Needle Localized Breast Biopsies
NEEDLE-LOCALIZED BREAST BIOPSIES
Jerry K. Myers, M.D.
Sometimes an abnormality in a mammogram that requires a breast biopsy cannot be felt or palpated in a physical exam. To biopsy this abnormality requires some method of finding or localizing the area at the time of the surgical biopsy. This localization is usually done in the Breast Center stereotactically but may be done in the radiology department just prior to the surgical procedure.
If done in the hospital, following admission and obtaining the appropriate lab tests for the surgical biopsy, the patient to have the localization done will go to the radiology department, prior to going to the surgical suite for the operation. If done in the Breast Center, the patient will arrive at the Breast Center for the localization prior to admission to the hospital. After stereotactic localization is completed, the patient will go to the hospital for surgery.
The localizing technique requires visualizing the abnormality in stereo views. If the area of concern cannot be seen in two views (medial-lateral and cranial-caudal), it cannot be localized for the surgery. Once it can be visualized in the two noted views, the radiologist can place a small guide wire (via a needle – thus the name needle-localized) directly into the lesion or abnormality. The patient then goes to the outpatient room to await surgery or goes directly from the radiology department to surgery.
The surgical procedure then proceeds similar to any other breast biopsy, with the exception that the surgeon removes the area at the tip of the guide wire as opposed to an area felt as in a standard biopsy. The biopsied tissue then usually goes to the pathologist who will take it back to radiology for a specimen mammogram (taking a mammogram of the tissue removed). This is sometimes done to be sure the abnormality is present or to help the pathologist find the specific area in the tissue for microscopic evaluation.
Potential problems are the same as with other breast biopsies. The most common are related to the surgical wound; i.e. bleeding or infection that may require further surgery to correct. One significant fact to understand in the needle localized procedure is that the only 100% way to know that the area of concern is removed is to do a follow-up mammogram after the biopsy. We do this on all benign needle-localized biopsies one month later. If the area has not been adequately removed (as may be shown on the follow-up mammogram in one month), then further surgery may be indicated to remove more tissue. This re-biopsy is possible on all needle-localized biopsies – thus this fact is very important to understand and accept for the patient prior to the initial surgical procedure.
Another very important fact to understand and accept prior to the biopsy is that at the time of the mammogram, when the needle-localization is being done, the physician may actually decide that surgery is no longer needed. The breast abnormality could change in a manner not to be bothersome any longer, could actually disappear (especially if it were hormonally caused), may not be able to be adequately seen in two stereo views so that the guide wire can be successfully placed, or may actually be a cyst that drains when the guide wire goes into it. Whatever the reason, it is not unusual for the surgical biopsy to be cancelled after the mammogram is taken. This is usually a reason to celebrate – since most of the time there is a change for the better making the biopsy not indicated. This decision to cancel the surgery is made after outpatient admission and lab procedures are completed. It is thus necessary not only to fully understand, but to fully accept responsibility for this possibility occurring prior to proceeding with the procedure. Mammography and needle-localization of small and sometimes near microscopic lesions has been responsible for diagnosing early breast cancers for cure more than any other modality in breast treatment.
