Image-guided needle biopsies are one of the most common procedures performed on women for diagnosing breast disease. Please remember that the majority of breast biopsies do not reveal cancer. Although, these biopsies have been instrumental in the early detection of breast cancer. By being diagnosed early, women have more options and a better chance of recovery. These biopsies take approximately one hour to perform and offer an alternative to standard, open surgical biopsy. These procedures are less invasive, less painful, and less costly than traditional surgical biopsy.

Three types of Minimally Invasive Breast Biopsies include:

1) Fine Needle Aspiration (FNA)

• Fine needle aspiration is a biopsy procedure that is performed on lumps that can be felt or identified on mammography. If the physician can feel the area, this procedure can be performed in an outpatient setting.
  
• The area is cleansed with an antiseptic solution to destroy surface bacteria. The area may or may not be numbed with an anesthetic. Some physicians prefer not to use an anesthetic because the amount of pain is minimal, similar to having your blood withdrawn. Others will use a very small needle to deaden the tissue in the biopsy area. Your physician will inform you of the preferred method prior to the procedure. The physician inserts a needle with an empty syringe into the lump. The needle is gently and slowly moved back and forth in the mass while the syringe pulls out cells or fluid to be examined.
  
• If the lump is determined to be a cyst, fluid ranging from light yellow to a dark yellow greenish color may be withdrawn. This fluid is characteristic of normal breast fluid. Occasionally, there may be signs of old blood (resembling chocolate milk) or fresh blood (which will be bright red). Your physician will discuss with you any further tests or follow-up evaluations if this occurs. After the cyst is aspirated, you should not be able to feel the lump.
  
• Cyst fluid is usually not sent for cytology unless it contains blood. The cells removed from a solid lump are sent to the pathology lab for study. The pathology report is sent to your physician stating if the results are malignant or benign. Ask when the results of this report will be available to you and how you will be notified, whether by letter, by phone, or in person.
  
• The entire procedure takes five to ten minutes. A bandage is placed on your breast and regular activities can be resumed. You may remove the bandage and shower the same day. Occasionally, a small hematoma (collection of fresh blood appearing as a red lump under the skin) may occur if a small vessel is ruptured by the insertion of the needle. Tell your physician if this occurs so it can be recorded.

2) Stereotactic Breast Biopsy

• If a suspicious area that cannot be felt or is very small is seen on a mammogram, stereotactic breast biopsy may be used to biopsy the area. This biopsy procedure is performed using a mammography table or an add-on unit to the mammography machine, a biopsy needle, and the guidance of a computer. This test, and alternative to surgical biopsy, is done without the discomfort, risk, disfigurement or the expense of surgery. The procedure takes approximately 45 minutes to perform, and most patients return to their normal activities within a few hours.
  
• Your breast will be compressed with a special mammography machine while stereo x-ray pictures are taken at angles. After the suspicious area has been identified, the radiologist enters information into a computer that calculates where the needle should be injected. The area of the breast to be biopsied is deadened with a local anesthetic. An instrument moves the biopsy needle in position and, at a rapid rate of speed, removes a sample of the suspicious tissue. Because stereotactic biopsy uses a needle, damage to the nearby tissue is minimal - unlike surgery that may cause scarring to the breast. When the biopsy is completed, a small bandage will be placed over the biopsy site and you may return to your normal activities. You may shower the same day you have the biopsy.
  
• The biopsy sample will be sent to the pathology lab for evaluation. The pathologist will send the referring physician a report stating if the biopsy was malignant or benign. Consult your physician regarding how and when you can expect to receive the biopsy results.

3) Ultrasound Guided Breast Biopsy

• If a lump has been found that is relatively small, close to the chest wall, or has been observed through mammography screening but cannot be felt by a physician, and ultrasound guided needle biopsy, core biopsy or vacuum assisted core biopsy will allow a physician to accurately biopsy the area. Using ultrasound to observe the area during the biopsy is necessary because a small lump may be missed. If the lump is near the chest wall, there is a danger of puncturing the lungs; and if the lump cannot be felt, the physician is unable to stabilize the area for biopsy.
  
• This procedure is performed in a breast center, physician's office or wherever the ultrasound equipment is located. The area is cleansed with an antiseptic to remove surface bacteria. An anesthetic to numb the area may or may not be used. A gel substance is placed on the breast and a transducer, which resembles a microphone, is passed over the breast to obtain images or pictures of it. The ultrasound machine locates the lump. As the physician looks at the area on a monitor, the needle is inserted into the suspicious area or lump to obtain the tissue sample. The lump is a normal cyst if the fluid removed ranges from light yellow to dark yellow or green. The ultrasound picture will allow the physician to see the cyst area disappear as the fluid is withdrawn. A bloody fluid that resembles chocolate milk or fresh blood will require the physician to conduct further tests and evaluations of the area. If a biopsy is obtained from a solid lump, the physician is assured the biopsy is from the suspicious area.
  
• The biopsy tissue is sent to the pathology lab for evaluation. Results will be sent to your doctor. You will need to ask when and how the results will be made available to you.
  
• The procedure will take approximately 15 minutes. When it is completed a small bandage will be placed over the needle biopsy site and you can return to your regular activities. You may shower the same day. If a hematoma forms after your leave the office, inform the physician so the information may be recorded on your medical chart. The area of the hematoma formation can show up on mammograms later as an area of change. Infection from biopsy is rare.