Breast Imaging - Biopsies

  • Ultrasound Fine needle biopsy/aspiration (FNA; FNAB; FNB)

    This involves taking a small sample of tissue (cells) through a needle. The needle is guided into place using ultrasound.

    The sample is sent to a pathology laboratory where the specimen is later analysed. Results are usually available in 1 or 2 days. The report will be sent to your referring doctor who will then convey these results to you.

    The pathology company may also charge a gap for these services. Please discuss this with us if you have any questions.

    Is any preparation required?

    It is essential that your previous mammogram and ultrasound films are available at the time of the biopsy. Please bring these with you to your examination.

    Please inform us if you are on medication to thin your blood (eg. Warfarin, Aspirin or Clopidogrel) at the time of booking. These may need to be stopped for certain procedures.

    No other specific preparation is required and you may eat and drink before and after the procedure. If you are on any special drugs or have diabetes and are on insulin, take your usual medicines and diet.

    What happens during the procedure?

    You will be positioned on the ultrasound table in the best way to access the area to be biopsied. Your skin and a covered ultrasound probe will be cleaned with antiseptic. The radiologist, together with the sonographer, will use ultrasound to guide a fine needle into the correct area. Commonly up to 3 needle passes may be required to obtain an adequate sample. Sometimes it is necessary to proceed to a larger needle. The radiologist will discuss this with you if thought necessary.

    Are there any risks or side effects?

    Potential risks include infection and bleeding.

    • Aseptic technique is used to minimise the risk of infection as much as possible.
    • There may be some mild bruising at the site.
    • Bleeding in the area may cause it to swell up, which should subside naturally over the course of a few days
    • Rarely excessive bleeding can occur and may require drainage.


    The biopsy may not obtain an adequate sample of tissue. This may require a repeat biopsy.

    After the biopsy

    You may eat and drink immediately after the procedure.

    You may remove your dressing/band aid that night or the next day.

    You should avoid strenuous activity for 24 hours following the biopsy.

    You may experience some discomfort following the procedure.

    • If required, a simple analgesic such as paracetamol (Panadol), NOT Aspirin, should be sufficient.
    • A small ice pack applied to the area may help settle any pain.


    Infection and bleeding are potential complications.

    • If you notice any increasing redness, swelling, fever or pain

    notify your referring doctor or call the clinic where the injection was performed immediately.

    If you have not been contacted about your results in 1 to 2 weeks please contact your referrer.


  • Ultrasound Core Biopsy

    This involves taking a tiny sample of tissue through a needle. The needle is guided into place using ultrasound.

    The sample is sent to a pathology laboratory where the specimen is later analysed. Results are usually available in 2 to 3 days. The report will be sent to your referring doctor who will then convey these results to you. The pathology company may also charge a gap for these services. Please discuss this with us if you have any questions.

    Is any preparation required?

    It is essential that your previous mammogram and ultrasound films are available at the time of the biopsy. Please bring these with you to your examination if you have them.

    Please inform us if you are on medication to thin your blood (eg. Warfarin, Aspirin or Clopidogrel). You may need to stop this prior to the procedure after discussion with your doctor.

    It is important that you have someone to drive you home after the procedure.

    What happens during the procedure?

    You will be positioned in the best way to access the area to be biopsied. The area will be cleaned with antiseptic and local anaesthetic administered. A tiny incision will be made in the skin before the core needle is inserted with ultrasound guidance. It is often necessary to make more than one pass of the needle to obtain a sufficient sample.

    Are there any risks or side effects?

    Potential risks include infection and bleeding.

    • Aseptic technique is used to minimise the risk of infection as much as possible.
    • There may be some mild bruising at the site.
    • The needle may puncture a blood vessel.
    • Rarely, excessive bleeding can occur into the biopsy site.

     
    The biopsy may not obtain an adequate sample of tissue. This may require a repeat biopsy.

    After the biopsy

    Steristrips and a waterproof dressing will cover the incision. The outer dressing should remain in place for at least 24hours, the steristrips are left to gradually lift off after a few days. You will be given an ice pack to use to reduce bleeding and discomfort.

    You may eat and drink immediately after the procedure.

    You should avoid strenuous activity for 24 hours following the biopsy.

    You may experience some discomfort following the procedure.

    • If required, a simple analgesic such as paracetamol (Panadol), NOT Aspirin, should be sufficient.
    • A small ice pack applied to the area may help settle pain.


    Bleeding and infection are potential complications

    • If you notice any increasing redness, swelling, fever or pain

    notify your referring doctor or call the clinic where the injection was performed immediately

    If you have not been contacted about your results in 1 to 2 weeks please contact your referrer.

  • Stereotactic Biopsy

    Biopsies may need to be performed using the mammogram equipment. This only occurs if the area to be biopsied is not visible under ultrasound. Using special attachments to the mammography equipment, fine needle or core biopsies can be performed using stereotactic guidance, using an aseptic technique. For more information see FNA or CORE BIOPSY. The procedure is much the same as under ultrasound, but you will be sitting on a chair or lying on a special trolley while the procedure is performed. Local anaesthetic is used and the mammographers will make sure it is as comfortable a procedure as possible.

    These procedures are only performed out our rooms at Burnside Hospital (Attunga Medical Centre) and St Andrew's Hospital (MRI section).

    This involves taking a tiny sample of tissue through a needle. The needle is guided into place using x-ray.

