WHAT IS A BIOPSY?

You’ve had a mammogram or an ultrasound.  The Radiologist sees an area that they are concerned about, and they want to biopsy it.  In the breast, the area of concern can either be a mass (described as a solid lesion), calcifications (described as flecks of calcium) or a cyst (a bag of fluid).

Biopsies are not surgical procedures. The goal of a biopsy is not to completely remove the lesion, but rather to take a small representative piece of the area of concern and send to the lab for a Pathologist to look at it under a microscope and give us a definitive answer as to exactly what the abnormality is.  With this knowledge, your care, follow up and management can be handled in the best manner for you.  

Having a biopsy does not mean that an abnormality is a malignancy. In fact, most biopsies (up to 80%) will come back with favourable results, however, the reason a biopsy is done is that unfortunately, the appearance of a benign lesion may look similar to the appearance of an early cancer. Using the BI-RADS system (lesions that are categorized as Bi-Rads 4 (2-94% chance of malignancy) and Bi-rads 5 (>94%)need to be biopsied.

There are different kinds of biopsies, and all are performed under imaging guidance which allows Radiologists to be accurate when sampling the area of interest. We use either ultrasound, x-ray or MRI guidance.  The decision as to which type of imaging we use to biopsy depends on how best we see the area of interest and how accessible it is with that type of imaging.

KINDS OF BIOPSIES:

FINE NEEDLE ASPIRATION(FNA)-A thin needle is used to draw out the sample, usually fluid from a cyst. This is rarely used nowadays to biopsy a solid breast mass because of the very small size of the sample which can lead to an inaccurate diagnosis.

CORE BIOPSY: This uses a small needle as well, larger than an FNA needle. Local anaesthesia is used and many patients, in my experience, find this to be a very comfortable procedure. The skin entry is so small.  There is no need for sutures after.

The biopsy device is not always but is often spring loaded.  This means that it makes the sound of a stapler or earring piercer when it is sampling the lesion.  I make sure patients hear the sound that the device makes, before I start the biopsy procedure.

For a breast biopsy, at least3-4 samples will be taken and sent to the lab

VACUUM ASSISTED BIOPSY:  Essentially similar to a core biopsy, with the following differences- when the biopsy is performed, instead of the Radiologist removing and reinserting the needle intothe breast, the needle stays in the breast the whole time and rotates as the sample is being removed.  You will hear a vacuuming sound while the biopsy is happening. The samples are also a larger volume than a core biopsy.

BIOPSY COMPLICATIONS:

Infection- The breast is cleaned thoroughly with antiseptic prior to the procedure

Bleeding and bruising- This may occur occasionally.  The vessels tend to be small and the bleeding, if any, is usually stopped by direct compression.

Allergy- I have very rarely come upon a patient or two that are allergic to the local anaesthesia.  If this is known in advance, a different form of local anaesthesia will be used.

WHAT IS A BIOPSY CLIP AND WHY DO YOU NEED ONE?

·      A biopsy clip is a tiny marker, about the size of a pin head or smaller, that is placed in the breast AT the site of biopsy, after a biopsy is performed. It is usually made of Titanium.

·      We tend to place clips after we biopsy very small lesions, vague lesions such as small areas of architectural distortion and after calcifications are biopsied, when most of the flecks of calcium have been removed during the biopsy.  

·      If the marker is not removed, it will be visible on your future breast imaging, confirming the site of biopsy.  If, however, the biopsy result shows cells that need to be removed, the biopsy clip will serve as a target for surgical removal to make sure that the correct tissue and area is removed.

·     Rest assured, this marker will not set off any metal detectors anywhere and it is not trackable.  It is also so tiny that it is not something that one would feel.

WHAT TO KNOW BEFORE A BIOPSY

·      Your meds will be reviewed.  We are particularly interested to know if you are on any blood thinners.

·      Do let us know of any known allergies

·      This is a minor procedure, not considered to be surgical

·      It is your right to ASK QUESTIONS and to make sure that you do understand the procedure BEFORE it is done.

·      You do not need to fast before the biopsy

·      You will likely be in the clinic for about a half hour after the biopsy.  Plan to take the rest of the day off and relax.

·      It is acceptable to take an anti-anxiety med if you need it, however, plan to bring a driver with you if you choose to take one.

You will be checked into the clinic by the patient guide

Prior to the procedure, if additional imaging is needed, this will be performed.

The Technologist will explain the procedure and consent you for it. They will also help you get into the position that works best for the type of procedure you are having and the location of the lesion that needs to be biopsied. They will also ensure that you are in a position that is most comfortable for you.

If you are having an US guided biopsy or FNA, you will be lying on your back. For a vacuum biopsy, you will be sitting in a reclinable chair or lying prone.  For an MRI biopsy, you will be lying on your stomach.

I will enter the room and introduce myself if we have not met.  You always have an opportunity to ask questions before I start the biopsy.  I let you hear the sound of the biopsy device if it is a core biopsy.

Some patients do not want to be told anything about the process as it is occurring, and others want to know everything- please let me know your preference and I will respect this.

·      The skin over the area is cleaned with sterilizing liquid

·      The skin is then numbed with local anaesthetic

·      The biopsy will be performed- at least 3-4 samples will be taken.  

·      At any point during the procedure, you can ask for more anaesthesia.  You should not feel any pain; however, you may likely feel some pressure.

·      A biopsy marker, if needed, will be placed after the biopsy samples have been taken.  You may need a post biopsy image.

·      Post biopsy, the Technologist will hold light pressure over the skin to ensure minimal bruising.

·      The actual biopsy itself usually lasts less than 5minutes.

·      Before I leave the room, I will write information on the pathology time such as – the description of the lesion, the time it was removed.

·      You have another opportunity to ask questions before I leave the room.  

·      If you want to see the samples removed, please ask andI will show it to you.

AFTER BIOPSY CARE INSTRUCTIONS

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• You will be given post care instructions verbally and in written form. The numbing medicine typically lasts for about1-2 hours. If you experience discomfort, acetaminophen is the preferred over  the counter pain reliever. We recommended avoiding aspirin and other meds classified as non-steroidal anti-inflammatory medications (NSAID’s) such  as ibuprofen (Advil), for the first 24 hours after biopsy.

• You will be informed about when to shower, when to remove the bandage and allowed/recommended level of activity.

• You will be asked to watch for signs of concern such as bleeding or infection. When you leave the clinic, you will not be bleeding

In AB, specifically Calgary, currently, patients are told to expect their results in about 7-10 days.  Often, this occurs sooner.

The result goes both to the ordering physician/GP as well as to theRadiologist.  The Radiologist will write a letter to your physician.  This letter will note if the pathology result and the imaging findings match- CONCORDANT or do not match DISCORDANT.  We will also recommend the appropriate follow up which may simply include that you return to screening as per usual.

Please ensure that you do find out what the results of your biopsy are and do not accept no news as good news.