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St. Maarten Medical Center
An ultrasound-guided breast biopsy uses sound waves to help locate a lump or abnormality and remove a tissue
sample for examination under a microscope. It is less invasive than surgical biopsy, leaves little to no
scarring and does not involve exposure to ionizing radiation.
Tell your doctor about any recent illnesses or medical conditions and whether you have any allergies,
especially to anesthesia. Discuss any medications you're taking, including herbal supplements and aspirin.
You will be advised to stop taking aspirin or blood thinner three days before your procedure. Leave jewelry
at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you are to be sedated,
plan to have someone drive you home afterward.
Lumps or abnormalities in the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous.
A breast biopsy is performed to remove some cells from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. This can be performed surgically or, more commonly, by a radiologist using a less invasive procedure that involves a hollow needle and image-guidance.
Image-guided needle biopsy is not designed to remove the entire lesion but to obtain a small sample of the abnormality for further analysis.
Image-guided biopsy is performed by taking samples of an abnormality under some form of guidance such as ultrasound, MRI or mammography.
In ultrasound-guided breast biopsy, ultrasound imaging is used to help guide the radiologist's instruments to the site of the abnormal growth.
An ultrasound-guided breast biopsy can be performed when a breast ultrasound shows an abnormality such as:
There are times when your doctor may decide that ultrasound guidance for biopsy is appropriate even for a mass that can be felt.
Ultrasound guidance is used in four biopsy procedures:
You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all
clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure.
Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including
herbal supplements, and if you have any allergies, especially to anesthesia. Your physician may advise
you to stop taking aspirin, blood thinners, or certain herbal supplements three to five days before your
procedure to decrease your risk of bleeding.
Also, inform your doctor about recent illnesses or other medical conditions. You may want to have a
relative or friend accompany you and drive you home afterward. This is recommended if you have been
Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object's size, shape and consistency (whether the object is solid or filled with fluid).
In medicine, ultrasound is used to detect changes in appearance, size or contour of organs, tissues, and vessels or to detect abnormal masses, such as tumors.
In an ultrasound examination, a transducer both sends the sound waves into the body and receives the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive receiver in the transducer records tiny changes in the sound's pitch and direction.
These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Short video loops of the images may also be saved.
Using an ultrasound probe to visualize the location of the breast mass, distortion or abnormal tissue change, the radiologist inserts a biopsy needle through the skin, advances it into the targeted finding and removes tissue samples. If a surgical biopsy is being performed, ultrasound may be used to guide a wire removes tissue samples. If a surgical biopsy is being performed, ultrasound may be used to guide a wire directly into the targeted finding to help the surgeon locate the area for excision. With continuous ultrasound imaging, the physician is able to view the biopsy needle or wire as it advances to the location of the lesion in real-time.
Image-guided, minimally invasive procedures such as ultrasound-guided breast biopsy
are most often performed by a specially trained radiologist. Breast biopsies are usually done on an
You will be positioned lying face up on the examination table or turned slightly to
the side. A local anesthetic will be injected into the skin and more deeply into the breast to numb it.
Pressing the transducer to the breast, the sonographer or radiologist will locate the lesion. A very
small nick is made in the skin at the site where the biopsy needle is to be inserted. The radiologist,
monitoring the lesion site with the ultrasound probe, will insert the needle and advance it directly
into the mass.
Tissue samples are then removed using one of three methods:
After this sampling, the needle will be removed. If a surgical biopsy is being performed, a wire
is inserted into the suspicious area as a guide for the surgeon.
A small marker may be placed at the biopsy site so that it can be located in the future if
necessary. Once the biopsy is complete, pressure will be applied to stop any bleeding and the
opening in the skin is covered with a dressing. No sutures are needed. A mammogram may be
performed to confirm that the marker is in the proper position. This procedure is usually
completed within an hour.
You will be awake during your biopsy and should have little discomfort. Many women report little pain and no scarring on the breast. However, certain patients, including those with dense breast tissue, or abnormalities near the chest wall or behind the nipple may be more sensitive during the procedure.
When you receive the local anesthetic to numb the skin, you will feel a pin prick from the needle followed by a mild stinging sensation from the local anesthetic. You will likely feel some pressure when the biopsy needle is inserted and during tissue sampling, which is normal. The area will become numb within a few seconds.
You must remain very still while the imaging and the biopsy are being performed. As tissue samples are taken, you may hear clicks or buzzing sounds from the sampling instrument. These are normal.
If you experience swelling and bruising following your biopsy, you may be instructed to take an over-the-counter pain reliever and to use a cold pack. Temporary bruising is normal. You should contact your physician if you experience excessive swelling, bleeding, drainage, redness or heat in the breast.
If a marker is left inside the breast to mark the location of the biopsied lesion, it will cause no pain, disfigurement or harm. Biopsy markers are MRI compatible and will not cause metal detectors to alarm. You should avoid strenuous activity for at least 24 hours after the biopsy.
Breast biopsy procedures will occasionally miss a lesion or underestimate the extent of disease present. If
the diagnosis remains uncertain after a technically successful procedure, surgical biopsy will usually be
The ultrasound-guided biopsy method cannot be used unless the lesion can be seen on an ultrasound exam.
Clustered calcifications are not shown as clearly with ultrasound as with x-rays. Very small lesions may be
difficult to target accurately by ultrasound-guided core biopsy.