Wire
Localization Biopsy of the Breast
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What is the
test?
For a surgical biopsy, the surgeon makes an
incision in the skin and removes all or part
of the abnormal tissue for examination under
a microscope. Unlike needle biopsies, a surgical
biopsy leaves a visible scar on the breast and
sometimes causes a noticeable change in the breast's
shape. It's a good idea to discuss the placement
and length of the incision with your surgeon
beforehand. Also ask your surgeon about scarring
and the possibility of changes to your breast
shape and size after healing, as well as the
choice between local anesthesia and general anesthesia.
Sometimes an abnormal area will be seen on the
mammogram that clearly should be tested for cancer
or completely removed from the breast, but this
area is not easily felt as a lump on examination.
The mammography department can help your surgeon
to find the area more easily by using a technique
called "wire localization."
In this technique, the radiologists (who have
had the benefit of seeing the abnormal area on
your mammograms) mark the abnormality with a
wire that is inserted under your skin into the
area of breast that is causing concern. Right
afterward, the surgeon can meet you in the operating
room and can use the wire to find the abnormal
spot in your breast so that he or she can remove
it.
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How
do I prepare for the test?
You'll undergo a breast exam and possibly a
mammogram before the biopsy to determine where
the lump is located. If you are having a sedative
with local anesthesia, or if you are having general
anesthesia, you'll be asked not to eat anything
after midnight on the day before the surgery.
Tell your doctor if you're taking insulin, NSAIDs,
or any medicine that can affect blood clotting.
You might have to stop or adjust the dose of
these medicines before your test.
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What
happens when the test is performed?
The first part of this procedure occurs in the
mammography department. Although you probably
just recently had a mammogram, a radiologist
will perform another one to find the abnormal
area. While watching your x-ray on a screen,
the radiologist will then decide where in your
breast the abnormality must be. He or she will
insert a needle into your breast in this area
and will take another mammogram picture that
shows the needle in place, to be sure the end
of the needle is (hopefully) right in the middle
of the area of concern. The needle might require
some adjustment so that it is placed just right.
The needle is hollow and the radiologist can
slide a small wire right through it. This wire
has a tiny fishhook on its end so when the end
of the wire reaches the point of the needle in
your breast, it can grab onto your breast tissue
and hold itself in place. Then the needle can
be pulled out, sliding over the outside end of
the wire and leaving the wire in your breast.
You will be taken to the operating room for
the second part of the biopsy. You will have
an IV (intravenous) line placed in your arm so
that you can receive medicines through it. Your
procedure may be done under either "local" or "general" anesthesia.
Local anesthesia is similar to the kind most
people get at the dentist —
a numbing medicine is injected in a few places
under the skin surface so that you won't feel
anything in the specific area that will be worked
on during the surgery. General anesthesia, on
the other hand, causes you to be asleep and unconscious
during the procedure and is administered by an
anesthesiologist. For general anesthesia, you
breathe a mixture of gases through a mask. After
the anesthetic takes effect, a tube may be put
down your throat to help you breathe.
An incision will be made in your breast right
where the wire sticks out of your skin. The surgeon
will feel along the wire and separate the breast
tissue from the wire until he or she finds where
the end of the wire is hooked into your breast.
The surgeon knows that it is the area right at
the end of the wire that looks abnormal on your
mammogram and needs removal. He or she will take
out a small sample of breast tissue from the
area surrounding the end of the wire — the
wire will be removed with the chunk since it
will still be holding onto the middle of it.
Any light bleeding is stopped with a wand-like
instrument called a "cauterizer"
that uses an electric current to seal the ends
of bleeding blood vessels. So that you do not
feel any electric shock from the cauterizer,
your doctor will have attached a plastic pad
to your leg, back, or abdomen that works to ground
the current.
While you are still in the operating room, your
surgeon will give the breast lump he or she has
removed (still with the wire attached) to your
radiologist. The radiologist will take a special
x-ray of your removed lump of breast to see if
it looks the same as the spot that had worried
him or her on your mammogram. Then he or she
can confirm for the surgeon that the correct
piece has been removed.
Right afterward, your surgeon might give the
same piece of tissue to a pathologist. The pathologist
will put dye around the outside of the lump and
take a quick look at a few slices of the tissue
under a microscope. The pathologist can then
tell the surgeon if it looks like cancer or not.
If there is cancer inside the lump and if the
cancer reaches out all the way to the edges with
the colored dye, the pathologist might advise
your surgeon to remove some extra tissue from
around the edges, increasing the likelihood that
the whole cancer will have been removed. If enough
tissue has been removed to protect you, your
surgeon will then stitch your wound closed.
If you have had general anesthesia, you will
have your anesthesia stopped so that you can
wake up within a few minutes of your biopsy being
finished.
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What
risks are there from the test?
Following a surgical breast biopsy, you'll have
a short scar in the shape of a line. There may
also be some distortion in the shape of the breast
depending on its size, and the amount of tissue
removed and its location. Expect to feel some soreness
and swelling near the surgery site for a few days.
There are also some risks associated with anesthesia,
although the risk of general anesthesia is lower
for breast surgery than for other forms of surgery,
because the anesthesia isn't used for very long
and the surgery is only slightly more than skin
deep.
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Must
I do anything special after the test is over?
Medical staff monitor you for a few hours after
your surgery to make sure that you're recovering
well and not having any adverse reactions to anesthesia.
Contact your doctor if you develop a fever, strong
pain at the incision site, or bleeding from the
incision. You may need a follow-up visit so that
your doctor can remove stitches and make sure you
are recovering well.
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How
long is it before the result of the test is
known?
A preliminary report from the pathologist might
be available when your surgery is over.A final
report typically takes three to four days.
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