The Duke Breast Biopsy Experience

A breast biopsy can be a complicated time for many patients. The Duke Radiology Breast Imaging team is here to support you in this process. Our goal is not only to provide you with outstanding medical care, but also to make you as comfortable as possible as you go through this experience. A biopsy can be a complicated time for many patients. This webpage is designed to explain the biopsy procedure and to answer many frequently asked questions.

Calming Meditation For Breast Biopsy

What happens during a needle core biopsy?

During a needle core biopsy, several small pieces of tissue are removed from the abnormal area in the breast. The tissue is sent to the Pathology Department for a pathologist to evaluate under a microscope. We first thoroughly numb the skin and abnormal area of the breast. Then we use mammogram, ultrasound, or MRI images to guide a special needle into the abnormal area. Once a needle is in the abnormal tissue, several small samples of tissue can be retrieved. It takes approximately two to three working days for the tissue to be processed and the pathologist to make a diagnosis. The needle biopsy procedure differs slightly depending on the type of abnormality that is seen in your breast. The specific procedure will be explained to you by the technologist and radiologist performing the procedure and is outlined below. You will be asked to sign a consent form prior to the procedure.

Ultrasound guided biopsies

An ultrasound guided needle core biopsy is used to take tissue samples of masses (lumps). The procedure is performed while you lie on your back on a table in the ultrasound room.

How long does it take?

The actual procedure takes approximately 30 minutes to sample one site; however, you should plan to be in the Radiology Department for about 2 hours, allowing time to check in, undress, review the consent form, undergo the procedure, and obtain mammogram pictures after the procedure.

Am I allowed to eat before the study?

Yes. Because you are not being sedated for this procedure, you are welcome to eat, drink, and take all of your regular medications as usual unless you have been advised to stop any blood thinning medications by your radiologist or regular doctor.

What happens during the procedure?

The radiologist will do an ultrasound to evaluate where the abnormality is in the breast, then mark the skin to indicate the area to biopsy. The technologist will then thoroughly clean the breast to reduce the likelihood of infection. A sterile drape will be placed over the breast to keep the area clean. The radiologist will then numb the skin and tissue in the breast where the needle will be placed. The numbing medicine is called Lidocaine (similar to Novocain, which is often used in dental procedures). If you are allergic to Lidocaine or Novocain please notify the technologist and radiologist prior to the beginning of the procedure, and a different medicine will be used to numb the area. The radiologist will use a very small needle to prick the skin and deliver the numbing medicine, which may sting for a few seconds before the area becomes numb. After that point, you should not feel any pain from the procedure, but, if you do, you should notify the radiologist so he/she can administer more numbing medicine. We can almost always make this procedure quite comfortable.

Once the breast is numb, the radiologist will place a needle in the breast guided by ultrasound and take several small strips of tissue from the abnormal area. The strips of tissue will be placed in a container and submitted to the Pathology Department after the procedure. In almost all circumstances, a small metallic marker is inserted into the breast to mark the site where the abnormality was located. The marker is then available to later guide a surgeon to the site of the abnormality if surgery is required. If no surgery is necessary, the clip remains anchored in place and indicates on future mammograms that the area biopsied is benign, and does not need further attention. Following the biopsy procedure, the needle will be removed, a temporary bandage will be placed on your breast, and often the technologist will take additional mammographic images of that breast. A final dressing will be applied to the skin, and then you will be allowed to leave the department.

What are the risks of this procedure?

The risks of this procedure include:

  1. Bleeding or bruising. This is usually minimal though a bruise can be large. In patients who have taken aspirin, Advil, other nonsteroidal anti-inflammatory agents or Coumadin or other blood thinners within the past week, the risk for developing a bruise at the site of the biopsy increases. We prefer that you do not take these medications the week prior to the procedure; however, you should talk to the radiologist or your regular doctor before stopping any medications. Please notify the technologist and radiologist before the procedure if you have taken any such medications in the previous week.
  2. Infection. Everything we use (needles, clips, etc.) is sterile and brand new, and your skin is sterilized before the procedure; therefore, infection is very unlikely.
  3. Collapsed lung (very rare). Another risk of the procedure, which is extremely unlikely, is the possibility that the needle could be advanced past the breast and into the chest, causing collapse of the lung. We have developed our technique for doing these biopsies so that the needle is directed parallel. to the chest wall, not directly towards the lung, which makes this risk extremely unlikely during the procedure.
  4. This type of procedure is designed to sample the abnormality within your breast in order to make a diagnosis. Occasionally, a definite diagnosis cannot be made from the sample of tissue acquired at the needle core biopsy. In these cases, a surgical biopsy may be recommended following the needle core biopsy for these indeterminant results.
  5. Rarely, the procedure cannot be performed because the calcifications or mass cannot be clearly seen or in a location in the breast the prevents us from doing the biopsy safely. In these cases, surgical biopsy will be recommended.

