How do you prepare for a breast core biopsy?

What is a breast core biopsy?

A breast core biopsy is a procedure to remove small samples of breast tissue for examination under a microscope. It is typically performed to evaluate an abnormal finding on a mammogram or breast ultrasound. The biopsy is done using a specialized needle to extract cylindrical samples of tissue from the area of concern.

The samples are then sent to a pathology lab, where they are processed into slides and examined by a pathologist. The pathologist analyzes the breast tissue to determine if cancer or other abnormalities are present. Breast biopsies are the most accurate way to evaluate suspicious breast lesions and are an important part of breast cancer diagnosis.

Why is a breast core biopsy done?

A breast core biopsy may be recommended for several reasons:

  • To evaluate an abnormal finding on a screening mammogram such as a mass, architectural distortion, or suspicious calcifications.
  • To further assess an abnormal finding on diagnostic mammogram or breast ultrasound that may require tissue sampling.
  • To evaluate palpable lumps or abnormalities found during a clinical breast exam.
  • To characterize breast lesions that were deemed probably benign on prior imaging to definitively rule out cancer.
  • To confirm the diagnosis of breast cancer if imaging tests are highly suspicious for malignancy.

The biopsy provides important diagnostic information to determine if cancer is present and guides appropriate management. For many suspicious breast abnormalities, a biopsy is the only way to make a definitive diagnosis.

What are the different types of breast biopsies?

There are several approaches that can be used to obtain breast tissue samples:

  • Core needle biopsy – This is currently the most common type of breast biopsy. A specialized hollow needle is used to extract cylindrical samples of breast tissue through small skin nick. Multiple samples are usually obtained.
  • Vacuum-assisted biopsy – This uses a needle probe with a vacuum device to collect larger, more intact tissue samples. It may provide more tissue for analysis than regular core biopsy.
  • Stereotactic biopsy – This approach uses mammogram guidance to precisely locate the abnormality and position the biopsy needle. It is typically used for abnormalities only visible on mammography.
  • MRI-guided biopsy – MRI is used to guide placement of the biopsy needle for sampling abnormalities only visible on breast MRI exams.
  • Surgical biopsy – This may be recommended if the lesion cannot be accessed well for needle biopsy. A small incision is made to remove the entire lump or abnormal tissue.

Core needle biopsy only removes small samples rather than the entire lump or lesion. For this reason, it is considered a minimally invasive approach.

How should you prepare for a core biopsy?

Here are some tips on how to prepare for your breast core biopsy procedure:

Discuss your medical history

Inform your doctor of any medications, supplements, or allergies you may have. Specifically mention if you take any blood thinning medications or have bleeding disorders, as this may increase your risk of bleeding after the biopsy.

Arrange a driver

You will receive local anesthesia for the procedure so you will be awake. However, you should still have someone drive you home afterwards as a precaution.

Wear a comfortable, accessible top

Wear a top you can easily lift up or lower to expose the breast area for the biopsy. You may want to wear a soft, supportive bra without underwire on the day of your biopsy.

Expect fasting instructions

Your doctor may recommend fasting for 4-6 hours before the biopsy to minimize risks related to sedation. Follow any fasting instructions provided by your care team.

Take medications as prescribed

If you have been instructed to take any antibiotics, pain relievers, or anti-anxiety medications prior to the biopsy, be sure to take them according to directions.

Refrain from applying lotion or powder

Do not apply lotion, powder, or deodorant in the breast or underarm area on the day of your biopsy. This can interfere with proper sterilization and prep of the biopsy site.

Arrive early

Be sure to arrive 15-30 minutes early for your appointment time to complete any necessary paperwork and get prepped for the procedure.

Expect the biopsy location to be confirmed

The radiologist will verify the location of the abnormality first by mammogram or ultrasound before performing the biopsy. This ensures the correct area is sampled.

Make arrangements for after care

Plan for someone to drive you home and assist you for the rest of the day after your biopsy. Most patients can resume normal activity the next day but a brief recovery period is often needed.

What happens during the breast core biopsy procedure?

Here is a general overview of what you can expect during your breast core biopsy appointment:

Consent process

You will meet with the radiologist or breast health nurse to discuss the details of the procedure, its benefits and risks, and to sign a consent form indicating you understand and agree to have the biopsy.

Positioning

You will undress from the waist up and lie face down on the biopsy table with your breast positioned through an opening cushioned support. The breast will be thoroughly cleaned and sterilized.

Local anesthesia

The radiologist will inject a local anesthetic, typically lidocaine, to numb the biopsy area. This will sting briefly as it is administered. The anesthetic will take effect within minutes.

Imaging guidance

The radiologist uses mammogram or ultrasound images to guide accurate needle placement into the target abnormality.

Needle insertion

Using the images, the radiologist will firmly insert the biopsy needle into the suspicious lesion and obtain tissue samples. You may feel pulling or pressure but not sharp pain due to the anesthetic.

Sample collection

Several samples will be collected by rotating the needle or repositioning it into different areas of the lesion. On average 5-10 core samples are obtained.

