Minimally invasive Biopsy Procedures
There are several different ways biopsies can be performed, and they are often characterized based on how invasive they are.
Surgical biopsies are considered to be the most invasive. They are also called “open” biopsies because they involve an open surgical incision. This procedure may involve taking a sample from the tumor (incisional biopsy) or removing the entire tumor (excisional biopsy).
Core needle biopsies are much less invasive than surgical biopsies. Several tissue samples are obtained using a hollow needle. Imaging techniques described below may be used to guide the surgeon to the best site to take the tissue samples.
Fine needle aspiration biopsy is the least invasive technique. The needle used for this procedure is smaller than that used for a core needle biopsy, and the amount of tissue removed is smaller.
Whenever possible, our physicians at Houston Methodist will use minimally invasive biopsy techniques.
If you do have cancer, our hope is that it will be very small. The imaging tests used to detect cancer can also guide the surgeon to the right place to take the biopsy specimen. However, if a tumor is very small, especially if it cannot be felt, a biopsy might miss the cancerous tissue within normal breast tissue.
An ultrasound can be used to guide the biopsy when a lump can be detected with ultrasound.
What to Expect During an Ultrasound-guided Biopsy
Ultrasound biopsies are usually the quickest and easiest of all biopsy procedures. You will lie on your back or slightly on your side, just as though a routine ultrasound is being performed.
During an ultrasound-guided biopsy, the radiologist injects a local anesthetic to numb the area. Through a small cut in the skin, a needle is inserted and pieces of tissue are removed. This incision is so small, stitches are unnecessary.
A small metal clip is placed in the area of the biopsy. The clip helps identify the mass in future mammograms to prevent re-biopsy of the area. Also, if the lump does prove to be a small cancer, the clip helps the surgeon find and remove this area accurately.
Magnetic Resonance Imaging (MRI)-Guided Biopsy
An MRI is a very sensitive test to look for breast cancer. In an MRI-guided biopsy, an MRI scan of the breast is used to locate suspect tissue and guide a fine biopsy needle to the site for the collection of tissue samples. An MRI-guided biopsy might be used to collect a tissue sample if the area of concern is very tiny (perhaps too small to be located with a mammogram) or in cases in which the patient's breast tissue is very dense. Sometimes cancer will show up in a breast MRI that is not seen in the mammogram or ultrasound. In these cases, the only way to take an accurate biopsy is to guide a needle into the lesion using an MRI.
What to Expect During Your MRI-guided Biopsy
The magnet used in breast MRI can interfere with metal objects in your body.
Please make sure you alert the technologist before you have the procedure if you have any of the following:
- Artificial heart valve
- Implanted drug infusion port
- Infusion catheter
- Intrauterine device (IUD)
- Artificial limb
- Joint prosthesis
- Implanted nerve stimulator
- Metal pins, screws, plates or surgical staples
Breast MRI cannot be performed on people who have any of the following:
- Internal defibrillator
- Cochlear implant
- Clip for brain aneurysm
- Implanted electronic device (such as a pacemaker)
Patients are instructed prior to the procedure to remove any of the following:
- Credit cards
- Hearing aids
- Metal zippers or clothing accessories
- Removable dental work
- Pocket knives
- Eye glasses
As in the breast MRI, the procedure will be performed while lying on your stomach. Once the radiologist locates the suspect tissue within the breast, a computer program is used to determine the precise placement of the needle. The breast radiologist administers local anesthesia, makes a small incision, and the needle is placed at the target site. A tiny tissue sample is removed for analysis and sent to a pathologist, who determines the diagnosis. Usually, the radiologist will leave a small metal clip in the area of the biopsy. The clip helps to identify the mass in future mammograms to prevent re-biopsy of the area. Also, if the lump is a small cancer, the clip helps the surgeon find and remove it accurately. Most patients can resume normal activity within 24 hours of the biopsy procedure.
A stereotactic biopsy is guided by digital X-ray. It is most helpful in sampling areas of calcifications that look suspicious in your mammogram.
What to Expect During Your Stereotactic Biopsy
First, the nurse and technologist will help you onto the padded table and get settled as comfortably as possible. You will lie face down with your breast inserted through an opening in the table. Your breast will be held in compression during the procedure. It is very important that you take the time to get comfortable so you stay perfectly still, as any movement or talking can interfere with the biopsy.
The breast radiologist will inject a local anesthetic to numb the area. Through a small cut in the skin, a needle will be inserted and pieces of tissue will be removed. The incision is so small, stitches are not needed. The breast radiologist will X-ray the tissue removed to make sure the calcifications have been removed, and will place a tiny clip marking the biopsy site. The clip will not be seen or felt by you or others and will not interfere with any of your daily activities.
The procedure will generally last 30 minutes to one hour.
What to Expect After a Minimally Invasive Breast Biopsy Procedure
You will be instructed to keep the breast area dry for 24 hours after the biopsy. Also, strenuous activity like weight lifting or aerobic activity should be avoided during this time. Most women find they can resume their normal activities the day after the biopsy procedure. It is important to carefully follow the post-procedure instructions so any circumstances specific to you will be taken care of properly. It is normal to have bruising after a breast biopsy. To reduce the amount of bruising, the nurse will apply pressure to the biopsy site at the end of the procedure. You will be instructed to place ice on your breast at intervals during the remainder of the day. Though needle biopsies are minimally invasive and are usually over quickly, there are some risks associated with the procedure. As with any needle procedure, bleeding and infection at the biopsy site can occur, so be sure to follow all instructions carefully.
Pathology results are typically ready within a few days. This report will go to your referring physician and your breast radiologist. Your referring physician or breast radiologist will call to inform you of the results, ask how you are healing and answer any questions or concerns you might have.
In analyzing your biopsy specimen, the pathologist will determine if and what type of cancer you have. This is essential information in determining the optimal treatment and procedures that will constitute your individual treatment plan. Please click here for more information on breast cancer treatments and procedures.
Houston Methodist provides minimally invasive biopsy procedures at the following convenient locations: