Breast Core Biopsy

Authors:  Dr Michelle Bennett*
                        A/Prof Liz Wylie*

What are the prerequisites for having a breast core biopsy done?

Clinical breast examination and the appropriate imaging investigations should have been performed prior to a biopsy. If it is a nonpalpable abnormality the radiologist should have the imaging provided for review prior to performing the biopsy, especially to plan whether ultrasound or mammography will be used to find the abnormality and guide the biopsy needle. In the unlikely event that the biopsy is stereotactic (mammographic guidance) and the woman thinks she may be pregnant, then a pregnancy test should be performed.

What are the absolute contraindications for a breast core biopsy?

There are no absolute contraindications.

What are the relative contraindications for a breast core biopsy?

Anticoagulants are a relative contraindication for core biopsy. If the patient is taking an anticoagulant such as warfarin, arrangements are usually made by the referring doctor to ensure the clotting parameters are within an acceptable range prior to the core biopsy. It is safe to perform a core biopsy on a patient taking aspirin although there may be less bruising if the aspirin is stopped three days prior to the biopsy.

Prone tables used for stereotactic biopsies have a weight limit, usually about 150kg. This limit varies according to the manufacturer. There is no weight limit for an ultrasound guided core biopsy or a core biopsy on an upright stereotactic biopsy unit.

Pregnancy is a relative contraindication for stereotactic (mammographically guided) biopsy, which would only be performed in exceptional circumstances.

If a woman is lactating this is a relative contraindication for a core biopsy due to the very small risk of developing a milk fistula.

What are the adverse effects of a breast core biopsy?

Some bruising usually occurs at the biopsy site. On the rare occasion where there is arterial bleeding this usually settles with application of pressure to the breast.

There is a risk of infection, however this is very uncommon.

A pneumothorax is a very rare complication but may occur after biopsy of a lesion close to the chest wall.

Are there alternative imaging tests, interventions or surgical procedures to a breast core biopsy?

A fine needle aspiration is an alternative to a core biopsy, and a recommendation is usually made by the specialist performing the biopsy as to which method of biopsy is considered most appropriate.

The main diagnostic alternative to percutaneous biopsy is diagnostic surgical biopsy. Percutaneous core biopsy is generally preferred because of comparatively minimal intervention with less scarring and deformity and core biopsy is performed on an outpatient basis under local anaesthesia.

Although MRI can further characterise lesions, this test does not obviate the need for biopsy of a lesion that is clinically suspicious or of concern on another imaging modality.

Useful websites about breast core biopsy:

Breast fine needle aspiration cytology and core biopsy: a guide for practice.

*The author has no conflict of interest with this topic.

Page last modified on 29/3/2017.

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