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Women's Interventional Procedures

Our women's interventional procedures include:

Breast Biopsy

Core Needle Biopsy

A core needle biopsy is most often minimally traumatic and less expensive than a surgical or open biopsy. As the number of screening mammograms increases, the number of biopsies also increases. The biopsy technique has spared many women unnecessary surgical procedures in the hospital setting, as this particular procedure is done in the physician’s office. When a core needle biopsy rules out cancer - and most do - the patient has achieved that diagnosis with a 30-min procedure. The procedure itself involves local anesthetic, avoids disfiguring the breast, leaves no scar, has almost no risk of infection, and leaves you well enough to immediately return to normal activities. For this reason, many times women will prefer needle biopsy to the surgical option. 

A core needle biopsy is a procedure which involves the removal of small samples of breast tissue using a hollow “core” needle. The examination of those samples under a microscope can detect the presence of cancerous cells. Each sample taken is about the size of pencil lead. If the lump in your breast is palpable (able to be felt), your physician may secure the lump by holding it still with one hand while performing the biopsy with the other. Ultrasound may also be used to locate the area. If the lump cannot be felt, either ultrasound, stereotactic biopsy or excision biopsy should be used.

What to Expect During Your Core Needle Biopsy

Upon arrival for your biopsy, you will be asked to sign a consent form stating that you understand the procedure being performed and the risks involved and that you agree to have the procedure. Talk to your healthcare professional about any concerns or questions that you may have regarding the need for the biopsy and its risks or how it will be performed. It is important for you to feel comfortable with your decision.

You will be escorted to a specially equipped procedure room and asked to undress above the waist. A paper or cloth drape or covering will be available for you to place around your shoulders. The biopsy will be done while you lie on an exam table. Your hands will be placed at your side or above your head depending on which position makes it easiest to find the lump. An injection of local anesthetic with a very small needle will be inserted. Once the area is numb, a small incision (less than 1/2 inch) will be made in the skin and the biopsy needle will be inserted through the skin. The radiologist or surgeon will guide the needle into the area of concern by ultrasound. You may feel a slight pressure during the procedure, but you should not experience any significant pain. Once the sample is obtained, the needle will be removed and the sample will be prepared and sent to a pathologist for diagnosis. This procedure may be repeated for additional samples, usually through the initial incision. After the samples are collected, pressure will be applied to the needle site to help stop any bleeding and a bandage will be applied (usually an adhesive strip). The procedure takes approximately 30 minutes. The findings will be reported to your healthcare provider who will, in turn, forward the results to you, and referring provider. 

Ultrasound Guided Breast Biopsy

An ultrasound-guided biopsy is just as it states - a biopsy performed by using ultrasound to locate the area in question. It is helpful to know that the terms ultrasound and sonogram are used interchangeably. Unlike procedures the require the use of x-ray, ultrasound-guided biopsy requires no exposure to x-ray. This procedure is very useful when suspicious changes can be seen by mammogram and ultrasound, but no abnormality can be felt during an exam. However, your healthcare provider may decide to use ultrasound guidance for a biopsy even when the mass can be felt. This type of biopsy is a minimally invasive way to obtain a sample of breast tissue for further diagnosis. It is also faster and less painful than traditional surgical biopsy.

Your Medications

It is extremely important that you inform your healthcare provider regarding all medications you are currently taking. This includes vitamins, herbs and over the counter medications.

What to Expect During Your Ultrasound-Guided Breast Biopsy

There is no special preparation required prior to having an ultrasound-guided breast biopsy. It is recommended that a comfortable two-piece outfit be worn, since you will be undressing from the waist up. When you arrive for your procedure, you will be asked to change into a hospital gown and escorted to the room where you will have your biopsy. Before you arrive, the radiologist will have studied your previous breast images to become familiar with the location of the abnormality. 

You will be awake during your biopsy and should have little or no discomfort. The procedure itself will usually take less than an hour. The first part of the procedure will be performed while lying on your back or turned slightly on your side. Your breast will be scanned to find the abnormality. Then the radiologist/technician will mark your skin over the area in question. The radiologist will sanitize your breast and then numb the area with enough anesthetic to ensure that you will not feel discomfort during the procedure. The anesthetic used is very similar to what is used at the dentist. There is a tiny stick on the outer skin and may feel a sting as the medication enter the tissue. After the anesthetic has taken effect, the radiologist will make a very small incision in the skin where the biopsy needle will be inserted. Using ultrasound guidance, a hollow “core” needle or vacuum-assisted needle is placed in the breast and guided to the location of the mass where specimens are collected.

