Ultrasound-guided Biopsy of Breast Mass: An In-depth Patient Guide

Updated: September 23, 2024

Ultrasound-guided biopsy is one of the types of biopsies doctors use to obtain samples from abnormal tissue masses for lab analysis and eventual diagnosis. 

Using ultrasound waves, the medic or specialized radiologist follows the guidance of the ultrasound image to locate the lump and obtain the tissue sample.

When the target organ is the breast, the procedure is called ultrasound-guided breast biopsy. 

The primary reason medics perform breast biopsy is to test tissue for cancer. Luckily, evidence shows that only 20% of breast biopsies are malignant, meaning they return positive results for cancer. The remaining 80% are benign or non-cancerous.

Radiologist taking breast ultrasound

Regardless, anyone with a lump in the breast should be tested for confirmation that it is non-cancerous, and if it should be malignant, get the needed medical attention.

For any patient, having to undergo a breast biopsy procedure can be emotionally stressful. Nonetheless, knowing what an ultrasound-guided biopsy entails and what to expect can ease the anxiety. 

If you have a scheduled ultrasound-guided breast biopsy, we want to achieve that reassuring purpose with this article. 

We tell you what is an ultrasound-guided breast biopsy, why your doctor may recommend it, how long it takes, and what to expect before, during, and after the procedure.

Let’s start with a bit more details on what is ultrasound-guided breast biopsy. 

What is Ultrasound-Guided Breast Biopsy?

Ultrasound-guided breast biopsy is a marginally invasive procedure that uses ultrasound imaging to guide a hollow needle in obtaining a biopsy sample of an abnormal tissue mass in the breast.

Doctor taking breast biopsy

Medics prioritize ultrasound-guided biopsy of breast mass because it is less invasive than surgical biopsy. Besides, it helps to make a focused target on the lump in the breast.

And, as we mentioned already, less than a quarter of all breast biopsies are non-cancerous, usually a fibroadenoma. That means they won’t need to be removed or require any additional medical intervention unless they are large, painful, or have risks of becoming cancerous. 

For the majority of the benign cases that require no additional attention, using an ultrasound-guided biopsy leaves only a tiny scar.

Why Would a Doctor Recommend a Breast Biopsy?

Generally, a doctor recommends a breast biopsy based on two factors:

  • The presence of a lump in your breast.
  • The nature of the lump in your breast

The Presence of a Lump in Your Breast

The most common reason a doctor will recommend a breast biopsy is if you have a lump in your breast that is noticeable with physical examination, mammography, or other breast exams. 

For any healthcare provider, a lump in the breast is a sign of breast disease. Plus, breast lumps are a common occurrence. As a matter of fact, over 25% of women present with a bump in their breast in their lifetime. 

More significantly, if a breast lump turns cancerous, early detection is considered the best weapon against breast cancer.

Since the mentioned breast tests cannot tell if a lump in the breast is cancerous or not, doctors proceed to request a breast biopsy for precise analysis and diagnosis.

Apart from a palpable bump in the breast, your doctor will also recommend a breast biopsy in the following cases:

  • You have a perceptible thick tissue in your breast.
  • Your nipple presents abnormal skin, such as scales, crust, or dimples.
  • You have a bloody discharge coming out of the breast.
  • A previous MRI, mammogram, or ultrasound has shown suspicious results.

The Nature of the Lump in Your Breast

It’s worth noting that once a lump is found in your breast, the doctor can choose from different types of breast biopsy, including stereotactic (mammogram-guided) biopsy, MRI-guided biopsy, vacuum-assisted core biopsy, surgical biopsy, and, of course, ultrasound-guided biopsy. 

The choice of the type of breast biopsy recommended by the doctor depends on the location, size, and characteristics of the breast lump.

Going by that, a doctor will recommend an ultrasound-guided biopsy in these specific cases:

  • The lump in the breast is small and will not require further attention should the biopsy result show it is non-cancerous.
  • The lump is located in a position that’s close to the armpit or the chest wall. As such, it would be difficult to use other methods, like stereotactic biopsy, without causing unintended injury.

In other cases where the lump is large or is causing pain or discomfort, a surgical biopsy that entails removing the lump is preferred.

How Should I Prepare for an Ultrasound-guided Biopsy?

Once you have a prescription to undergo an ultrasound-guided biopsy, you will probably be wondering what not to do before a breast biopsy. 

No need to fret, as your doctor will give you instructions on how to prepare for it. 

Here are the things you should do or not do to prepare for an ultrasound-guided breast biopsy: 

  • Way before your scheduled breast biopsy date, inform your doctor if you are on any medication, including herbal supplements. The medic may advise you to stop using meds that affect blood clotting, such as blood thinners, aspirin, and vitamin E, 3-5 days before the procedure.
  • On the material day, wear loose-fitting clothes and leave out your usual jewelry details. That makes changing into a gown for the procedure a lot easier.
  • Talk to your doctor about any allergies to medications or materials that could be used during the procedure, such as latex.
  • Tell your doctor if you have been sick recently, have any chronic medical conditions, are pregnant or suspect you could be pregnant.
  • As a safety precaution, ask a family member or friend to accompany you to the breast biopsy appointment. Having someone drive you to and from the appointment is a safer choice.
  • Ask any questions you might have about the breast biopsy procedure before it commences. 

