What is a Fine Needle Biopsy?
Your doctor has requested that you have a fine needle biopsy of an area of your breast. A very small needle will be introduced into the area in question and some cells from this area will be drawn into the tip of the needle using a syringe. Slides are then prepared and sent to a pathologist. The pathologist is then able to determine whether there are any suspicious cells present.
How is it done?
Almost all fine needle biopsies are performed using ultrasound. Ultrasound is able to target the area and, using the ultrasound image, the needle can be directed into the correct position with great accuracy.
Will it be painful?
The procedure is performed using a small amount of local anaesthetic. The local anaesthetic does sting slightly and sometimes there is some further minor discomfort as the small needle is introduced into the correct area. The pain is usually minimal and the vast majority of patients manage the procedure without any significant discomfort.
Are there any risks?
Fine needle biopsy is an extremely safe procedure. There is always a small amount of bleeding and bruising around the biopsy site. The breast at this site is often a little tender for a few days and there may be minimal bruising in the skin overlying the area. It is extremely unusual for there to be any major bruising or bleeding. It is however very important to let the radiologist know if you have any clotting disorders or are on any medication to thin the blood e.g. Warfarin. Medications containing Aspirin should be avoided for a few days before and after the procedure.
What happens afterwards?
Almost all people who have a fine needle biopsy have minimal discomfort and are able to return to normal activity immediately. A very small number of people will have some tenderness and bruising, which may require minor pain relief or the application of an ice pack to the breast.
The specimen slides are sent immediately to the pathologist. A report is usually issued within 48 hours. A copy of the report is sent directly to your own doctor by the pathologist.
If you have any queries regarding this or any other procedure, please contact our practice where your appointment has been made. The telephone numbers can be found on our referral form.
Imaging of the Breast
Why have a Mammogram?
Although some women delay having a mammogram because they think it is going to be an uncomfortable or unpleasant experience, it is one of the single most important things you can do to take care of your health and help diagnose an abnormality before it is advanced.
When some lesions are diagnosed early, we are able to offer a complete cure. The death rate from breast cancer is decreasing each year due to more women having regular mammograms.
What is involved?
In a standard procedure, four mammograms are taken - two images of each breast. In order for the films to be of the very highest quality, exact positioning and compression of the breast is essential. Although this can be uncomfortable, the radiographer will try to reduce the discomfort as much as possible. Compressing the breast significantly improves the image quality and ability to diagnose early lesions.
If you are having a screening mammogram, which is when you are completely asymptomatic, this may be all that is required. If however you have a particular problem - such as a breast lump, focal tenderness, etc., then the radiologist may wish for further views to be taken, and you will probably also have an ultrasound performed.
Can I just have an ultrasound instead?
Unfortunately, no. An ultrasound will not detect microcalcifications, which may be the very first signs of breast cancer in women who have no symptoms at all.
Nor may it detect subtle areas of distortion in the breast. For these reasons, although sometimes uncomfortable, it is very important to have screening mammograms.
Ultrasound does however play a very important role in the assessment of many breast conditions. It is particularly useful in young women under the age of 35, whose breasts are often too dense to assess on mammograms, and also in distinguishing solid from cystic structures.
How do I know if I am at increased risk of breast cancer?
The current incidence of breast cancer in the Australian population is 1 in 12 women. Although having a family history of breast cancer may increase your risk slightly, 80% of cases have no significant family history or other risk factors. The incidence increases with age, with breast cancer being most common in women over the age of 50. Therefore all
Australian women over this age should have screening mammograms.
What is significant Family History?
Family history that increases your risk of breast cancer is having a first degree relative such as your mother or sister diagnosed with breast cancer at a young age, prior to menopause. For these women screening should commence earlier than age 50, and is generally recommended 5-10 years prior to the onset of the condition in that relative.
What if I have implants?
Breast cancer screening for women with implants is safe and is just as important as for women without implants. Unfortunately though, the implant will obscure some of the breast tissue, making it more difficult to detect small breast cancers. For this reason an ultrasound is also performed.
As previously mentioned, ultrasound alone cannot detect microcalcifications and distortion of tissue structure, and so must be combined with mammography. The radiographer performing the mammogram is highly trained and will take extra care in performing the examination, applying less compression than normal.
The implant will be pushed back slightly against your chest wall so that only the breast tissue is compressed. Although you may experience some discomfort, this does not last for long.
After 20 years of screening mammography there have been few, if any, cases of implant rupture shown to have occurred from the mild compression of mammography. After a period of time, all implants show some “wear and tear”, particularly after having been in place for more than 15 years, and the state of the implant will therefore also be assessed.
Is there any radiation risks?
No. There is virtually no radiosensitivity in breast tissue in people over the age of 20. The risk of developing breast cancer from screening mammography every year over 20 years is equivalent to the risk of developing lung cancer after smoking 3 cigarettes!
Is a lump always bad news?
No. 80% of lumps are BENIGN. This means they have no association with breast cancer. Cysts are by far the most common cause of lumps, and these represent enlargement of a lobule of breast tissue containing fluid. If painful, they can easily be aspirated. Other times the lump may just represent a prominent area of fibroglandular tissue. Of course, we cannot always see what cells are present in the breast tissue from ultrasound alone, and therefore we will often take a sample of tissue to be certain. Queensland X-Ray has further patient information brochures related to the Fine Needle Aspiration and Core Biopsy procedures.
The Future
As more research has been focused on breast cancer, new techniques of imaging and assessment have evolved. Two such techniques are Sentinel Node Biopsy and Magnetic Resonance Imaging (MRI).
MRI of the Breast
In certain situations, neither mammography nor ultrasound is able to identify the suspected breast cancer. In these cases, performing a breast MRI may be useful. It is also useful in assessing dense breast tissue after surgery or radiotherapy for recurrence, and in women with implants.
This test is reserved for difficult cases or complex situations. Unfortunately, at this stage there is also no Medicare rebate for this procedure.