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Tomographic Guided Biopsies

Image by Qingbao Meng
tomo bx.JPG

What is it?

Basic overview

If you have had an abnormality detected on your breast imaging that is suspicious or indeterminate and it is only visualized with mammography you may be recommended for tomographic biopsy. Normally this technique is used to biopsy very subtle areas of distortion or masses not visualized on ultrasound. 

Biopsy is a minimally invasive way to take some cells from the area that catches your doctor's eye and find out what they are. The goal of biopsy is to sample the abnormality to determine diagnosis. This procedure is not curative or therapeutic in any way, but it will help your care team plan what the best course of clinical management is for this finding.

Mammography is used to find this abnormal region, clean the surface of your skin and give you an injection of local anesthetic. 

You will be awake during this procedure and you will need to remain still while the doctor is working. 

Once you are numb a needle will be advanced into location - verified by taking some images - and the doctor will take several tissue samples from the area to send to the lab for pathologists to review and determine what is being seen for further clarification.

You will get a small bandage over the area post procedure, there are no stitches as this is truly a needle procedure. 

The length of time of these exams is highly variable. First we need to find the area and sometimes this adds a few minutes to your exam. A computer will have to calculate your tissue thickness to ensure the correct needle is selected and that it is safe to obtain a sample this way. Please be patient - we don't want to tell you this is going to be a quick test because it can take somewhere between 15 min to an hour or more.

Normally pathology takes several days to get the result. You will not know the results immediately. Pathology is like the ultimate diagnosis at the cellular level - be patient, we don't want the pathologist to rush and not make the correct diagnosis.

Most patients cannot find the point of entry when they return for subsequent imaging. Your body will heal quickly from this type of test and the majority of people do not scar. 

Remember that the majority of biopsies preformed result in a non-cancerous finding, but we would rather you be safe than regret not proceeding with biopsy if it is breast cancer.

What should I expect?

On the day of biopsy and after.

Your doctor will inform you of the procedure risks and benefits and ask you to sign a formal consent to proceed with biopsy. 

Tomographic breast biopsy utilizes mammography as the tool to guide your doctor into the correct location. Due to the nature of how small these findings can be it is imperative that you remain as still as possible once you are positioned. You will be seated in a large chair on wheels in front of a mammo unit. Your breast will remain in compression the entire duration of the exam.

Finding the area that needs to be biopsied sometimes takes the longest amount of time. Once the area is visualized and the computer calculates that it is safe to proceed the procedure will move along at a faster pace. 

Your skin will be cleaned and you will receive an injection of numbing medication directly in the area that requires biopsy. Doctor may make a small surface nick in your skin with scalpel. A needle will be advanced into location and some images will be taken to ensure that the needle is still on target. Once your doctor is satisfied with the placement of the needle a tissue sample will be taken. Don't be alarmed if more images are taken prior to the actual start of the biopsy - we want to make sure that we biopsy the correct area. 

Most tomographic breast biopsies use a vacuum assisted device to help extract the tissue from your breast so that it can be examined. Due to the nature of this assistance you may hear some loud suction sounds - this is completely normal. Unfortunately this test is noisy. We put you in a potentially uncomfortable position, tell you to hold completely still and then proceed to make a racket in the room. All the noises you will experience are standard, please don't try to look around for the origin of the sounds - we really don't want you to move. 

Once the sample has been taken a small tissue marker will be inserted in the area of the biopsy. If the area is cancerous we need to know where to get back to so a surgeon can operate to ensure you will be cancer free.

A post biopsy mammogram will be obtained and you will have a small bandage placed over the area prior to going home. 

The doctor who ordered your biopsy should contact you once the results are available and let you know exactly how to proceed with next steps, if any. Results should be available with-in 2 weeks. If you haven't heard after 2 full weeks have gone by, check in to see what the hold up is.

How do I prepare?

What am I going to wear?

and.... when can I shower after?