Note: Your doctor or radiologist may give additional instructions to prepare for the breast biopsy, depending on your unique situation.for ultrasound techs?

How is an Ultrasound-guided Biopsy Done?

Although it might sound complicated, an ultrasound-guided breast biopsy is a simple and quick procedure.

The first thing your doctor or radiologist will do is ask you to sign a consent form and inform you about the risks and benefits of the procedure over others. This preparatory step may already be done before the actual day.

Once that is done, the radiologist or medic follows these steps to obtain a biopsy sample from your breast:

  1. You are asked to remove your clothes, at least from the waist up, and change into a gown.
  2. The doctor or radiologist directs you to lie down on your back or the side. The preferred position ensures the most effective needle and ultrasound probe access to the location of the lump.
Person undergoing breast ultrasound

Source: iStock

  1. The radiologist or doctor sterilizes the skin on the biopsy area and the ultrasound probe. A sterile probe sleeve may be used as an alternative.
  2. Local anesthesia is applied on the skin and the deeper tissues to numb the breast. The needle may cause a quick-sting feeling, but you don’t feel any pain for the rest of the procedure. The radiologist waits for the area to be numb. 
  3. The doctor or radiologist uses an ultrasound probe to locate the lump in your breast. If a radiologist is carrying out the procedure, your doctor may check in at this point to cross-check the location of the lump with previous ultrasound records. 
  4. A small incision is made at the access area, and a biopsy needle is introduced into the breast at the guidance of the ultrasound image on the ultrasound monitor.
  5. The radiologist takes samples of the abnormal tissues by rotating the biopsy needle. Every rotation draws a different sample. 
  6. A tiny clip is placed at the location of the biopsy inside your breast to mark the location of the biopsy. That avoids taking a biopsy sample from the same location should one be required in the future.
  7. Once the sample is obtained, the area of access is bandaged, and pressure is applied for a few minutes to stop or prevent any bleeding. An ice pack may also be applied for the same purpose.
  8. The physician gives you any post-procedure instructions you may need to follow. 
  9. The sample is delivered to the lab for analysis.

You are now ready to head home and, for most patients, get back to your usual life. However, we recommend precaution by taking the day off to avoid any strain on the biopsy area.

Your doctor will call you with the results in 4-5 days.

Do you prefer a visual option for how an ultrasound-guided biopsy is done? 

This video by the Memorial Healthcare System will do the trick.

How Long Does a Breast Biopsy Take?

Although your breast biopsy appointment may take about an hour, most of that time goes to waiting and the preparatory procedures.

The actual breast biopsy sample collection takes about 2-5 minutes.

Your doctor or radiologist may ask you to sit and spend a few more minutes resting in the waiting room to ensure no undesired aftermaths occur following the breast biopsy procedure. That could go up to 15 or 20 minutes.

Is an Ultrasound-guided Biopsy Painful?

An ultrasound-guided biopsy is pain-free.

However, you will feel a slight sting on the skin from the anesthesia needle. Also, it is normal to experience a little discomfort and pressure when the biopsy needle is introduced into the breast and when it is turned to take a few biopsy samples.

Other than that, you shouldn’t feel any pain.

Inform your doctor or radiologist immediately if you feel a sharp pain or extreme discomfort. That may call for additional anesthesia as the breast may not be completely numbed.

What are the Benefits of an Ultrasound-guided Breast Biopsy?

We noted earlier that an ultrasound-guided biopsy leaves minimal scarring on the spot of the biopsy compared to other procedures like surgical biopsy. 

But, this is only one of the benefits of an ultrasound-guided biopsy.

Here are a few others:

  • An ultrasound-guided breast biopsy is minimally invasive.
  • It does not involve any ionizing radiation, as is the case with mammogram-guided biopsy.
  • It is fast, avoiding prolonged anxiety in the patient.
  • Provides sufficient tissue samples to determine if a breast lump is benign or malignant.
  • It is a secure way to follow the biopsy needle movement inside the patient’s breast.
  • It is effective in delicate breast lump positions like the underarm and chest wall where alternative procedures like stereotactic biopsy may not reach or may be used with higher risks.
  • It is less expensive than other biopsy procedures, especially the surgical option.
  • The patient enjoys a quick recovery period considering that little injury is caused to the breast tissue.

Despite these benefits, ultrasound-guided biopsy comes with some limits: 

  • Any breast needle biopsy may under-evaluate a breast lump and fail to conclusively tell the extent of breast disease, requiring additional procedures like the surgical biopsy.
  • Ultrasound-guided biopsy works well only where the lesions are clearly visible on the scan image. It may not be effective with clustered breast lumps or cysts.
  • Tiny cysts or lumps may be hard to target with ultrasound-guided biopsy.

