to stop taking aspirin, blood thinners, or some herbal supplements before the procedure to prevent excessive bleeding. The breast center will give you specific instructions before your biopsy. If the patient has any known bleeding problems it is important that the doctor be made aware of this before this procedure.
On the day of the procedure, patients are recommended to wear loose-fitting clothes and remove all jewelry. Patients can also eat before this procedure.
What Should I Expect During My Exam?
The patient will most likely be asked to undress and wear a surgical gown. The procedure will require them to lay on their back and the doctors will then sterilize the breast area before a surgical gel is applied. This gel will allow the ultrasound transponder to glide easily on the skin and allow the ultrasound scanner to easily capture and visualize the area in which the breast abnormality is occurring. The radiologist will then numb the area they’re going to be working with local anesthetic.
A doctor will then insert a needle into the abnormal breast mass and extract tissue from it. Once the needle is removed, pressure will be applied to the area to stop any bleeding and the open wound will be dressed. Typically, doctors will place a small MRI-compatible marker inside the procedure site for future monitoring purposes but this will not cause any harm or disfigurement to the patient. The opening created by the needle will be very small so sutures will not be required and scarring is very uncommon.
Are There Any Special Precautions Needed After the Procedure?
It is normal to feel slight discomfort and numbness during the procedure, but this should be a relatively painless process without any lasting after-effects.
Usually, the whole process takes about an hour, and although patients are largely unaffected by the procedure, doctors recommend that patients avoid strenuous exercise for the following 24 hours.
Some women may experience soreness or bruising in their breast after the procedure, but this is nothing to worry about. Temporary bruising is normal and over-the-counter pain-relievers or cold packs are common remedies in this stage.
However, if you’re experiencing the following symptoms you should contact your doctor:
- Excessive swelling
- Excessive bleeding
- Heat in the breasts
How Do I Get My Results?
Although the radiologist will perform the procedure, a pathologist will be the one who will examine the sample taken from the procedure and make the final diagnosis. The radiologist will then evaluate the results of the pathology analysis and the biopsy to make sure that the findings are in agreeance with each other.
If the findings do not agree, then removal of the entire biopsy site or additional testing may be required for a conclusive diagnosis.
The result will either be shared by the radiologist or the referring physician. In any case, follow-up exams are recommended to track any changes in the issue over time.
What Are the Benefits and Risks of an Ultrasound Guided Breast Biopsy?
- the procedure is less invasive than a surgical biopsy involving little to no scarring
- It is a quick procedure with minimal recovery time
- Ultrasound imaging avoids the need for using ionizing radiation exposure used in stereotactic breast biopsies.
- Is a quick and easy way to determine whether lumps are cancerous or benign.
- The ultrasound allows the radiologist to track the motion of the needle while performing the procedure.
- Ultrasound-guided breast biopsies can extract breast tissue from hard-to-reach places, like under the arm or near the chest wall, that other biopsies cannot reach.
- Ultrasound-guided breast biopsies tend to be less expensive than other biopsy methods.
- There is a small risk (less than 1%) of developing hematoma which is a collection of blood at the biopsy site due to excessive bleeding.
- There is a small risk of infection, though your doctor will take all necessary precautions to reduce this risk.
- Patients can experience some pain or discomfort for which over-the-counter pain medicine could be a solution.
- In some extreme cases, there has been a risk that the needle being inserted during extraction can pass through the chest wall and allow air to come in around the lung, causing it to collapse.
- There is a chance that additional testing may become necessary if this procedure cannot find a definite explanation for the abnormality.
Limitations of Ultrasound guided Breast Biopsies
The biggest limitation of this type of biopsy method is that it can only be used if the lesion can be seen clearly through an ultrasound. Small lesions or clustered calcifications can be seen better through x-rays than with ultrasounds making certain cases more suitable to test with other types of biopsies.
Sometimes a breast biopsy may miss or underestimate the severity of an abnormality in the breast. If conclusive results cannot be determined through a successful biopsy procedure, a surgical biopsy will become necessary.