It is important to disclose all of your medications and allergies to the facility BEFORE scheduling your biopsy. If you are taking some blood thinning medicines like Aspirin (even low dose), Coumadin, Warfarin, Plavix, etc. you may need to discontinue their use for a period of time. Please check with your doctor prior to discontinuing any medicines to ensure it is safe for you to do so.

Most breast imaging facilities have you change into a gorgeous outfit upon arrival. We recommend wearing a comfortable two piece outfit just in case the facility gives you a half gown or a very sexy paper gown. So in short, be comfortable and it's not the best day for a dress.

Post procedure extra support is always beneficial for healing so bring or wear a sports bra. If you don't have a sports bra bring  your most supportive bra. If you don't wear bras you may need to be wrapped in an ace wrap post procedure for a bit more compression over the area. 

To reduce the risk of post procedure bleeding or bruising we recommend that you not use any non-steroidal anti-inflammatories (NSAIDS) the day before, of, or after your exam. So you may want to have some Tylenol on hand in case you have a headache or experience some discomfort after biopsy.

Post procedure we recommend that you take it easy. Common sense goes a long way - if it hurts don't do it. Try to avoid heavy or strenuous activity for at least 24 hours post procedure just to help your body heal. We're not saying clean house prior to your procedure, but maybe refrain from going to the gym or doing hot yoga for a bit after this and the laundry can wait for another day or two while you heal - it'll still be there...

Ice is your friend post procedure. Ice will help to reduce swelling in the area and help with soreness. Do not place ice directly on the surface of your skin as it can be irritating. Use some sort of barrier or put it on top of your clothing. Patients have suggested wearing two bras and sneaking the ice pack in between them over the area that was biopsied. 

Shower the morning of procedure, you will likely be asked to keep the bandage dry for 24 hours post procedure. When you do shower, just let the water and soap run over the area and pat dry - don't scrub.

Your biopsy facility will outline more specific pre and post procedure care instructions and recommendations for you. Ask questions if anything is unclear. 

Benefits and potential risks

Why should or shouldn't I proceed with biopsy?


Biopsy offers a minimally invasive way to determine whether or not you have breast cancer. 


You may bleed or bruise - we are inflicting some trauma to your breast by sticking a needle in it. Bleeding post procedure is pretty uncommon. You might notice a bit of dried blood on the bandage or a few drops even post procedure, but it should never be uncontrollable. If you bleed hold a lot of pressure over the area until your body is able to clot naturally. A bruise may blossom in your breast post biopsy as well, it may not be exactly where your bandage is either. We expect that a bit, just monitor it to make sure that your body is healing it.

Hematoma can occur if there is bleeding inside your breast. If you get a new lump or bump you might have one. Hematomas frequently resolve on their own (in a few months), but it can seem like what is an eternity. If you have a lump post biopsy and it is getting bigger - seek medical attention.

Infection is another potential risk. We do not see this frequently but it is documented in our literature so we have to warn you of the possibility. If the area that was biopsied is hot to the touch, red and inflamed, if there is pus or any type of foul discharge your doctor needs to be notified immediately. If you get a fever in the few days following procedure you should also check in with your doctor. Antibiotics normally clear any problem up quickly, but are best administered as soon as possible.

Will it hurt? Well... it's not going to tickle... Everyone's pain threshold is different so we can't outright say no. None of your doctors are really sadistic people (as far as we know) and they don't want to hurt you. The numbing medicine normally does pinch and burn but it doesn't last long. You will feel sore after but nothing should really hurt. If you are experiencing severe pain, please get evaluated as this is not a normal response for needle biopsy.

Insufficient sampling can also occur but most doctors ensure they have enough so that you aren't called back to repeat the biopsy. During stereotactic breast biopsies you doctor will likely step away with your tissue sample so that they can take a mammogram image of it to ensure there is enough tissue in the sample.

Unfortunately sometimes your pathology result is "discordant" with the imaging findings. This means that diagnosis from pathology does not match what the area looks like on your imaging. This may mean repeat biopsy or surgical biopsy for further clarification.

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