In addition to these limits, an ultrasound-guided breast biopsy may pose the risks associated with any needle introduction to body tissue.

What are the Potential Risks of a Breast Needle Biopsy?

After an ultrasound biopsy, your breast should heal quickly without any undesired consequences from the procedure.

However, some people may show these risk signs from a breast needle biopsy:

  • Pain and discomfort. These can be managed with painkillers given by your doctor or obtained over-the-counter. Ibuprofen and Tylenol (Acetaminophen) are suitable options, but consider that the advice from your doctor takes precedence.
  • A bruise on the biopsy access area or swelling of the breast.
  • Continued bleeding after the breast biopsy procedure is already completed. 
  • Fever with a red and warm appearance on the biopsy access spot, a sign of infection.
  • Changed breast appearance. This could show an adjustment to the amount of tissue removed or be a sign of the healing process. It may also point to other tissue reactions, which could require medical attention.
  • Excessive drainage from the biopsy access location. This can also be a sign of infection.

If any of the risk signs appear on your breast after a biopsy, contact your doctor immediately.

Important note!

It’s crucial to keep in mind that your doctor recommends a breast biopsy because it is essential to the precise diagnosis of your case. As such, you should trust that the benefits of an ultrasound-guided biopsy outweigh any potential risks.

What Kinds of Conditions Can Look or Feel Similar to Breast Cancer?

We mentioned already that physicians associate the presence of a lump in the breast with breast disease, especially cancer. We also mentioned fibroadenomas, the non-cancerous tumors consisting of stromal cells and glandular tissue.

Doctors doing breast operation

Source: Unsplush

However, several other conditions can look or feel similar to breast cancer. 

They include: 

  • Fibrosis and Cysts: They present in fibrous (scar-like) or thickened tissue in the breast.
  • Hyperplasia: An overgrowth of lobules and ductal cells. The first are the milk-producing glands, and the latter are the tiny milk tubes in the breast.
  • Mastitis: The condition presents as a painful localized swelling on the breast that feels hot.
  • Adenosis: The enlargement and abnormal increase of the milk-producing glands, usually due to hormonal changes.
  • Phyllodes Tumors: Rare fibrous lesions occurring in the breast connective tissue. They can progressively go from benign to cancerous.
  • Lobular Carcinoma in Situ: Abnormal cells in the lining but not the wall of the lobules. 
  • Duct Ectasia: Irregular enlargement of the main milk duct with consistent inflammation and thickened breast tissue.
  • Fat Necrosis: Inflammation of the adipose tissue due to poor oxygen supply to fat cells. This can eventually cause the death of the cells.
  • Intraductal Papilloma: The growth of wart-like tumors in the milk tubes.

Bear in mind that although these conditions are non-cancerous and not life-threatening, experts associate them with future risks for cancer. 

For this reason, every breast lump should be checked and analyzed for proper medical diagnosis and treatment. 

With all the knowledge you’ve learned so far about ultrasound-guided breast biopsy, one last question may still be ringing in your mind.

How Much Does an Ultrasound-guided Breast Biopsy Cost?

The U.S. medical media company MJH Life Sciences suggests that ultrasound-guided breast biopsy can cost between $500 for those with medical cover and $2,000 for patients paying from their pocket. 

For consoling news, however, research shows that ultrasound-guided biopsy is a lot cheaper than other options. 

A study comparing ultrasound-guided breast biopsy and surgical biopsy revealed that the cost was reduced by up to 56% using ultrasound-guided biopsy. Cost reduction was only 39% when surgical biopsy was compared to stereotactic biopsy.

Quick Summary

Ultrasound-guided biopsy involves the use of an ultrasound machine to create an image that guides a doctor in introducing a biopsy needle to the target tissue to obtain a sample for lab analysis.

When the target organ for an ultrasound-guided biopsy is the breast, the procedure is described as an ultrasound-guided breast biopsy.

Cancer is the number one suspect for the presence of lumps in the breast. Luckily, it only turns up in 2 out of every 10 cases.

There are other options for collecting a biopsy sample from a breast. But the ultrasound-guided biopsy procedure is often preferred. That’s because it is less invasive, leaves minimal scaring, is quick and painless, and is usually more cost-effective.

Your doctor will give you instructions on how to prepare for an ultrasound-guided breast biopsy and educate you on what to expect during the procedure. We sought to give you those details in advance in this article.

Don’t forget to contact your doctor immediately if you should notice any unexpected consequences after an ultrasound-guided breast biopsy.

Sources

Article by

Scott Caswell

Scott is a co-founder of PUM and an ultrasound technology expert with a passion for innovation in the medical field. Scott has dedicated his career to advancing portable ultrasound devices, making medical imaging more accessible to professionals around the globe.

When not refining ultrasound devices, he enjoys hiking, experimenting with new recipes, and exploring the latest tech gadgets. Scott is dedicated to making healthcare more accessible and efficient through cutting-edge ultrasound solutions.

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