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Ultrasound-guided Core Biopsy


Medical editor Marit Muri Holmen MD
Radiologist
Oslo University Hospital
Norway

General

Ultrasound-guided core biopsy is utilized for diagnosing inconclusive findings in the breast, either as an independent method or as a supplementary examination after a fine needle biopsy. In most breast diagnostic centers, core biopsy is preferred as a diagnostic method before breast cancer surgery.

There is an indication for core biopsy if the cytology result does not provide a conclusive diagnosis, or if there is lack of agreement between cytology results, image diagnostics, or clinical examination.

Indications

  • Diagnostics
  • Special analysis of a known malignant lesion

Goal

  • To conclude whether a lesion, palpable or non-palpable, is benign or malignant.

Equipment

  • Ultrasound apparatus
  • Local anesthesia
  • Biopsy gun
  • Needles (14G and 16G)

Preparation

  • Local anesthesia is injected through a thin needle.
  • It is important that the patient is able to lie still during the examination. The patient must be informed that the biopsy gun gives a moderate crack when the sample is taken to prevent her from spontaneous movement.
  • Ultrasound-guided core biopsy may be performed regardless of anticoagulation treatment.

Implementation

The examination is performed aseptically.

  • The lesion is localized by means of ultrasound.
  • The breast is disinfected.
  • Local anesthesia is applied.
  • An incision is made for the puncture.
  • The biopsy needle is inserted onto the lesion during ultrasound guidance.
  • When the gun is “fired”, the needle thrusts 22 (or 15) mm forward, first the core needle then the external casing.
  • The biopsy remains in a notch in the core needle.
  • Usually 1-3 samples are taken.
  • The area of puncture is compressed after the biopsy is taken.
  • Patients on anticoagulation are observed up to 30 minutes after the procedure.
  • The incision is bandaged.

Follow-up

The patient can go home after the procedure.

The patient should:

  • Observe the puncture point for possible bleeding
  • Minimize physical activity and should not lift heavy objects or do sport activities the same day
  • Wait until the next day to shower

Pain reducing drugs such as paracetamol should be used as needed (no salicylate drugs).

Results are usually available in 4-7 days.


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