Ultrasound guided breast biopsy

Ultrasound
guided breast biopsy • Ultrasound-guided breast core-biopsy - Ganzer Fall bei Radiopaedia
Di Muzio B, Ultrasound-guided breast core-biopsy. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-18029 • CC by-nc-sa 3.0 (modified)
Ultrasound
guided breast biopsy • Spiculated complex sclerosing lesion of the breast: radial scar - Ganzer Fall bei Radiopaedia
Holland M, Spiculated complex sclerosing lesion of the breast: radial scar. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-25309 • CC by-nc-sa 3.0 (modified)
Ultrasound
guided breast biopsy • Fibroadenoma with microcalcifications - Ganzer Fall bei Radiopaedia
Di Muzio B, Fibroadenoma with microcalcifications. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-47399 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Ultrasound-guided percutaneous breast biopsy is a widely used technique for an accurate histopathological assessment of suspected breast pathology. It is a fast, safe and economical procedure.

Indications

Ultrasound guidance is limited to lesions visible on ultrasound study. The biopsy is generally undertaken for lesions that are assessed as BI-RADS 4 (suspicious for malignancy) or BI-RADS 5 (highly suggestive of malignancy).

Contraindications

History of aspirin or anticoagulant use is not an absolute contraindication to biopsy. This is a superficial procedure that, in the case of profuse bleeding, could be easily compressed. In these cases, discussion with the referring physician should be done to weigh the risk of hematoma versus the risk of discontinuing anticoagulation .

Procedure

Preprocedural evaluation

Laboratory tests are usually not performed.

Positioning

The patient may be positioned supine as for a conventional breast ultrasound exam or in lateral decubitus position if it promotes safer access to the lesion. Only the breast to be biopsied should be uncovered.

Equipment

This may vary according to institutional protocols and usually includes:

  • 14G or 16G core biopsy needle, single or co-axial, with 10 mm or 20 mm cutting lengths
  • trigger device
  • 1% lidocaine without epinephrine
  • chlorhexidine, surgical scalpel blade (usually n.11), needle and syringe for anesthetic, dressing, and sterile gloves
Technique
  • study the target lesion and its best biopsy approach.
  • skin antisepsis.
  • local block with 1% lidocaine using US guidance while injecting it.  
  • a small incision is made with a scalpel blade (enough to overcome resistance and allow the entry of the core-needle biopsy).
  • ultrasound-guided introduction of the core-needle biopsy and subsequent removal of the fragments.
  • local compression may be necessary to stop any bleeding.
  • skin cleansing and dressing.
    • Postprocedural care

    Dressing over the incision point. General instructions for the patient.

    Complications

    • bleeding (easily compressed)
    • local hematoma
    • non-diagnostic sample
    • post-biopsy obscuration of the target lesion, particularly if very small or had a ruptured cystic component; consider placement or marker/clip in such cases

    Outcomes

    In cases with equivocal pathologic findings or with discordant radiologic and histologic findings, a new biopsy or suggestion for a surgical excision should be contemplated .

    See also