Ultrasound-Guided Core Needle Biopsy of the Breast

Breast diseases are common health concerns that significantly impact women's physical and mental well-being. Among these, breast nodules are particularly important to monitor. The term "breast nodule" is a general term used in imaging studies, including breast ultrasound, mammography, MRI, and chest CT. Nodules are generally smaller than 3 cm and can be benign (such as breast cysts, adenosis, fibroadenomas) or malignant (such as breast cancer or lymphoma), or even related to inflammation (such as mastitis).

For patients suspected of having malignant breast tumors, determining the nature of the mass is crucial for developing an individualized treatment plan, which aids in comprehensive therapy. Early diagnosis and treatment are key to improving survival rates for breast cancer patients, and core needle biopsy is one of the most common methods used to obtain tissue samples for pathological examination. This minimally invasive procedure, performed under ultrasound guidance, plays an essential role in early detection and treatment.

Ⅰ What is Ultrasound-Guided Core Needle Biopsy of the Breast?

Ultrasound-guided core needle biopsy is a minimally invasive technique that requires close cooperation between breast surgery, ultrasound, and pathology departments. A biopsy needle is inserted into the breast lump to obtain tissue for histological examination. The sample is used to confirm the benign or malignant nature of the lesion, classify the pathology, and perform immunohistochemistry or genetic testing.

▲ Image 1: Biopsy Procedure Diagram

Ⅱ Who Needs a Breast Biopsy?

1. BI-RADS Category 4 or Above: Patients with a Breast Imaging Reporting and Data System (BI-RADS) score of 4 or higher have a significant risk of malignancy and require a biopsy for further evaluation.
2. BI-RADS Category 3 with High-Risk Factors: Patients with BI-RADS 3 lesions and a family history of breast cancer or other risk factors may also require a biopsy.
3.  Late-Stage Breast Cancer Suspects: Patients with late-stage breast cancer or those desiring breast-conserving surgery may undergo a biopsy before neoadjuvant therapy to confirm cancer and assess biomarkers such as estrogen receptors, progesterone receptors, HER-2, and Ki67.
4. Clinical Suspicion of Breast Cancer: A biopsy is recommended when a physician suspects breast cancer based on clinical examination and imaging results.
5. Subtle or Hidden Masses: Even if no palpable mass is detected during a physical exam, suspicious lesions found on ultrasound or mammography may warrant a biopsy.

▲ Image 2: Breast Imaging Example

Ⅲ Advantages of Core Needle Biopsy

1. Simple and Quick: The procedure typically takes around 10-15 minutes.
2. Minimally Invasive: The biopsy causes minimal tissue damage, offers quick recovery, and is safe with no radiation involved.
3. Accurate and Reliable: It provides precise diagnostic results and can help avoid unnecessary surgeries.

Ⅳ Steps of the Core Needle Biopsy Procedure

1. Local Anesthesia and Incision: After disinfecting the area, a small 2-3mm incision is made on the breast surface to facilitate needle entry.
2. Ultrasound-Guided Biopsy: The biopsy needle is inserted into the lesion under ultrasound guidance. Typically, 3-6 tissue samples are taken. The samples are then fixed in 10% formalin and sent to pathology.
3. Post-Biopsy Care: The biopsy site is disinfected and pressure is applied for 20-30 minutes to stop any bleeding.

▲ Image 3: Ultrasound-Guided Biopsy Needle Insertion

Ⅴ Post-Biopsy Care Tips

1. Apply Pressure to Stop Bleeding: After the biopsy, gentle pressure should be applied to the biopsy site for approximately 30 minutes to control bleeding.
2. Observation: Stay in the clinic for 30 minutes after the procedure to ensure there are no complications. Inform the doctor immediately if you experience dizziness, chest tightness, palpitations, or bleeding.
3. Return to Normal Activities: You can resume normal activities after one day, but avoid heavy physical labor.
4. Bruising and Tenderness: Mild bruising and tenderness at the biopsy site are common and should subside within a few days.
5. Monitor the Wound: For 1-2 days after the biopsy, closely observe the biopsy site for signs of redness, swelling, heat, or pain. If none of these symptoms occur, the dressing can be removed, and regular bathing can resume. However, avoid excessive stimulation of the biopsy site.

▲ Image 4: Post-Biopsy Healing Wound

Ⅵ Conclusion

Ultrasound-guided core needle biopsy is a crucial procedure for diagnosing breast diseases, especially in suspected cases of malignancy. This technique provides accurate diagnostic information while being minimally invasive, quick, and safe. Proper post-procedure care ensures a smooth and rapid recovery, allowing patients to return to their normal routines in no time.