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Minimally Invasive Breast Biopsy

We offer several options for obtaining a minimally-invasive outpatient breast biopsy, all here in the calm setting of the Washington Women's Center.

Jason Cheng
Jason Cheng, MD, radiologist, medical director, Washington Hospital Medical Imaging Department

The goal of breast cancer screening is to try to detect cancers at an early stage when they are most treatable and curable. Physical examination, mammography, ultrasound and breast MRI all play important roles in the detection and evaluation of breast lesions. In many cases lesions can be characterized as benign or probably benign and safely followed with short interval follow up examinations. In other cases, however, the lesions may be suspicious for cancer or fall in a 'grey zone' where they could be either benign or malignant. Obtaining a sample of the tissue for analysis is necessary in these circumstances.

Traditionally, most breast biopsies were done with a surgical procedure and an excisional biopsy where the surgeon goes in and removes the lesion. If the abnormality is not palpable, this may be done following localization of the area of concern using ultrasound, mammography or MRI. Your radiologist would mark the area of concern with the injection of a blue dye and placement of a fine wire to help direct your surgeon to the correct area.

Excisional biopsy is sometimes the best or only choice. However, in many cases today, lesions can be effectively sampled with a much less invasive procedure. Instead of a standard surgical incision and removal of the lesion, many lesions can be sampled with special vacuum-assisted needle biopsy devices. Only a small skin incision, much smaller than that required for an excisional biopsy, is needed to allow the introduction of the needle. The procedure is done under local anesthesia similar to that used in dental procedures. There should be very little discomfort from the biopsy itself. There tends to be very little scarring and deformity from vacuum-assisted core needle biopsy. Only minimal recovery time is required.

The actual biopsy is done under imaging guidance. Depending on the type of lesion, this may be done under ultrasound guidance, with a stereotactic unit (special type of mammography machine that allows targeting of a lesion in three dimensions), or under MRI guidance. In many cases, a tiny marker will be left in the breast to denote the area of the biopsy in case it should be necessary to re-excise the area in the event that the lesion turns out to be malignant or pre-malignant.

The specimens obtained are submitted to pathology for analysis where they are processed and evaluated. The results are typically available in two working days and will be sent to your referring doctor. After the biopsy you will be sent home with some simple postprocedure instructions and will follow up with your referring physician.

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