Bandage and compression

Once complete, a bandage and ice pack are applied to the biopsy site. Gentle pressure is applied to prevent bleeding and minimize bruising. A supportive bra and compression band may be provided.

Recovery

You will be moved to a recovery area for observation for 15-30 minutes until stable to go home. Be sure your driver is present after the procedure completion to take you home.

What should you expect after the breast biopsy?

Here’s what to expect and keep in mind during your recovery after your breast core biopsy:

Soreness

Mild to moderate soreness, bruising, and swelling can occur. Use ice packs periodically the first 1-2 days to help minimize discomfort. Take over-the-counter pain medication as recommended by your doctor.

Bleeding

Notice any bleeding from the biopsy site. Apply pressure and contact your doctor if concerning bleeding occurs.

Drainage

Expect a small amount of drainage from the biopsy site for the first day. Cover with gauze and refrain from scrubbing the area while showering.

Infection

Look for increasing pain, swelling, warmth, redness or pus-like drainage which could indicate an infection. Call your doctor promptly if these occur.

Activity

Avoid strenuous activity for the first 48 hours. Then you can gradually return to your normal routines. Avoid any repetitive impact to the breast that was biopsied for 1-2 weeks.

Bathing

You may shower after 24 hours but avoid soaking the biopsy area or scrubbing it directly. Pat it dry gently with a towel after bathing.

Dressing

Keep initial bandage on for 24 hours. Then you can leave it uncovered or apply light gauze as needed for drainage.

Results

Biopsy results are typically available within a few days up to a week depending on your pathology lab. Your doctor will review the results and recommend any needed follow-up.

How accurate is a breast core biopsy?

Breast core needle biopsy is very accurate for diagnosing breast cancer and other abnormalities when performed correctly. Studies evaluating breast biopsies show:

  • Accuracy rates of over 95% for definitive cancer diagnosis when adequate sampling is obtained.
  • False negative rate around 1-3% on average when biopsy fails to detect known malignancy.
  • High sensitivity for benign conditions such as fibroadenomas or cysts.

Accuracy depends on the radiologist sampling the appropriate lesion and obtaining enough tissue to make a confident diagnosis. Precise image-guidance and adequate samples are keys for maximizing accuracy.

If biopsy results are inconclusive or clinical suspicion for cancer remains, a repeat or surgical biopsy may be warranted to provide more definitive diagnosis. Overall, core biopsy prevents the need for surgery in most patients with benign lesions or early cancers.

What are the risks associated with breast core biopsy?

Breast core biopsy is considered a low risk procedure, especially when performed by an experienced radiologist. However, some possible complications include:

Pain

Most patients have only mild to moderate discomfort that resolves quickly. Use ice and over-the-counter medication as recommended by your doctor. Severe or worsening pain could indicate a complication.

Bleeding

Noticeable bleeding affects less than 5% of patients but may require additional treatment or transfusion rarely.

Infection

Estimated infection rate is 1-3%. Oral antibiotics can treat minor infections while major infections are very rare.

Hematoma

Collection of blood around biopsy site. May cause bruising or a firm lump lasting weeks-months that eventually resolves.

Failure to obtain sample

Inadequate sampling occurs in about 2-7% of cases. Repeat biopsy is often needed if this occurs.

Pneumothorax

Collapse of lung tissue. Very rare for breast biopsy but slightly higher risk for lesions near the chest wall.

Overall, serious complications are uncommon when proper technique is used. Make sure you discuss risks and your concerns with your doctor before the biopsy.

What happens if breast cancer is diagnosed?

If breast cancer is found on your core biopsy, additional steps will be needed to determine the extent of disease and develop your treatment plan:

  • Your cancer will be staged through imaging tests like mammogram, ultrasound, and possibly MRI and PET/CT scan.
  • Receptor testing is performed on biopsy tissue to see if the cancer is hormone receptor positive, HER2 positive, or triple negative.
  • Genomic tests like Oncotype Dx may be applied to the tumor to assess prognosis and predict response to treatment.
  • Your care team of breast surgeon, medical oncologist, radiation oncologist, and other specialists will tailor treatment recommendations based on the cancer details.
  • Common treatments include lumpectomy or mastectomy, radiation, chemotherapy, HER2 or hormonal therapy.

Treatment is personalized based on the type of breast cancer, its extent, and your own preferences. With current therapies, there are many good options for successfully treating breast cancer including less invasive approaches.

Conclusion

While the prospect of breast biopsy may be stressful, it is a critical diagnostic test to evaluate suspicious breast lesions. Being prepared with the right information helps ease anxiety about the procedure. Core needle biopsy is a safe, well-tolerated, and highly accurate method to obtain tissue for analysis. Knowing what to expect before, during, and after the biopsy allows for greater peace of mind. If breast cancer is diagnosed, the biopsy provides key information to appropriately guide treatment. With proper care by your breast health team, most women do very well after a breast cancer diagnosis.

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