Stereotactic Guided Biopsy

A stereotactic biopsy is performed to sample suspicious calcium deposits,  , distortion of the tissue, or suspicious masses in the breast that cannot be seen by ultrasound.

How long will the procedure last?

The actual procedure takes 30-60 minutes for a single site, but plan to be in the radiology department up to 2 hours, allowing time to check in, undress, review the consent form, and undergo the procedure. If more than one abnormality has been found in your breast, allow for additional time.

How is the procedure performed?

A stereotactically guided needle core biopsy is most often performed while you lie on your stomach on the stereotactic table. The breast containing the abnormality will be placed through the hole in the table and will be compressed by the mammographic device, which is located underneath the table. An alternative method requires you to sit up during the procedure. Mammographic images will be taken to localize the abnormal area in the breast. The image will be shown on the computer screen. Once the abnormality is localized, computer system will calculate the exact location for us to determine where to place the needle.

The technologist will then carefully clean the breast. The radiologist will numb the skin and tissue in the breast where the needle will be placed. The numbing medicine used is called Lidocaine (similar to Novocain, which is often used in dental procedures). If you are allergic to Lidocaine, please notify the technologist and the radiologist prior to the beginning of the procedure, and a different medicine will be used to numb the area. The radiologist will use a very small needle to prick the skin and deliver the numbing medicine, which may sting for a few seconds prior to making the area numb. After that point, you should not feel any pain from this procedure, and if you do, please notify the radiologist so he/she can administer more numbing medicine.

At this point, the radiologist will place a needle in the breast and take several small pieces of tissue from the abnormal area. The small pieces of tissue will then be x-rayed to determine if some of the calcium deposits have been obtained within the specimen. If no calcifications are seen with in the specimen, we will take additional samples of tissue in order to obtain calcifications. Once we have an adequate sample of calcifications, we insert a small metallic clip into the breast to mark the site where the calcifications were located. The marker clip would then be available to guide the surgeon to the location if the tissue is abnormal. If surgery is required, the clip would be removed at the time of surgery.

Following the biopsy procedure, the needle will be removed, a temporary bandage will be placed, and the technologist will take additional mammographic images of the breast. A final dressing will be applied to the skin, and then you will be allowed to leave the department. The tissue strips will be submitted to the Pathology Department for evaluation.

What are the risks of this procedure?

The risks of this procedure include:

  1. Bleeding or bruising. This is usually minimal though a bruise can be large. In patients who have taken aspirin, Advil, other nonsteroidal anti-inflammatory agents or Coumadin or other blood thinners within the past week, the risk for developing a bruise at the site of the biopsy increases. We prefer that you do not take these medications the week prior to the procedure; however, you should talk to the radiologist or your regular doctor before stopping any medications. Please notify the technologist and radiologist before the procedure if you have taken any such medications in the previous week.
  2. Infection. Everything we use (needles, clips, etc.) is sterile and brand new, and your skin is sterilized before the procedure; therefore, infection is very unlikely.
  3. This type of procedure is designed to sample the abnormality within your breast in order to make diagnosis. Occasionally, only atypical cells may be identified by the pathologist, and a definite diagnosis cannot be made from the sample of tissue acquired at the needle core biopsy. In these cases, additional surgery may be recommended following the needle core biopsy for these indeterminant results.
  4. Rarely, we attempt to biopsy calcifications or a mass but are unable to retrieve samples because the calcifications or mass are difficult to see or are in a location that precludes needle biopsy. In these cases, surgical biopsy will be recommended

MRI guided biopsy

An MRI guided biopsy is performed to sample an area that was only seen on a prior MRI.

How long will the procedure last?

