Ultrasound guided breast biopsy

Last revised by Fabio Macori on 18 Aug 2023

Ultrasound-guided percutaneous breast biopsy is a widely used technique for an accurate histopathological assessment of suspected breast pathology. It is a fast, safe and economical procedure.

Ultrasound guidance is limited to lesions visible on ultrasound study. The biopsy is generally undertaken for lesions that are assessed as BI-RADS 4 (suspicious for malignancy) or BI-RADS 5 (highly suggestive of malignancy).

A history of aspirin or anticoagulant use is not an absolute contraindication to biopsy. This is a superficial procedure that could be easily compressed in the case of profuse bleeding. In these cases, a discussion with the referring physician should be done to weigh the risk of hematoma versus the risk of discontinuing anticoagulation 1

Laboratory tests are usually not performed. 

The patient may be positioned supine as for a conventional breast ultrasound exam or in lateral decubitus position if it promotes safer access to the lesion. Only the breast to be biopsied should be uncovered.

This may vary according to institutional protocols and usually includes:

  • 14G or 16G core biopsy needle, single or co-axial, with 10 mm or 20 mm cutting lengths

  • trigger device

  • 1% lidocaine without epinephrine

  • chlorhexidine, surgical scalpel blade (usually n.11), needle and syringe for anesthetic, dressing, and sterile gloves

  1. study the target lesion and its best biopsy approach.

  2. skin antisepsis.

  3. local block with 1% lidocaine using US guidance while injecting it.  

  4. a small incision is made with a scalpel blade or a large bore hypodermic needle (enough to overcome resistance and allow the entry of the core-needle biopsy).

  5. ultrasound-guided introduction of the core-needle biopsy and subsequent removal of the fragments.

  6. local compression may be necessary to stop any bleeding.

  7. skin cleansing and dressing.

Dressing over the incision point. General instructions for the patient.

  • bleeding (easily compressed)

  • local hematoma

  • non-diagnostic sample

  • post-biopsy obscuration of the target lesion, particularly if very small or had a ruptured cystic component; consider placement or marker/clip in such cases

In cases with equivocal pathologic findings or with discordant radiologic and histologic findings, a new biopsy or suggestion for a surgical excision should be contemplated 2.

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Cases and figures

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