What is image-guided core needle biopsy?
Image-guided core needle biopsy is a minimally invasive procedure performed under ultrasound/mammographic/MRI guidance in which small strips of breast tissue are removed using a needle. Biopsies of axillary lymph nodes are performed under ultrasound guidance.

Why do I need this procedure?
This is to obtain tissue from breast lesions or abnormal looking lymph nodes for analysis to determine if it is benign or cancerous. Core needle biopsy is accurate and this procedure is used in situations where a breast lump, any other breast abnormality or an abnormal looking lymph node in the axilla requires tissue analysis.

What does it involve?
Image-guided core needle biopsy is minimally invasive and is performed with local anaesthesia. The procedure is usually done on an outpatient basis. Fasting and sedation are not required. A preliminary scan of the breast and/or axilla is performed to confirm the correct breast lesion or axillary lymph node for biopsy. Local anaesthesia will be given to numb the planned biopsy site followed by a small skin incision to allow placement of the biopsy needle in the breast or axilla. Only a small skin incision is necessary with no significant resultant scarring. The breast lesion or lymph node is then targeted under ultrasound/mammographic/MRI guidance and strips of tissue (usually 3-5 samples) are removed by the biopsy needle. The biopsy needle will be inserted and withdrawn through the same skin incision each time a biopsy is obtained.

What precautions must I take for the procedure?
Please inform your doctor if you have any medical illnesses. Before the procedure, please inform your doctor if any of the following are applicable:

1. You have a history of allergy or reaction to any medications, drugs, or food.
2. You have a history of bleeding or clotting disorders.
3. You are taking drugs (e.g. Aspirin, Clopidogrel, Warfarin and Rivaroxaban) or supplements (e.g. Cordyceps, Gingko Biloba and Lingzhi), that thin your blood, as these substances may affect blood clotting and increase the risk of bleeding. If you are taking any of these, your doctor will advise you accordingly.
4. You are pregnant.
   

What are the risks and complications of Image-guided core needle biopsy of the breast?

Bleeding
Patients may experience some bleeding during and after the biopsy (1 – 5%). This normally stops following compression to the biopsy area. The risk of severe bleeding requiring surgery for haemostasis is very low (less than 1%).

Infection
The risk of post-biopsy infection is very low (less than 1%) and usually resolves with antibiotics.

Pneumothorax
During biopsy of tissues located deep in the breast, there is a very rare chance of the needle entering the chest wall resulting in air leaking into the chest. However, performing the procedure under ultrasound guidance helps to minimize this risk.

What are the risks and complications of Ultrasound-guided core needle biopsy of the axillary lymph node(s)?

Bleeding
Patients may experience some bleeding during after the biopsy (1 – 5%). This normally stops following compression to the biopsy area. The risk of severe bleeding requiring surgery for haemostasis is very low (less than 1%). There may be bruising over the site of biopsy.

Injury to blood vessels in the axilla
There are large blood vessels in the axilla that may be close to the lymph nodes. There is a rare chance of the needle entering these vessels during the biopsy. You may require emergency surgery to stop bleeding should this occur. However, performing the procedure under ultrasound guidance helps to minimize this risk.

What can I expect after the procedure?
A small wound dressing with overlying pressure bandage will be applied to the breast. The pressure bandage may be removed after one day. You should keep the pressure bandage dry and avoid bathing until it is removed the next day. Mild discomfort and spotting on the wound dressing at the biopsy site may be expected. There may be some bruising in the overlying skin. This generally disappears in 1-2 weeks.

Avoid strenuous activities (e.g. carrying heavy loads and swimming) for 2 days. There should be no problems with routine house or office work.

What are my options?
An alternative procedure includes open surgical biopsy. Open surgical biopsy involves removal of the breast lesion or axillary lymph node by operation, usually under general anaesthesia. The skin incision is bigger and may result in internal scarring which can affect future mammographic and ultrasound interpretation.

The breast lesion or abnormal looking lymph node may also be followed-up in certain circumstances over a period of time, to see if it develops increasingly suspicious changes. However, this may result in delay in diagnosis and treatment of the breast disease. You are encouraged to discuss the alternatives and management with your doctor so that the most suitable procedure may be performed based on your clinical condition.