The Hospital of Saint Raphael uses several methodologies for breast biopsy.  The most appropriate choice for each patient depends on the size, location, appearance and characteristics of the abnormality.  Among the imaged-guided proceudres we offer are:

Ultrasound-Guided Needle Biopsy

Ultrasound-guided breast biopsy is a highly accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. The procedure prevents the need to remove tissue surgically and also eliminates the radiation exposure that comes from using X-rays to locate a mass.

For the procedure, you will be lying face up on a table. The radiologist will apply a special gel to the breast and can watch the needle on the ultrasound monitor to help guide it to the area of concern.  The area to be biopsied is cleansed with an antiseptic and the technician administers a local "numbing" anesthetic to the area with a thin needle.  A special "core" needle is then inserted into the breast and tissue is withdrawn. This process is repeated so that several samples are obtained. You will hear clicking sounds from the machine as these samples are taken.

Once the samples are obtained, they are sent to the pathology department. Pressure is applied to the biopsy area and a dressing will be placed over the site. The dressing should remain in place for 24 hours.

MRI-Guided Imaging

Magnetic resonance imaging (MRI) of the breast is a relatively new technique that is very useful in a select group of women. It does not replace mammography.  Mammography remains the best tool for screening and detecting breast cancer.

Currently, the most accepted role for breast MRI is the evaluation of women who have already been diagnosed with breast cancer and for treatment planning prior to surgery. Sometimes breast MRI is useful for questions that physical exam, mammography, and ultrasound cannot answer. There are some women at particularly high risk for breast cancer, such as those with known genetic mutations (BRA-CA1 and BRA-CA2) who may benefit from routine evaluation with breast MRI.

Stereotactic biopsy

Stereotactic core biopsy is extensively used by radiologists specializing in breast imaging to obtain tissue samples containing microcalcifications, which can be an early sign of breast cancer.  With stereotactic mammography, it's possible to pinpoint the exact location of a mass based on images taken from two different angles of the X-ray machine.

In this procedure, a technician uses a computer and imaging performed in at least two planes to localize a target lesion (such as a tumor or microcalcifications in the breast) in three-dimensional space and guides the removal of tissue for examination by a pathologist under a microscope.

Fine Needle Aspiration

Fine needle aspiration (FNA) is a percutaneous ("through the skin") procedure that uses a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass. With FNA, the cellular material taken from the breast is usually sent to the pathology laboratory for analysis. FNA can also be used by the radiologist or surgeon to drain fluid from a benign cyst. This procedure is called cyst aspiration.

A Fine Needle Aspiration procedure is almost painless and takes only a few minutes to perform.

Core Needle Biopsy

A core needle biopsy is a procedure that removes small but solid samples of tissue using a hollow "core" needle. For lesions that can be felt, the physician fixes the lesion with one hand and performs a freehand needle biopsy with the other. In case of non-palpable lesions, stereotactic mammography or ultrasound guidance is used.

The needle used during core needle biopsy is larger than the needle used with FNA. The core biopsy needle also has a special cutting edge allowing removal of a bigger sample of tissue. With Core Needle Biopsy, relatively large samples can be removed through a small single incision in the skin. First, the breast area is locally anesthetized with a small amount of anesthetic fluid. Then, the needle is placed into the breast.

As with FNA, the radiologist or surgeon will guide the needle into the area of concern.  If the lesion can't be felt. the core needle biopsy is performed under image-guidance using either stereotactic mammography, ultrasound or even magnetic resonance imaging (MRI). A core needle biopsy procedure takes a few minutes to perform and is almost painless. Most patients are able to resume normal activity immediately after the procedure.