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MRI is an excellent tool to detect breast cancer. Cancerous growths enhance or “light up” on breast MRI. Unfortunately, many non-cancerous abnormalities may enhance as well. In order to diagnose a cancerous lesion that is only seen on MRI, and not felt or seen on a mammogram or sonogram, and sometimes in order to distinguish between a cancerous and benign (non-cancerous) lesion, a biopsy may need to be performed.

What is MR-Guided Breast Biopsy?

A breast biopsy is performed to remove some cells—either surgically or through a less invasive procedure involving a hollow needle—from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. Image-guided needle biopsy is not designed to remove the entire lesion, but most of a very small lesion may be removed in the process of biopsy. In MRI-guided breast biopsy, magnetic resonance imaging is used to help guide the radiologist's instruments to the site of the abnormal growth.

Preparation for the biopsy:

Similar to Breast MRI in general, contrast is required. Therefore you must not eat or drink for two hours prior to the test.

If you are on blood thinners such as Coumadin, Heparin or Plavix they generally should be discontinued for a certain length of days prior to the biopsy. THIS MUST BE DONE AT THE DIRECTION OF YOUR PRIMARY DOCTOR OR CARDIOLOGIST (WHOEVER IS PRESCRIBING THE MEDICATION FOR YOU).

If you are taking daily aspirin, this must be discontinued for at least five days prior to the biopsy, ONLY WITH THE APPROVAL OF YOUR DOCTOR.

You must refrain from taking non-steroidal anti-inflammatory drugs, such as Advil or Motrin for five days prior to the procedure. You must also refrain from taking any over-the–counter medications that contain any of these drugs or aspirin for five days prior.

We also ask that you refrain from taking any Vitamin supplements or herbal medications for five days. Please inform the schedulers of any and all medications you are taking so you may be properly prepared for the biopsy.

How is the procedure performed?

The majority of the procedure is performed in the same manner as Breast MRI. You will be asked to sign a consent (permission form) for both the intravenous contrast and the biopsy.

Once the area is located by the Breast Radiologist, the skin is cleansed with a special cleanser (Betadine), local anesthesia (numbing medicine) is given, a very small incision is made in the skin overlying the area. A probe is then placed into the breast. The position of the probe is confirmed and the biopsy is then performed. We use a special biopsy device that is linked to a vacuum (Vacuum- assisted). With a vacuum-assisted device (VAD), vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, eight to 10 samples of tissue are collected from around the lesion.

After tissue sampling is complete the probe is removed and a small marker (clip) is placed at the biopsy site. This clip can be identified on a mammogram and may be used for future identification of the site if needed. Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.

A mammogram will be performed to confirm that the marker is in the proper position.

This procedure is usually completed within 45 minutes.

What will I experience during and after the procedure?

You will be awake during your biopsy and should have little or no discomfort. Most women report little or no pain. Some women find that the major discomfort of the procedure is from lying on their stomach for the length of the procedure, which can be reduced by strategically placed cushions.

When you receive the local anesthetic to numb the skin, you will feel a slight pin prick from the needle. You may feel some pressure when the biopsy needle is inserted. The area will become numb within a short time. You must remain still while the biopsy is performed.

If you experience swelling and bruising following your biopsy, you may be instructed to take an over-the-counter pain reliever and to use a cold pack. Temporary bruising is normal. You should contact your physician if you experience excessive swelling, bleeding, drainage, redness or heat in the breast.

If a marker is left inside the breast to mark the location of the biopsied lesion, it will cause no pain, disfigurement or harm.

You should avoid strenuous activity for 24 hours after returning home, but then usually will be able to resume normal activities.

Who interprets the results and how do I get them?

A pathologist (a physician who specializes in making diagnoses by examining tissue samples under a microscope and using special stains) examines the removed specimen and makes a final diagnosis. In almost all instances, the Breast Radiologist who performed the procedure will contact you within 48-72 hours with the results. In some instances, your surgeon may contact you with the results.