Stereotactic
Biopsy of the Breast (Breast Core Biopsy)
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What is the
test?
This method uses a larger needle than the one
used for a fine needle aspiration, to increase
the amount of tissue that can be removed for
microscopic examination. Large core needle biopsy
is often performed using either x-rays or ultrasound
to show where the tip of the needle is. Since
the early 1990s, large core needle biopsy has
been the diagnostic method of choice to evaluate
abnormalities that are visible on a mammogram
but cannot easily be felt by hand. In the more
advanced medical centers, this technique is considered
the standard of care. However, core needle biopsy
may not be suitable for women who have an irregularity
close to the chest wall, the nipple, or the surface
of the breast; those with calcifications that
require magnification; or women with very small
breasts. In these situations, accurate results
may not be possible. Instead, your doctor may
recommend a surgical biopsy.
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How
do I prepare for the test?
If you take blood thinners or NSAIDs, you might
have to stop using them for several days before
the test to avoid bleeding complications. If
you've had an allergic reaction to lidocaine
or a similar local anesthetic, let your doctor
know this before having the test.
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What
happens when the test is performed?
You wear a hospital gown that is open in the
front. The needle used during a core biopsy is
about as thick as a pen tip. It usually is placed
into the breast through a tiny incision that
has been made in the skin of the breast. Using
mammogram or ultrasound images as a guide, or
by feeling the lump, the doctor moves the needle
into the area of concern.He or she removes one
or more tissue samples through the needle with
the help of suction from a syringe.
If mammograms or ultrasound are used to guide
insertion of the biopsy needle, the required
equipment should be in the same room. If your
doctor is using a special kind of x-ray procedure
called a stereotactic biopsy, you'll lie on your
stomach on a special x-ray table. This table
has an opening that allows your breast to hang
down during the procedure. An x-ray (mammogram)
is taken, and a computer determines the position
of the suspicious tissue inside your breast.
Then, the computer guides the tip of the biopsy
needle directly to the suspicious tissue. Although
the biopsy itself takes only a few minutes, the
entire stereotactic procedure takes 20-40 minutes.
Women who cannot remain still for that long because
of physical illness or other problems are not
good candidates for stereotactic core needle
biopsy.
In an ultrasound-guided core needle biopsy,
the radiologist uses ultrasound imaging to precisely
con- firm the location for biopsy. The doctor
makes only a single puncture in the skin to extract
three to six separate core needle tissue samples
for analysis. This procedure takes only a few
minutes, and you should feel pressure but not
pain.
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What
risks are there from the test?
After the biopsy, you might have a small amount
of bleeding or bruising and some breast soreness.
This procedure leaves only a tiny dot for a scar.
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Must
I do anything special after the test is over?
No. After a core needle biopsy is completed,
the doctor may place a bag of ice on the site
for 15–30 minutes.Most likely, you'll be
able to resume normal activity almost immediately
afterward.
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How
long is it before the result of the test is
known?
Examination of the biopsy sample usually requires
several days. At centers where physicians are
experienced in these biopsies, 65% of women who
undergo this procedure are diagnosed with a benign
condition and can resume having annual mammograms.
Another 25% have a malignancy or a premalignant
condition and proceed with treatment. For the
remaining 10%, results are inconclusive; in most
of these cases, the next step is a surgical biopsy.
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