    The sample is sent to a pathology laboratory where the specimen is later analysed. Results are usually available in 2 to 3 days. The report will be sent to your referring doctor who will then convey these results to you. The pathology company may also charge a gap for these services. Please discuss this with us if you have any questions.

    Is any preparation required?

    It is essential that your previous mammogram and ultrasound films are available at the time of the biopsy. Please bring these with you to your examination if you have them.

    Please inform us if you are on medication to thin your blood (eg. Warfarin, Aspirin or Clopidogrel). You may need to stop this prior to the procedure after discussion with your doctor.

    It is important that you have someone to drive you home after the procedure.

    What happens during the procedure?

    You will be positioned in the best way to access the area to be biopsied. The area will be cleaned with antiseptic and local anaesthetic administered. A tiny incision will be made in the skin before the core needle is inserted with x-ray guidance. It is often necessary to make more than one pass of the needle to obtain a sufficient sample.

    Are there any risks or side effects?

    Potential risks include infection and bleeding.

    • Aseptic technique is used to minimise the risk of infection as much as possible.
    • There may be some mild bruising at the site.
    • The needle may puncture a blood vessel.
    • Rarely, excessive bleeding can occur into the biopsy site.

     
    The biopsy may not obtain an adequate sample of tissue. This may require a repeat biopsy.

    After the biopsy

    Steristrips and a waterproof dressing will cover the incision. The outer dressing should remain in place for at least 24hours, the steristrips are left to gradually lift off after a few days. You will be given an ice pack to use to reduce bleeding and discomfort.

    You may eat and drink immediately after the procedure.

    You should avoid strenuous activity for 24 hours following the biopsy.

    You may experience some discomfort following the procedure.

    • If required, a simple analgesic such as paracetamol (Panadol), NOT Aspirin, should be sufficient.
    • A small ice pack applied to the area may help settle pain.


    Bleeding and infection are potential complications

    • If you notice any increasing redness, swelling, fever or pain

     notify your referring doctor or call the clinic where the injection was performed immediately

    If you have not been contacted about your results in 1 to 2 weeks please contact your referrer.

  • MRI Biopsy

    Preparation

    Please advise our staff when your appointment is made if you are on blood thinning agents – for example warfarin, aspirin, and fish or krill oil.

    Please fast for 4 hours prior to the procedure, as you will lie on your stomach for approx. 45mins.

    Day of the scan

    When you arrive for your examination, you will be asked to fill out a safety questionnaire and a form that is used by our Doctors in assessing your individual case.  

    You will lie in the scanner on your front with your breasts in a special coil (the same as when you underwent your diagnostic scan) and enter the scanner feet first. During the examination, you will have a normal diagnostic scan which will involve the injection of contrast dye (gadolinium) to locate the area to be biopsied.

    During the biopsy process, the bed you are lying still on will be moved in and out of the machine for additional imaging to ensure the correct region of interest is being targeted and for placement of the biopsy needle.

    The scan is noisy so you will be given headphones and a buzzer to press if you want to talk to the technologist at any time. It is important that during the procedure, you lie extremely still.

    After the biopsy

    After the biopsy is completed one of our trained nurses will compress on the biopsy site for 10-15mins, and then place steri-strips bandage on the small skin incision. You will have a bruise that typically lasts for 2 weeks and you may manage any bruising or discomfort with compression and ice packs and pain relief such as paracetamol if required.

    Once the biopsy has been completed, a site marker is placed within the biopsy site so that there area may be identified by either MMG or Ultrasound for future reference. The site marker is made of titanium; it is inert and safe to stay in your body indefinitely. It does not ‘beep’ at airport security. A MMG will be performed after the site marker has been placed to confirm its position.

    Duration

    The entire process (preparation and imaging) can take 45-60mins.

  • Carbon Tracking/Hookwire insertion

    Sometimes a surgeon requires us to localise an area that needs to be removed surgically. This occurs if the area is not palpable, ie the surgeon cannot feel it. We use 2 different methods to do this, and the surgeon will choose the most appropriate method for their requirements in the operating theatre.

    Carbon Tracking

    A small amount of carbon (charcoal in suspension) which looks like ink, is injected into the breast. This is done using ultrasound or mammography. The radiologist and mammographer/sonographer use ultrasound or mammography to guide the tip of the needle to the correct area, and the carbon is injected as the needle is removed, leaving a track of carbon in the breast tissue. It is a quick, easy procedure. Local anaesthetic is used to reduce discomfort. No preparation needed. A banadaid is used after the procedure, no post procedure instructions.

    It is VERY important to bring relevant previous mammogram and ultrasound imaging with you to the appointment, to help with this localisation.

    Hookwire insertion

    For various reasons, a surgeon may prefer the use of a hookwire to guide the surgeon to the area requiring removal. A very fine wire is inserted into the breast through a needle. This is usually done on the day of surgery, after you are admitted to hospital and is done using ultrasound or mammography. The radiologist and mammographer/sonographer use ultrasound or mammography to guide the tip of the needle to the correct area. The wire is inserted through the needle. Local anaesthetic is used before the procedure. The wire will be taped to the breast and covered with a dressing, after which 2 mammogram pictures will be taken to show the position of the wire. You will then be returned to the ward or to theatre to prepare for surgery.

    It is VERY important to bring relevant previous mammogram and ultrasound imaging with you to the appointment, to help with this localisation.