Ultrasound Guided Needle and Vacuum-Assisted Breast Biopsies

What is an Ultrasound-Guided Breast Biopsy?


A minimally invasive biopsy of the breast using ultrasound guidance is called an Ultrasound-Guided Breast Biopsy” Some masses can be followed while others may require a needle biopsy to determine if they are benign (noncancerous) or cancerous.


How Does Breast Ultrasound Work?


Ultrasound is an imaging tool that uses sound waves to characterize lumps or masses in the breast. Sound waves are emitted from crystals in a hand-held wand called a transducer or probe. The sound waves reflected back are presented as images for interpretation by a specialized radiologist to distinguish various findings. The radiologist looks for changes that may be as obvious as “masses” or as subtle as slight pulling of the tissue called “architectural distortion”. Many of the findings we see on a breast ultrasound are too small or too deep to be felt on examination.

How Are Masses and Architectural Distortion Found?

Women who perform regular screening mammography have the best chance of finding early changes on a mammogram before they can be palpated on clinical or self-breast examination. If a mass is found on a screening mammogram, then diagnostic imaging such as breast ultrasound or a diagnostic mammogram will be requested to get a closer look at a particular area. Which diagnostic imaging tools are used depends on many factors including the reason for the examination, the age of the patient, and any risk factors such as family history. 

Some masses are palpated in the breast instead of being found on a mammogram.

What About Lumps That Come and Go? 

 For lumps that come and go with the menstrual cycle, it is reasonable for a premenopausal (before menopause) woman to observe a nonsuspicious finding until after the next menstrual cycle. If the finding does not resolve after the next monthly cycle, then you should seek attention from your physician or dedicated breast imaging center. However, some women may present with serious breast complaints such as a fixed mass, skin change including thickening redness, nipple inversion, or bloody discharge is noted. If you experience any of these serious symptoms or signs, then immediate imaging workup is indicated.

What are the Ultrasound Features of Breast Masses?


The radiologist looks for particular criteria of the mass such as shape, orientation, the margin of the mass, lesion boundary, echo pattern, and posterior acoustic features. This lexicon is established by the American College of Radiology and is called the Breast Imaging- Reporting and Data System (BIRADS). For example, a well-circumscribed isoechoic oval nodule oriented parallel to the skin with a distinct lesion boundary is most likely to be a benign fibroadenoma. These mass characteristics would be categorized as BI-RADS 3: Probably Benign. On the other hand, an irregular spiculated hypoechoic mass taller than wide with posterior shadowing with surrounding echogenic halo is more likely to be malignant.  This lesion would be categorized as BI-RADS 5 with the recommendation for breast biopsy.  


This is where experience matters. The Women’s Imaging Center specialized radiologists have decades of experience to help provide a more certain diagnosis. 

Some Masses May Be Followed While Others Require Biopsy-

When an indeterminate or suspicious finding is found, the radiologist may recommend a needle biopsy to determine if the mass is benign (noncancerous) or malignant (cancer). A lesion seen by ultrasound can be biopsied using ultrasound as a guide, even if it cannot be felt on clinical or self-breast examination. The physicians at The Women’s Imaging Center use their extensive clinical experience to determine the need for biopsy.


What Should I Do to Prepare for the Ultrasound Breast Biopsy?


At The Women’s Imaging Center, procedures are performed on-site for your comfort and convenience. Ultrasound-Guided Needle Breast Biopsy can be performed at any one of our multiple locations. If the radiologist suggested that you have a vacuum-guided breast biopsy, then that procedure is performed at the main Denver/Cherry Creek location. We ask that you do not take medicines that can thin the blood unless you are directed to continue taking them by your referring physician. Some patients may have special reasons they need to stay on their blood thinners such as a recent metal bore cardiac stent or clotting disorder. Always listen to your referring clinician regarding those decisions. We advise against taking aspirin if you are solely on it for prevention reasons. Please refrain from any rigorous activities for one to two days after the procedure. So plan your exercise regimen either before or several days after your ultrasound-guided breast biopsy. Even though there will be only a tiny nick on the skin, we want to minimize the chance of soreness, infection, or bleeding at the site. 


What Should I Expect on the Day of the Breast Biopsy? 


You will see several assistants including a Medical Assistant and/or Ultrasound Technologist to help the radiologist perform the procedure. 

The Medical Assistant or Technologist will ultrasound the area to localize the finding for biopsy. The radiologist will anesthetize the skin with a tiny numbing needle and use the ultrasound transducer to optimally position and watch the entire procedure. Using ultrasound allows the radiologist to accurately visualize and sample the lesion in 3D and to avoid adjacent anatomy. Another special needle called a core needle is inserted at the target site, this needle has a hollow center and is spring-loaded into a hand-held device. When a sample is taken, you will hear a clicking sound similar to the sound you remember when getting your ears pierced. You shouldn’t feel any discomfort though because of the action of the local anesthetic.

What is a Vacuum-Assisted Breast Biopsy?

Some breast lesions are not homogenous, have calcification, or are complex in nature. For these, we may recommend a “vacuum-assisted breast biopsy”. The preparation is almost identical, but the needle (called a probe) is larger and is a single insertion. Using ultrasound guidance, the probe is inserted at the target site, a gentle vacuum extracts the lesion and a biopsy clip is usually placed at the site of removal. This is also referred to as a minimally invasive nonsurgical excisional biopsy.  The biopsy sample is prepared and delivered to the Pathologist for processing and interpretation. 

 What Should I Expect After the Biopsy?  

You will likely experience slight bruising of the breast for a few days. Some women may complain of feeling a lump under the biopsy site for up to a week. When we take a tissue sample containing the calcifications out of the breast at a particular site, the body sends scrum and blood to that area naturally. This lump is the body’s way of healing that area. If the lump is the size of a small plum or larger, we ask you to call our clinical Care Team at The Women’s Imaging Center and select the “physician/ patient pathology” phone extension option x 228, x 235 to discuss any changes to your protocol. Infection is extremely rare, but if you have any redness at the site (that does not follow the line of the tape), any fevers or chills, we ask that you call us or return to The Women’s Imaging Center for evaluation. Direct contact sensitivity from the tape on the skin can be common in some people and often is associated with a geographic non-warm, a non-streaking area that fits the line of the tape perfectly. So if the tape is itchy or burning, remove it and wear a tight sports bra instead. Call us or your referring clinician if you have any concerns at any time.  


How do I Obtain My Biopsy Results? 

 Results are available in 1-2 working days after the ultrasound-guided breast biopsy. Note that if the breast biopsy is performed on a Thursday, for example, then results will be available on Monday. The Women’s Imaging Center Patient Navigator and the Radiologist correlate the results and coordinate any follow-up care or management indicated. Follow-up ultrasound 0-6 months after biopsy may be recommended even for benign biopsies. If the biopsy proves to be cancer, then contrast Breast MRI will be recommended at The Women’s Imaging Center to help with treatment planning. We will work with your referring clinician to coordinate an individualized treatment plan with surgeons or oncologists to fit your particular needs




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