Biopsy (tissue sample) of the breast:
Only about 1 in 10 of women attending the clinic will need a biopsy sample from the breast. If it is required, we try to do it immediately so that there are no delays in getting the results to you. We know that waiting for these results is always a worrying time and almost always we can get the results within 10 working days and often sooner.
Needle aspiration: Occasionally it is necessary to remove the fluid from a troublesome cyst or for confirmation that the lump is only a cyst. This is done quickly and easily just like having an ordinary blood test with a similar sized needle. Although fine needle aspiration of lumps used to be done for diagnosis (by cytology), it is rarely used in our clinic as the results are less reliable than core needle biopsy (see below).
Core needle biopsy: This is the commonest and easiest way to confirm what has caused the area of concern. It takes about 3 minutes to do under local anaesthetic and most people find it painless. It is suitable for all lumps that can be felt or seen on ultrasound. The doctor doing the procedure will use the ultrasound to make sure that the sample is being taken from exactly the right place and will wish to take several samples in quick succession. Taking several specimens from different parts of the lump make it more likely that a clear diagnosis can be made.
The Peony Brest Care Unit Mammography guided
Vacuum Assisted Biopsy:
Sometimes an area of concern can only be seen on the mammogram. If this is the case then we will need to take the sample under the X-ray guidance. The Peony Breast Care Unit is equipped with the latest and easiest mammography system to do this (Vacuum assisted digital breast tomosynthesis guided Affirm system by Hologic). This allows us to mammogram the breast and a computer then works out exactly where to sample. A needle is then inserted under local anaesthetic and several samples are removed from the area without needing to remove the needle each time. These samples are then X-rayed separately to confirm the correct place has been sampled. Usually a small bead of metal is left at the site of the biopsy so that it can easily be identified on and subsequent mammograms.The procedure takes about 20 minutes but most of that time is spent correctly finding the abnormality and the sampling part usually takes only 2 minutes in the middle. Most women find this procedure painless and it is usual to be able to go home about half an hour later.
Open biopsy (sampling the breast under general anaesthetic):
Only rarely is it now necessary to remove a lump from the breast purely for diagnosis. However, if core needle and/or vacuum assisted biopsy fails to provide a clear answer then open biopsy will be needed. This is done as a day case under general anaesthetic (asleep) and requires a cut and consequent scar on the breast. If the area of concern cannot be felt easily then a fine wire may need to be placed into the breast using local anaesthetic and under either ultrasound or mammographic guidance shortly before the surgery. This allows the surgeon to trace the wire down into the breast to quickly and accurately find the area of concern.
Breast MRI (magnetic resonance imaging):
MRI of the breast is a very reliable way of excluding cancer in the breast but it is not a simple procedure and takes about 40 minutes to complete. For this reason it is not routinely used in our breast clinic. However, it is available and particularly helpful for women with very dense breast tissue that is difficult to examine, mammogram and ultrasound. It is most often used in young women with a strong family history of breast cancer and who are know to carry a breast cancer gene.
If you wish to know more about MRI of the breast please click here