Types of Breast Biopsies

What are the most common types of breast biopsies?

By far most of the biopsies that we perform are what's called image-guided biopsies that are done by guidance of either an ultrasound or a mammogram, and they're really considered minimally invasive procedures. They don't require a large incision. They don't require a general anesthetic. They are usually done in the breast centers or possibly in the office, but they're always done under local anesthetic with a tiny incision. We use the imaging of the mammogram or the ultrasound in order to gain a piece or pieces of tissue for us to evaluate.

Do patients need to take time off for an image-guided biopsy?

Typically, the image-guided biopsies that we do just take a few minutes to perform, are minimally uncomfortable, and most women resume their normal activities by the next morning. And, they're very well tolerated.

What can patients expect during an ultrasound-guided breast biopsy?

It can be done with either a small needle or small what we call suction probe or a mammotome probe. The biopsy just takes a couple of minutes. A local anesthetic is injected into the skin of the breast, which does sting and burn for a few seconds then goes numb. A tiny little incision is made after which a little needle or the suction probe is advanced towards the target area and sections or small pieces of tissue are removed. What most women experience during the procedure is some pressure, maybe some tugging of the breasts, or feel maybe a vibration from the machine, but typically it's not unusual for a woman when it's done to say, "That's it? I mean, that's really all?" Yep, we're done, everything went very well. Then, typically, we would put a little marking...we call it a chip or a clip inside the breast to mark the site, which is painless, and just marks the little area for us to follow the mammogram. A little bandage is applied. We typically would do a follow-up mammogram, and then the woman will go home with instructions to take it easy, rest, put your feet up, use some ice, and take it easy so that you don't do too much...maybe stimulate the possibility of having some bleeding.

What can patients who have a stereotactic biopsy expect?

It uses the guidance of a mammogram rather than an ultrasound to perform the biopsy. The reason that sometimes we do mammogram versus ultrasound is because not all abnormalities are able to be visualized by a mammogram and an ultrasound. Sometimes it's one or the other, and based on that, we'll make decisions are we going to use the mammogram or ultrasound to perform the biopsy. The stereotactic procedure's a little bit more involved but really essentially the same type of biopsy with the tiny incision and the suction probe that we use. However, you use the mammogram to guide the needle as opposed to the ultrasound and takes just a little bit longer and the woman is positioned differently in a prone position having a mammogram for the stereotactic biopsy, whereas an ultrasound-guided biopsy is done with the woman laying in the supine position having an ultrasound.

What happens after the biopsy is performed?

Then we get a report from the pathologist, usually within three to five business days, and we've always asked the patients if it's okay that we call them directly. Invariably patients are glad to be called that way because they know they get the information as soon as we do as opposed to make an appointment. And then based on that phone call, our next meeting is set up to discuss what needs to be done next.