Stereotactic Biopsy

What Is Sterotactic Breast Biopsy?
This simple procedure uses advanced computer imaging technology.  It allows for the removal of tiny sections of tissue that indicate they required further attention after showing up on a mammogram but cannot be felt.  The ease and safety of this procedure, typically performed during a brief office visit, is well-documented.

This modern procedure provides the same reliability as more complicated surgical biopsy, but provides these significant advantages:

• It does not require anesthesia

• It requires less time

• It is more cost effective

• It is much less complicated

What Will The Procedure Be Like?
The Stereotactic Biopsy of a small area of your breast tissue will be performed by Dr. Vopal.

Before the procedure begins, you will need to remove the clothing from the upper portion of your body and put on a gown.  Dr. Vopal will position you as comfortably as possible on your abdomen on a special X-ray table or seat you upright in a special chair.  If laying down, your breast will  be gently placed through an opening in the table, or if upright, onto the same type of tray used for your mammogram.  Once you are in position, your breast will be held in place with light compression.  You will then be asked to hold your breath as X-ray pictures are taken.  This is done to verify the location of the area to be sampled.  If not quite right, you will be repositioned until it is.

Dr. Vopal will review these films.  He will use a computer to read the X-rays and locate the precise area of your breast tissue which will be sampled.

Next, Dr. Vopal will numb the area to be tested.  You may feel a tiny pinch similar to a pin prick.  A small incision (no more than 1/4") will be made through which the biopsy needle will be inserted.  You may feel some slight pressure during this time.  It is important to relax.  This is rarely painful.

Ultrasound Guided Biopsy

Ultrasound is an excellent way to evaluate breast abnormalities detected by mammography, the patient or Dr. Vopal, but in some cases it is not possible to tell from the imaging studies alone whether a growth is benign or cancerous. Ultrasound-guided breast biopsy is a highly accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. The procedure prevents the need to remove tissue surgically, and also eliminates the radiation exposure that comes from using x-rays to locate a mass. After placing an ultrasound probe over the site of the breast lump and using local anesthesia, the Dr. Vopal guides a biopsy needle directly into the mass. Tissue specimens are then taken using either an automatic spring-loaded or vaccum assisted device (VAD).

Vacuum Assisted Biopsy

The relatively new vacuum-assisted breast biopsy is a percutaneous ("through the skin") procedure that relies on stereotactic mammography or ultrasound imaging. Stereotactic mammography involves using computers to pinpoint the exact location of a breast mass based on mammograms (x-rays) taken from two different angles. The computer coordinates help Dr. Vopal guide the needle to the correct area in the breast. With ultrasound, Dr. Vopal will watch the needle on the ultrasound monitor to help guide it to the area of concern. The patient will either by positioned in the upright or prone (face down) position for a vacuum-assisted biopsy.

Vacuum-assisted biopsy is a minimally invasive procedure that allows for the removal of multiple tissue samples. However, unlike core needle biopsy, which involves several separate needle insertions to acquire multiple samples, the special biopsy probe used during vacuum-assisted biopsy is inserted only once into the breast through a small skin nick made in the skin of the patient's breast.

Ductal Lavage

What Is Ductal Lavage
Physicians estimate that over 95% of breast cancers begin in the cells lining the breast ducts. It can take up to eight to 10 years before these cells grow into a tumor large enough to be detected by mammography (approximately one centimeter in diameter) or felt during a physical breast exam. The term "lavage" is French and means "wash" or "rinse." Ductal lavage involves analyzing cells washed out from the breast ducts to determine whether they have malignant qualities before they develop into breast cancer.

Ductal lavage is a minimally invasive procedure that involves collecting samples of breast ducts cells and then examining the cells under a microscope to determine whether they are normal, atypical, suspicious, or malignant. The idea of testing fluid from the nipple was first suggested in the 1950s by Dr. Papanicolaou, the physician who developed the Pap smear to test for cervical cancer.

How is Ductal Lavage Performed?
Most women who undergo ductal lavage experience little to no discomfort during the procedure. To perform ductal lavage, Dr. Vopal will apply a small amount of anesthetic cream to the nipple area. A breast pump (or aspirator) is then used to apply mild suction to the nipple to draw out tiny amounts of nipple fluid from the milk ducts up to the nipple surface. Typically, fluid will only be extracted from one or two breast ducts (each breast contains six to eight ducts). These ducts are most likely to contain abnormal cells. Once these ducts have been identified, an anesthetic is infused into the duct and a catheter is threaded into the duct opening in the nipple for a small distance. Next, salt water is sent through the catheter into the breast duct to "wash" the duct and collect cells. The breast cells that are washed out are sent to the pathology laboratory for analysis.