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Imaging in Breast Biopsy

Virtua radiology units provide imaging to support breast biopsy, and often perform the breast biopsy itself. A biopsy is used to obtain a tissue sample to send to the pathologist to evaluate in the lab and under the microscope, in order to determine whether a breast lesion is benign or cancerous. Imaging alone is often not adequate to make this determination. Specialists offer a number of different approaches to breast biopsy, based in part on whether a breast mass can be felt (palpated), as well as on its size and location.

images courtesy GE Healthcare
images courtesy GE Healthcare

Doctors can perform a simple type of biopsy for masses that they can feel and that might be cysts. They use a very fine needle inserted through the skin to see if they can draw fluid from the cyst. If the mass is a cyst it will typically recede or disappear after its fluid is withdrawn. If the mass seems solid, though, the patient my need a surgical or radiologic biopsy.

Quality breast biopsy requires practice, skill and team support in a properly equipped facility.

With the surgeon: For palpable masses, surgeons can perform a fine-needle or core-needle biopsy, or do partial or complete (open) surgical excision of the mass in the operating room, without direct radiologic guidance. However, if a mass calls for surgical biopsy but cannot be felt, Virtua radiology may use X-ray or ultrasound guidance to position the tip of a thin wire near the mass in order to point the surgeon to the targeted tissue during surgery.

Image-guided biopsy with radiologist: The radiologist may also use a fine needle –– or core needle or vacuum probe with gentle suction for a larger sample –– to remove breast biopsy tissue, especially for masses that are deep in the breast or cannot be palpated or otherwise easily located. Radiologists may use one or more of several imaging modalities for this safe, minimally invasive approach–

  • stereotactic biopsy. The radiology team can use X-ray mammographic images taken from more than one angle to find the coordinates for, and precisely locate and biopsy, a targeted mass. For this procedure, the patient lies face down with the breast positioned through a hole in the biopsy table. Compression panels hold the breast, as in a regular mammogram. The radiologist raises the table and performs the procedure from underneath, using the system’s computer to guide the needle or vacuum-assisted probe to gather small samples of breast tissue. Radiologists use this approach particularly for fine areas identified on a mammograms, such as small calcifications.
  • ultrasound-guided biopsy. The radiology team use an ultrasound probe, placed against the skin of the breast, to locate a breast mass before and during this type of biopsy. With this approach, they direct needle placement and confirm needle position in the mass, with the patient lying, back down, on the ultrasound table. Ultrasound-guided biopsy is particularly useful if a mass is confirmed or suspected to be a cyst that requires draining or possible further pathology.
  • MRI-guided breast biopsy. An MR imaging unit specially equipped to perform breast MRI can use the precise location information from this exam for needle biopsy. The Virtua team typically uses this technique for breast lesions that are difficult to detect with imaging other than MR. The patient lies face down with the breast in a hollow depression on the MR-unit table. The radiologist raises the table and performs the procedure from underneath, using the system’s computer to guide the biopsy needle to gather small samples of breast tissue.

All breast biopsies are performed using a local anesthetic to numb the breast area. After image-guided biopsy performed by the radiologist, patients can go home, applying only a small bandage and ice to the biopsy site. They resume normal activities within a day.

In some cases, if the breast lesion is small, use of the suction probe permits the radiologist to remove the entire lesion. Image-guided needle biopsy leaves no defect or distortion in the breast, and rarely a permanent mark on it.

While image-guided biopsy of the breast is a state-of-the-science approach, it does not guarantee that all of the relevant tissue is sampled or that the team will properly estimate the type or extent of the disease. No procedures currently available can insure this all of the time. If results are unclear, patients may undergo more than one type of breast biopsy including, in some cases, a follow-up surgical biopsy to gather as much information as possible.

More information on breast biopsy.

To arrange for radiology services at Virtua Our Lady of Lourdes or Virtua Willingboro Hospital:

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