19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance

Name of the Procedure:

Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet) when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance. Common Name(s): Breast biopsy with localization and imaging, Stereotactic breast biopsy.

Summary

A breast biopsy with the placement of a localization device and imaging is a minimally invasive procedure used to remove and examine a sample of breast tissue. This procedure often involves the use of stereotactic guidance, a type of imaging technology that helps pinpoint the exact location of the tissue that needs to be biopsied.

Purpose

This procedure is primarily used to diagnose abnormalities in the breast tissue, such as lumps or areas of concern identified through mammograms or other imaging tests. The main goal is to determine whether these abnormalities are benign (non-cancerous) or malignant (cancerous), facilitating early detection and treatment options for breast cancer.

Indications

• Presence of a lump or mass in the breast
• Abnormal findings on a mammogram, ultrasound, or MRI
• Persistent breast pain or other symptoms unexplained by other examinations
• Follow-up on previous breast biopsy results
• High-risk patient profiles for breast cancer

Preparation

• Patients may be asked to fast for a few hours before the procedure.
• Avoidance of blood-thinning medications such as aspirin or anticoagulants as per doctor's instructions.
• Pre-procedure imaging tests such as mammograms or ultrasounds to locate the area of concern.
• Wearing of comfortable clothing and possibly a bra without underwire, as a supportive garment will be needed post-procedure.

Procedure Description

1. The patient is positioned on a specialized table, and the breast is compressed to immobilize it.
2. Stereotactic guidance, typically using mammography, is employed to locate the abnormal tissue precisely.
3. After cleaning the skin, local anesthesia is administered to numb the area.
4. A small incision is made, and a biopsy needle is inserted through the skin to obtain tissue samples.
5. During the procedure, a localization device such as a clip or metallic pellet may be placed at the site to mark it for future reference.
6. Once the sample is collected, imaging of the biopsy specimen may be performed to ensure its accuracy.
7. The incision is closed with a small bandage or steri-strips.

Duration

The procedure usually takes about 30 to 60 minutes.

Setting

The procedure is performed in an outpatient clinic, radiology center, or hospital setting.

Personnel

• Radiologist or breast surgeon specializing in breast imaging and intervention
• Trained radiologic technologist or nurse
• Support staff for patient care and procedure assistance

Risks and Complications

• Bruising and swelling at the biopsy site
• Bleeding and infection
• Pain or discomfort during and after the procedure
• Rarely, pneumothorax (air leak into the space between the lung and chest wall) when deeply located lesions near the chest wall are biopsied
• Possible allergic reactions to local anesthetics

Benefits

• Minimally invasive with a quick recovery time
• Accurate diagnosis of breast abnormalities
• Early detection and treatment of breast cancer
• Placement of a localization device aids in future surgeries or treatments

Recovery

• Patients can usually go home the same day.
• Mild pain or discomfort can be managed with over-the-counter pain relievers.
• Keeping the biopsy site clean and dry, avoiding strenuous activities for a couple of days.
• Follow-up appointment for results and to remove any surgical tapes or check the healing.

Alternatives

• Fine Needle Aspiration (FNA): Less invasive but may not provide as comprehensive tissue samples.
• Core Needle Biopsy: Similar but doesn't always use advanced imaging for guidance.
• Surgical Biopsy: More invasive, involves removing a larger section of tissue or the entire lump.
• Pros and cons include the level of invasiveness, accuracy, recovery times, and potential complications.

Patient Experience

• During the procedure, patients may feel pressure or minor discomfort but should not feel pain due to local anesthesia.
• Post-procedure, patients might experience soreness or mild pain which can be managed with pain relievers.
• Anxiety related to the procedure and awaiting results is common; discussing concerns with the healthcare provider is beneficial.
• Adequate support and detailed instructions from healthcare professionals to ensure comfort and understanding throughout the process.