Once the placement of the needle is confirmed, you will be asked to remain motionless while the samples are taken. Ultrasound transmits a visual image during the entire procedure, enabling the physician to view the procedure on a video screen and ensure accurate placement of the needle.

There are two methods used to collect the tissue sample. One is the core needle biopsy method which uses a hollow “core” needle. The inside of the needle holds the tissue sample until the needle is withdrawn and the sample is placed in a specimen container. This may be repeated multiple times. The other method uses a vacuum assisted devise (VAD). Once the needle is in place, a vacuum is used to pull the tissue into the special collector. 

When the procedure is complete, the technician will apply pressure to the biopsy site for several minutes. Then the dressing is applied. 

Benefits

  • Ultrasound-guided breast biopsy reliably provides tissue samples that can determine whether a breast lump is benign or malignant.
  • Ultrasound-guided breast biopsy takes much less time than surgical biopsy and causes less tissue damage.
  • Compared to stereotactic-guided breast biopsy, the ultrasound method is faster and avoids the need for radiation exposure.
  • Ultrasound-guided breast biopsy is able to evaluate lumps under the arm or near the chest wall, which are hard to assess by stereotactic method.
  • Ultrasound-guided breast biopsy is less expensive than the stereotactic or surgical method.

Stereotactic Breast Biopsy

The stereotactic biopsy is another type of biopsy for identification of breast abnormalities. With this form of biopsy, diagnosis is easier and more accurate than ever before. Fortunately, it will enable you and your healthcare provider to know for sure about the area of concern. Since the procedure causes only minimal discomfort, you will most likely be able to resume your normal activities immediately afterward. Stereotactic technology uses a computer to enable healthcare providers to locate and obtain a sample in the center of the questionable area. It uses x-rays taken from multiple angles and a special biopsy needle. This new technique is rapidly replacing surgical biopsy, which requires an incision, the removal of a larger piece of tissue and a brief hospital outpatient admission.

Women who undergo stereotactic biopsy can take comfort in knowing that the procedure is safe, simple and only mildly uncomfortable.

Unlike the more invasive surgical procedure, there is…

  • No external scarring of the breast, and no internal scar to interfere with future mammogram readings.
  • No lengthy wait for test results. (Your healthcare provider can tell you when to expect your results.)
  • No exposure to general anesthesia.
  • No prolonged recovery period.

What to Expect During Your Stereotactic Biopsy

When you arrive, you will be escorted to a procedure room. It is best to wear a blouse and slacks or a skirt, since you will need to remove the clothing from the upper portion of your body. A trained assistant will help you change and prepare for your procedure. Depending on your facility, you may either have the procedure performed while sitting or lying down. If you are sitting, you will be in a special chair with the stereotactic machine in front of you or at the side of your affected breast. If lying down, you will be on your abdomen on a specially designed examination table. Your breast will be placed through an opening in the table. The tabletop is then raised and the radiologist and technologist perform the procedure from beneath you. For either position, your breast will be compressed as done during a mammogram. Several x-ray films will be taken in order to locate the area in questions. Once this is done, the healthcare provider will review the films and use a computer to locate the exact area to be sampled. The skin of the breast is then cleaned and a small amount of local anesthetic is injected into the skin and the deeper tissue of the breast with a small needle. This local anesthetic is similar to what one might have at a dentist’s office. You will feel a tiny pinch similar to a pinprick.

When the medicine has numbed the area, the healthcare provide will insert a biopsy needle and take additional x-rays to ensure its proper placement. Then, several samples of tissue will be extracted for analysis. After the samples are taken, a tiny clip may or may not be placed inside the breast to mark the area biopsied. You will not be able to feel the marker but it will show on future x-rays. That is it! You will probably find that the entire process takes about one hour and the procedure itself, only a few minutes. Afterward, a gauze pad will be applied to the site for several minutes to prevent bleeding. Finally, a simple dressing will be placed over the site. Most women feel well enough to resume their usual activities shortly after the procedure.

At Home

Ask your healthcare provider when you may remove your dressing. Afterward, you may shower or bathe using plain soap and water to wash the area. If you wish, you may protect the site with a sterile adhesive strip until it is completely healed. It is unlikely that you will experience any problems following the biopsy. However, please notify your healthcare provider if you should notice prolonged bleeding, unusual discharge or drainage, an odd odor, or any firmness, redness or warmth at the site. Also, please inform your healthcare provider if you develop a fever of 100% F or above.

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