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Ultrasound Guided Core Needle Biopsy

What is it?

Basic overview

If you have had an abnormality detected on your breast imaging that is suspicious or indeterminate and it is well visualized with sonography you may be recommended to undergo an ultrasound guided biopsy.

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.

A doctor will use ultrasound 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 ultrasound - 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. 

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. 

Some preliminary images will be taken to ensure that everything still looks the same. Your doctor might draw on you with a skin marker to easily find the area again. Once they know exactly where they are going your skin will be cleaned and some sterile drapes might be laid down. It is important that you not touch anything that the doctor has put on you or your breast during procedure as this may compromise the sterility. If something is bothering you - let your care team know.

 

You will get some local anesthesia to numb the area - it may pinch and burn a bit, but after a few seconds you should not feel anything sharp. You may still experience pressure as doctor needs to push on the ultrasound probe to make images and their hands will be working on top of you. 

Once you are numb the doctor will make a small nick in your skin and a needle will be advanced into the area with ultrasound guiding it into place. Some facilities use a coaxial needle and some use a vacuum assisted device. Either way you will experience some sounds as the tissue sample is taken: either clicking noises like a cap-gun or something that sounds like suction at the dentists office. 

Once doctor has a good sample to send off to the lab they will likely insert a small metallic tissue marker in place to mark the spot of biopsy. The tissue marker will not set off metal detectors, TSA will never know it is there and it will be safe for you to have future tests of any sort. 

 

The needle will be removed and some pressure with gauze will be applied to the area to ensure that there is no bleeding. A bandage will be applied and then you will probably have a gentle post procedure mammogram to visualize where the tissue marker is in your breast for future reference. 

We use mammography as the standard of care in breast imaging so we take these post biopsy mammograms so that we know what your breast looks like with the tissue marker in it. Think of the tissue marker as a bit of internal bling that only your radiology team will really appreciate.

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 don't lug the vacuum around when you get home and certainly try to avoid wrestling a 27lb turkey into the oven immediately following this procedure. 

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?

BENEFITS:

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

RISKS:

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. 

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.