What is a Guided Biopsy?

J.M. Willhite

A guided biopsy, also known as a needle guided biopsy, is a minimally invasive medical test that utilizes radiological technology for locating a target area for biopsy. The procedure is commonly conducted to determine the cause and composition of a breast tissue abnormality discovered during mammography testing. As with any medical procedure, there are risks associated with a guided biopsy, and these should be discussed with a physician prior to testing.

Guided biopsy is considered less invasive than open biopsy, which is a surgical procedure.
Guided biopsy is considered less invasive than open biopsy, which is a surgical procedure.

As an alternative to the traditional surgical biopsy, a guided biopsy is a minimally invasive procedure that uses a needle to collect the tissue sample. The procedure is conducted when a mammogram indicates either an abnormal mass that is not identifiable, the breast tissue appears distorted, or imaging demonstrates some type of atypical change in the tissue. Generally, a guided biopsy is performed when the abnormal growth is small enough to escape detection by palpation, or with the hand.

Types of imaging used for a guided biopsy include magnetic resonance imaging (MRI), stereotactic, and ultrasound. Traditional x-ray is sometimes employed to aid with locating the target area prior to performing a surgical biopsy. In some cases, a contrasting agent may be employed to provide a clearer picture of the target area.

Four distinct types of biopsy procedures employ radiological imaging guidance. Core needle (CN) procedures use a hollow needle to collect a single biopsy sample with each insertion. A fine needle aspiration (FNA) utilizes a small needle to extract either fluid or tissue from the abnormal growth. The use of a vacuum-assisted device (VAD) collects several samples at one time per needle insertion by means of tool powered by a vacuum. When surgical biopsies are conducted, a procedure called wire localization is employed, which involves the image guided placement of a wire into the target area to locate the abnormal growth.

Generally conducted on an out-patient basis, needle guided biopsies require some preparation. Women should inform their physician of all medications they are taking, including herbal supplements, existing allergies, and any recent illnesses or medical conditions. Individuals on an aspirin regimen or taking blood thinners may be asked to discontinue use at least three days prior to testing. Arrangements should be made prior to testing for a third party to drive the individual to and from the procedure.

Guided biopsies involving MRIs and ultrasound do not require exposure to ionizing radiation. Recovery time associated with needle guided biopsies is generally brief, and there are no associated restrictions on individual activity following the procedure. Healing with minimal to no scarring, guided biopsies usually take less than one hour to perform.

As with any medical procedure, there are certain risks associated with a guided biopsy. Individuals may experience some discomfort at the biopsy site, which may be eased with the administration of pain medication. Due to the removal of tissue, there is a risk of infection and excessive bleeding, which may lead to the formation of a hematoma. In some cases, there is a risk of the needle penetrating the chest wall, leading to the introduction of air into the chest cavity, which could cause lung collapse.

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