Written by Stephen Sevigny, M.D.
When you go for your annual mammogram, chances are you won’t actually see a doctor. Patients come to the imaging center for their examination; the images are obtained by the technologist; and the exam is interpreted shortly after by the physician radiologist who is in the reading room. The exception is diagnostic mammography. Most often the diagnostic imaging result is negative, but occasionally we have to tell a patient she needs a biopsy. Understandably, there is significant patient anxiety associated with the term “biopsy” so it helps to understand the procedures and processes associated with a breast biopsy.
Years ago a breast biopsy meant meeting the surgeon, general anesthesia, and an operation. That has almost been completely replaced by the “image guided biopsy” most often performed by a radiologist. There are primarily two types of biopsies: stereotactic and ultrasound (US) guided procedures. The type of abnormality will determine which procedure is used.
Let’s begin with ultrasound (US) guided procedures. The patient will lie on her back. The radiologist will find the abnormality and plan the approach. The skin is cleansed and is numbed with lidocaine. A small 6mm. long skin nick is placed into the area to be biopsied. No skin is removed, just a small slit to allow for a longer needle filled with more lidociane. Once the biopsy path is numbed, the slightly larger biopsy needle is placed next to or within the area of concern. Using a vacuum, the tissue is sucked into the needle trough and sampled. The patient is awake and alert the entire time often chatting with the physician performing the procedure. Once there is adequate tissue obtained for a diagnosis, a small inert marker is placed to document our location of biopsy. The marker is miniscule in size and of no concern after the procedure. It won’t set off metal detectors and the patient won’t ever feel it. Its placement is important because during biopsy we can remove ALL of the concerning tissue and if positive, we need to know where the primary tumor was.
The stereotactic biopsy is technically the same procedure but uses a different guidance. For “stereo” biopsy, the patient is face down and the breast is placed thru a hole in the table. An open faced mammogram machine compresses the breast and images are obtained allowing us to localize the abnormality. Occasionally, an MRI machine can also be used with a few minor changes but the concept is the same. Tissue is obtained exactly as is done with an US guided biopsy.
The entire procedure, including preparation time, takes about an hour. After the biopsy, pressure is held to minimize bruising. Patients will experience some soreness for a few days and universally do extremely well. The biopsied tissue is sent to the pathologist for review under the microscope which takes 2-5 days to get a diagnosis. Our patients tell us that waiting for the results is harder than the procedure.
Please always remember that if a biopsy is recommended, it does not mean you have breast cancer. We find that 80% of biopsies do not result in a cancer diagnosis. Biopsies are proactive and done in your best interest.
To learn more about Stephen Sevigny, MD, Board Certified Radiologist, breast biopsies, visit www.radiologyassociatesimaging.com or www.vcms.org. To schedule an appointment, call 386-274-6000.
Note: This article appeared in The Daytona Beach News-Journal and was written by Stephen Sevigny, MD, Board Certified Radiologist.