The actual procedure takes 60 minutes for a single site, but plan to be in the radiology department up to 2 hours, allowing time to check in, undress, review the consent form, and undergo the procedure. If more than one abnormality has been found in your breast, allow for additional time. Additionally, after the biopsy, you will need to have a mammogram performed to confirm.

How is the procedure performed?

An MRI guided needle core biopsy is performed while you are in the MRI scanner. You will lie on your stomach on the MRI table and your breast will be compressed underneath you. MRI images will be obtained, and special software will be used to precisely locate the area in question. In about 10% of patients, the abnormality in question will not be visible and the biopsy will be cancelled. In these cases, we will recommend you repeat an MRI in six months.

The technologist will then carefully clean the breast. The radiologist will numb the skin and tissue in the breast where the needle will be placed. The numbing medicine used is called Lidocaine (similar to Novocain, which is often used in dental procedures). If you are allergic to Lidocaine, please notify the technologist and the radiologist prior to the beginning of the procedure, and a different medicine will be used to numb the area. The radiologist will use a very small needle to prick the skin and deliver the numbing medicine, which may sting for a few seconds prior to making the area numb. After that point, you should not feel any pain from this procedure, and if you do, please notify the radiologist so he/she can administer more numbing medicine.

At this point, the radiologist will place a needle in the breast and take several small pieces of tissue from the abnormal area. Once we have an adequate sample of the area, we insert a small metallic clip into the breast to mark the site where the calcifications were located. The marker clip would then be available to guide the surgeon to the location if the tissue is abnormal. If surgery is required, the clip would be removed at the time of surgery.

Following the biopsy procedure, the needle will be removed, a temporary bandage will be placed, and the technologist will take additional mammographic images of the breast. A final dressing will be applied to the skin, and then you will be allowed to leave the department. The tissue strips will be submitted to the Pathology Department for evaluation.

What are the risks of this procedure?

The risks of this procedure include:

  1. Bleeding or bruising. This is usually minimal though a bruise can be large. In patients who have taken aspirin, Advil, other nonsteroidal anti-inflammatory agents or Coumadin or other blood thinners within the past week, the risk for developing a bruise at the site of the biopsy increases. We prefer that you do not take these medications the week prior to the procedure; however, you should talk to the radiologist or your regular doctor before stopping any medications. Please notify the technologist and radiologist before the procedure if you have taken any such medications in the previous week.
  2. Infection. Everything we use (needles, clips, etc.) is sterile and brand new, and your skin is sterilized before the procedure; therefore, infection is very unlikely.
  3. This type of procedure is designed to sample the abnormality within your breast in order to make diagnosis. Occasionally, a definite diagnosis cannot be made from the sample of tissue acquired at the needle core biopsy. In these cases, additional surgery may be recommended following the needle core biopsy for these indeterminant results.
  4. Rarely, the procedure cannot be performed because the calcifications or mass cannot be clearly seen or in a location in the breast the prevents us from doing the biopsy safely. In these cases, surgical biopsy will be recommended.

How do I care for the area after the biopsy?

Following either type of biopsy, you will have several small pieces of sterile tape or steri-strips over the opening in the skin.  The area must stay dry for 48 hours. Leave the steri-strips on until they begin to peel off on their own, one to two weeks later. In the first 24 hours after the biopsy, you may take extra strength Tylenol (if you are not allergic to it) and use an ice-pack locally to the affected area if there is localized pain in your breast. Pain should not increase after 24 hours. You should limit strenuous activities involving use of your arm such as lifting heavy items, tennis, golf, gardening, etc., on the side of the biopsy for the next 24 hours. If you have any symptoms of redness, swelling, fever or increasing pain in the breast on the fourth day or later after the procedure, please notify us (919) 681-2673.

How will I get the results from the biopsy?

You will be asked to give us one or more phone numbers where we can call you with the results two to three business days after the procedure. For confidentiality reasons, we will not leave results (benign or malignant) on your message machine or with a family member unless we have your written permission to do so. The radiologist will review the pathology results to confirm that they match the abnormality seen on your images and he/she will call you with the pathology results. If there is any discrepancy, the radiologist may recommend further evaluation with surgery. If you do have a premalignant or malignant finding that requires surgery, we will contact the physician who referred you for your mammogram in order to make sure that you get an appointment with a breast surgeon.

During any procedure in our department, we are always happy to explain exactly what we are doing and to answer any questions you may have.