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What is a core biopsy?

Your doctor has referred you for a breast core biopsy because a lump or area of breast tissue identified on ultrasound or a mammogram requires further investigation.

A breast core biopsy is a procedure where a special needle is inserted into the breast to take a small sample of breast tissue cells from an area of concern, so that it can be sent to a laboratory for testing. The procedure is performed by a specialist doctor, called a radiologist, using ultrasound or mammography to guide the positioning of the needle. The cells are then sent off to be examined by a specialist doctor, called a pathologist, under a microscope. The information from this procedure helps your doctor with a diagnosis, and if necessary, plan treatment you may require. A breast core biopsy may not give a definitive answer. It is not always possible to confirm or exclude cancer and you may need more tests.

How long will the procedure take?

If your breast lesion is visible on ultrasound, the procedure can be performed under ultrasound guidance and takes approximately 5 minutes to perform. However, you may be in the room with the doctor and nurse for up to 30 minutes. If your breast lesion is better visualised on mammography, this will be used to guide the procedure and may take up to an hour. You may be observed for a short time afterwards.

Is there any special preparation required?

No special preparation is required; however a breast core biopsy can be uncomfortable and may be painful. You may wish to ask a relative or a friend to attend the appointment with you if you think that you may need support before or after the procedure; however they will not be allowed to stay with you during the procedure. You may wish for someone to drive you home.

When booking your appointment, it is essential that you inform our staff if you have any allergies, take blood thinning medication, or are pregnant or breastfeeding.

Please list or bring all of your prescribed medications, including those medications that you buy over the counter at the pharmacy, herbal remedies and supplements. If you take blood thinning medication, you may need to stop taking these for a few days or reduce your dose. It is very important that you do not stop any blood thinning medications or change the dose without consulting with our radiology clinical staff and your own doctor. They will give you specific instructions about when to stop and re-start the medication. These drugs are usually prescribed to prevent stroke or heart attack, so it is very important that you do not stop taking them without being instructed to do so by your doctor or our clinical staff, or both. Aspirin is usually not stopped.

A blood test may be required to check your blood clotting onthe day before the procedure. You should continue with pain medication and all other medications as usual.

What do I need to do on the day of the procedure?

On the day of your appointment, please wear a two-piece outfit, as you will need to have your upper body uncovered for the procedure. Do not wear talcum powder or deodorant on the day of your procedure as this can look like calcium spots on the mammogram (breast x-ray) and may affect the accuracy of your procedure.

On the day of your appointment, please ensure you bring:

• Your referral form (if you have it)
• All previous relevant scans or x-rays
• Medicare and healthcare cards (e.g. DVA card or concession card)
• List of all medications

What happens during the procedure?

An antiseptic solution is used to clean the skin, and a sterile drape may be applied to the area to reduce the risk of infection. You will remain awake during the procedure. To prevent discomfort, the area where the biopsy will be performed may be numbed using local anaesthetic. Local anaesthetic causes a pinprick and stinging sensation that is uncomfortable for a few seconds

A small cut (approximately 2mm) may be made in the skin and under the guidance of ultrasound or mammography, the radiologist will place a biopsy needle into the breast lesion to collect cells. It is common for two to three samples to be collected. You make hear a clicking noise and feel pressure in the breast when the samples are taken.

At the end of the procedure, a small waterproof dressing will be placed over the area and an ice pack may be applied to assist in reducing bruising.

Are there any after effects from the treatment?

There is usually some bruising in the area that has been biopsied and it may feel a bit tender for several days.

What happens after the procedure?

Our staff will provide you with clear written instructions on ways to look after yourself following the biopsy. This includes information such as avoiding strenuous activity for a few days, arranging a follow-up appointment with your referring doctor and how to look after the biopsy site.

What are the benefits?

If there is an area of concern in your breast, biopsy samples of this area are taken for examination by a pathologist. Core biopsy is a method of gaining accurate information without the need for an operation to surgically remove the tissue for testing.

Are there any risks?

In referring you for this procedure, your doctor believes that the benefits of this procedure for you are greater than the risks. There are some risks and complications associated with a breast core biopsy. The use of ultrasound or mammography to guide the procedure minimises these risks.

• Bleeding or bruising at the site can occur and it may take several weeks for this to disappear. It is more likely if you take blood thinning medication or regularly take fish oil supplements.
• Everyone has an individual pain threshold so tell our nurse or specialist doctor, the radiologist, if you feel pain during the biopsy.

If you sometimes faint during medical procedures, please tell the nurse or radiologist before the biopsy starts. Some people may have an allergy to injected drugs (e.g., local anaesthetic), or the procedure may not be possible due to medical and/or technical reasons. There is a very small risk of infection; in the unlikely event that this occurs it can be treated with a course of antibiotics.

If the area of concern is located deep within your breast and next to your lungs, there is a slight risk that the biopsy needle could pass through the chest wall, allowing air around your lung and possible collapse of the lung. This is called a pneumothorax and it is a very rare complication.

Before the biopsy, our doctor, the radiologist, will discuss the procedure with you in detail, including any risks specific to you. You will be provided with the opportunity to ask questions. It may be necessary to do a formal consultation to ensure this procedure is the most appropriate for you.

When do I get the results?

The radiologist will send a report outlining the procedure to your referring doctor (this could be your family doctor, a breast surgeon or a breast physician) and your regular GP. It is important that you make a follow-up appointment with your referring doctor so that they can discuss the results with you.

The pathologist who studies the biopsy samples will provide a detailed report to your referring doctor. The pathology results are usually available and sent to your doctor within 3 days. Usually your doctor will already have made arrangements to discuss the results with you.

I still have questions; who can I ask?

Medical information can be complex, and you may receive information that you do not fully understand. It is important for you to consider the risks and outcomes of the procedure as well as your personal needs before making a decision to undergo the procedure.

If you have read this online information and are still unsure if this is the correct procedure for you; before making a booking, you should discuss your questions or concerns with your referring doctor in the first instance. Your regular GP and/ or your family may also be a useful resource. Your referring doctor can answer questions about the risks and benefits of not having the procedure and other options for treatment.

If you have questions before your appointment about what is involved on the day, our staff would be happy to assist. Please contact the imaging centre where you have made your appointment.