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 magnetic resonance guidance (MR-guided breast biopsy).

Summary

An MR-guided breast biopsy is a procedure where a small sample of breast tissue is taken using guidance from magnetic resonance imaging (MRI). This biopsy includes the placement of a small localization device like a clip or pellet to mark the area. It is done percutaneously (through the skin).

Purpose

MR-guided breast biopsies help diagnose abnormalities or suspicious areas seen in breast imaging. The goal is to obtain tissue samples that can be examined microscopically to determine if the abnormal area is cancerous or benign.

Indications

• Suspicious areas found on a mammogram or MRI
• Palpable lumps or abnormalities in the breast
• Patients with a high risk of breast cancer needing close monitoring
• Non-conclusive results from other types of biopsies

Preparation

• Patients may need to stop taking blood-thinning medications days before the procedure.
• Fasting may be required if sedation is to be used.
• A recent mammogram or MRI might be needed to plan the procedure.

Procedure Description

1. The patient lies face down on a special biopsy table with breast positioning through an opening.
2. MRI is used to locate the abnormal area.
3. The skin is cleaned and numbed with a local anesthetic.
4. Using MRI guidance, a small incision is made, and a hollow needle is inserted to obtain tissue samples.
5. A localization device (clip or pellet) might be placed at the biopsy site.
6. The biopsy specimen is imaged and sent to a lab for analysis.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

It is performed as an outpatient procedure at a hospital, surgical center, or specialized diagnostic imaging center.

Personnel

• Radiologist or breast surgeon
• Radiologic technologist
• Nursing staff
• Anesthesiologist or nurse for sedation, if needed

Risks and Complications

• Bleeding or bruising at the biopsy site
• Infection
• Pain or discomfort
• Rarely, altered sensation or numbness in the breast
• Possible false-negative result if the abnormal area is missed

Benefits

• Precise targeting of suspicious areas identified on MRI
• Minimally invasive with little to no scarring
• Quick recovery time compared to surgical biopsies
• High diagnostic accuracy

Recovery

• Patients can typically go home the same day.
• Mild swelling or bruising can occur; over-the-counter pain medications might be recommended.
• Avoid heavy lifting or strenuous activity for a few days.
• Follow-up appointment to discuss biopsy results.

Alternatives

• Stereotactic breast biopsy (using mammography for guidance)
• Ultrasound-guided breast biopsy
• Open surgical biopsy
• Pros: Non-surgical alternatives are less invasive but may require a different type of imaging guidance. Surgical biopsy is more invasive but often definitive.

Patient Experience

• The patient may feel pressure or mild discomfort during the biopsy.
• Mild soreness or bruising at the incision site is common post-procedure.
• Comfort measures include local anesthetic and over-the-counter pain relief as needed.