Image-Guided Biopsies and Needle Localization

Many biopsy procedures are performed with the help of some form of image guidance.

Types of image-guided biopsies

  • Stereotactic-guided biopsy is used to target calcifications, or masses, seen only on a mammogram. You will lie face down on a special table with an area for your breast. The breast is then compressed like a mammogram, and a sequence of images are obtained to localize the finding. Local anesthetic is then injected into your skin and breast, and additional images are obtained to guide the biopsy. The procedure usually takes 45 minutes.
  • Ultrasound-guided biopsy is used to target masses, cysts, or abnormal appearing axillary lymph nodes seen on ultrasound. You will lie on your back on a table, like you did for the diagnostic ultrasound exam. The radiologist will then inject local anesthetic into your skin and breast and use the ultrasound images to guide the biopsy or cyst aspiration. The procedure usually takes 15 to 30 minutes.
  • MRI-guided biopsy is used to target masses seen only on a MRI. You will lie on a table face down, like you did for the diagnostic breast MRI scan. A shorter version of the MRI scan will be performed while contrast is infused through an IV in your arm. The radiologist will then inject local anesthetic into your skin and breast, and MRI images will be repeated to guide the biopsy. The procedure usually takes 45 to 60 minutes.
  • Fine needle aspiration (FNA) biopsy involves using a thin needle and syringe to remove a very small sample of fluid or tissue. A fine needle aspiration biopsy may be used to help find out if a breast change is a cyst (a fluid-filled sac that's usually not cancer) or a lump.

The method used depends on the abnormality that is being evaluated. All of these procedures are performed by the breast radiologists at Moores Cancer Center on an outpatient basis. They do not require sedation; a local anesthetic is used. Most women feel some tenderness the day after the biopsy, however, are able to return to their normal activities.

We ask all patients to not take the following during the week before their biopsy:

  • Aspirin
  • Advil (ibuprofen)
  • Blood thinner medications

As biopsy can distort or even remove a lesion. A tiny marker clip is placed in all breast lesions that undergo a biopsy to identify the exact site. This clip cannot be felt through the skin, however, it is evident on mammograms.

Your biopsy tissue will be sent to pathology for evaluation. Results will be called to you by the radiologist or your breast surgeon as soon as they are available.

Image-guided Needle Localization

If breast surgery is required as a result of the biopsy, our radiologists can help the surgeon to localize the lesion - a technique used to precisely locate a breast abnormality for a more detailed X-ray examination of the area. On the morning of your scheduled surgery:

  • You will go to the Breast Imaging Center at Moores Cancer Center
  • Using mammography, ultrasound, or MR as indicated, the radiologist will place a thin needle and wire into the lesion or biopsy clip
  • A small amount of local anesthetic is infused into the area
  • The localization device is then secured to the skin with tape, and you are escorted to the surgical area
  • When your surgery is performed, additional x-rays are made of the removed tissue and reviewed by the radiologist

How to schedule your image-guided biopsy or needle localization

  • Ask your primary care physician for a referral
  • Appointments are available at UCSD Moores Cancer Center in La Jolla
  • Call us for an appointment at 858-822-6126