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Diagnostic Services

Diagnostic services

While mammography is an excellent way to detect breast abnormalities, additional testing is often needed to determine whether the finding is malignant (cancerous) or benign. A biopsy, MRI or ultrasound is typically the next step.

There are several types of breast biopsies, but all involve removing a sample of tissue from the breast and studying it under a microscope. A pathologist will examine the cells and make a diagnosis. In some cases, a diagnosis can be made using an MRI or ultrasound.

Services include:

Stereotactic biopsy

MRI-guided biopsy

This type of core needle biopsy is done under the guidance of MRI--an imaging technique that captures multiple cross-sectional images of your breast and combines them--using a computer to generate detailed 3-D pictures. During this procedure, you lie face down on a padded scanning table, and your breasts fit into a hollow depression in the table.

Preparing for your MRI-guided biopsy:

  • Please plan on having a driver take you home
  • No food two hours prior to the procedure
  • The procedure will take approximately two hours
  • Local anesthesia and an IV will be used
  • Check-in for the procedure is at the Ambulatory Cancer Center (ACC) on the northeast corner of the hospital (just east of the    main entrance). Enter through the ACC door and check-in at the Admissions office off the waiting area.

Ultrasound-guided biopsy

This type of biopsy is done under the guidance of ultrasound imaging. Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object's size, shape and consistency (whether the object is solid or filled with fluid).

The health care provider holds the ultrasound device against your breast to see the area. The ultrasound image helps the provider guide the needle as it enters the breast and reaches the abnormal area. The provider then removes a sample of tissue with the needle. The needle is inserted and removed quickly. You may feel a pushing and pulling sensation on your breast, which can cause some discomfort.

Preparing for your Ultrasound-guided biopsy:

  • Please plan on having a drive take you home
  • You may eat a light meal prior to the procedure
  • The procedure will take approximately one to one-and-a-half hours
  • Local anesthesia will be used
  • Check-in for the procedure is at the Ambulatory Cancer Center (ACC) on the northeast corner of the hospital (just east of the main entrance). Enter through the ACC door and check-in at the Admissions office off the waiting area.

Surgical biopsy

During a surgical biopsy, a portion of the breast mass is removed for examination (incisional biopsy) or the entire breast mass may be removed (excisional biopsy, wide local excision or lumpectomy). A surgical biopsy is usually performed in an operating room using sedation given through a vein in your hand or arm (intravenously) and a local anesthetic to numb your breast.

If the breast mass can't be felt, your radiologist may use a technique called wire localization to map the route to the mass for the surgeon. During wire localization, the tip of a thin wire is positioned within the breast mass or just through it. This is usually done right before surgery.

During surgery, the surgeon will attempt to remove the entire breast mass along with the wire. To help ensure that the entire mass has been removed, the tissue is sent to the hospital lab to check the edges (margins) of the mass.

If cancer cells are present in the margins (positive margins), some cancer may still be in the breast, and more tissue must be removed. If the margins are clear (negative margins), then the cancer has been removed adequately.

At the time of the breast biopsy, a tiny stainless steel marker or clip may be placed in your breast at the biopsy site. This is done so that if your biopsy is positive, your doctor or surgeon can relocate the biopsy area to remove more breast tissue surgically.

Breast MRI (Magnetic Resonance Imaging)

A breast MRI scan is an imaging test that uses powerful magnets and radio waves to create pictures of the breast and surrounding tissue. It does not use radiation (X-rays). During the exam, you lie on your stomach with your breasts positioned into the cushioned openings. The narrow table slides into the MRI scanner, which is shaped like a tunnel. You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a T-shirt). Certain types of metal can cause blurry images.

Exams require a special dye (contrast). The dye is usually given before the test through a vein (IV) in your hand or forearm. the dye helps the radiologist see certain areas more clearly. During the MRI, the technologists watches you from a another room. The test generally lasts 30 to 60 minutes, but may take longer.

Preparing for your breast MRI:

  • No food two hours prior to the procedure
  • The procedure will take approximately one hour
  • Check-in for the procedure at the main admissions area. Enter through the hospital's main entrance. Admissions is to the right of the revolving door.

Ultrasound breast imaging

Ultrasound, also known as sonography, uses sound waves to outline a part of the body. For this test, a small microphone-like instrument called a transducer is placed on the skin (which is often first lubricated with ultrasound gel). It emits sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into a black and white image that is displayed on a computer screen. This test is painless and does not expose you to radiation.

Ultrasound has become a valuable tool to use along with mammography because it is widely available and less expensive than other options, such as MRI. Usually, breast ultrasound is used to target a specific area of concern found on the mammogram. Ultrasound helps distinguish between cysts (fluid-filled sacs) and solid masses and sometimes can help differentiate the difference between benign and cancerous tumors.

Preparing for your Ultrasound breast imaging

  • No food restrictions
  • The procedure will take approximately 30 minutes
  • Check-in for the procedure at the main admissions area. Enter through the hospital's main entrance. Admissions is to the right of the revolving door.