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Breast biopsies are commonly requested for, sometimes for a mass and sometimes arising from breast screening. Often, the patient may wish to discuss more with their general practitioner (GP) or breast surgeon before agreeing to the biopsy.
Understandably, the patient may be rather anxious at this point. Thus, this list of commonly asked questions and suggested answers may be useful to GPs in guiding them through the biopsy journey and alleviating their concerns.
A biopsy of the breast may be necessary if the
patient has symptoms such as a solid breast lump
or other signs of breast cancer.
The biopsy may be performed freehand if it is large enough, but may also be image-guided for better
accuracy in smaller lesions.
A small amount of tissue is removed to be analysed
by the pathologist. If the sample is cancerous, the
hormone receptor status in the pathology report can
provide information on the treatment options for the
Biopsies are also recommended when:
There are unusual findings on a mammogram,
ultrasound or other breast imaging
The surgeons or radiologists are not absolutely
certain that the findings are benign
Both procedures can be performed under image
guidance and are commonly done with ultrasound
A core biopsy device only takes one sample at a
time and will have to be reinserted into the breast
A vacuum-assisted core biopsy utilises vacuum
assistance to help suction in the adjacent breast
tissue for sampling. Thus, it can take numerous
samples continuously without the need for reinsertion,
and often removes the entire small lesion.
This will depend on the size and imaging characteristics
of the lesion to be biopsied.
Typically, we recommend an ultrasound-guided core
biopsy for a sizeable palpable mass that is visible on
ultrasound. However, sometimes a vacuum-assisted
biopsy is recommended if the lesion is very small.
The breast radiologist will review all the patient’s
prior imaging to make the appropriate biopsy
Sometimes, a tiny breast biopsy marker made of
titanium will be necessary to mark the biopsied area,
which will not set off any airport alarms and is safe
for future MRI scans if needed. The patient should
not be able to feel the biopsy marker after it has
Generally, the breast biopsy is performed under local
anaesthesia which numbs the skin for the expected
half hour of the biopsy, and is generally tolerable.
The biopsy wound is normally only about 5 mm wide
with either Steri-Strips or a topical skin adhesive for
wound opposition, so no stitches are involved and the small scar will slowly fade away with time.
We ask patients to keep the area clean and dry for
at least 24 hours. When necessary, patients are
informed to keep the compression bandage on for
The patient should return to breast imaging for
evaluation during working hours, or the emergency
department after office hours, if:
It is expected to have a small haematoma post-biopsy
or even bruising, depending on the size of the
If the breast tissue is very thin, the patient may not
be able to undergo a stereotactic biopsy safely.
If we are able to visualise the abnormality on ultrasound,
it can be sampled with ultrasound guidance. However, if it is not visible on ultrasound, the patient
is referred to a breast surgeon for surgical excisional
If the mass is very close to the chest wall or skin
surface, we may still safely biopsy by using hydrodissection (injection of fluids) to create a safe
plane between the skin and mass, or to lift up the
mass from the chest wall to facilitate the biopsy.
These preparations will be done by the experienced
breast radiologist interventionist.
We do not use iodinated contrast for routine breast
biopsy procedures, therefore it is generally safe for
such patients to undergo biopsy.
If the patient is recommended to obtain an MRI-guided
biopsy procedure, the contrast we use is
gadolinium, which is different from iodinated contrast
in CT imaging studies. The biopsy technique using contrast-enhanced mammogram is rather new
locally and not often used.
1. SingHealth Duke-NUS Breast Centre. Your Breast Health Booklet, Making Informed Choices. Jan 2018. Accessed from: https://www.singhealth.com.sg/patient-care/patient-education/breast-health
Dr Tammy Moey is the Director of Breast Imaging and Senior Consultant with the Department
of Diagnostic Radiology at Singapore General Hospital and a Visiting Consultant at
KK Women’s and Children’s Hospital. Her clinical specialties are in breast imaging and
breast intervention, and she also has an interest in mentoring future leaders in radiological sciences.
GPs can call the SingHealth Duke-NUS Breast Centre for appointments at the following hotlines or click here to visit the website:
Singapore General Hospital: 6326 6060
Changi General Hospital: 6788 3003
Sengkang General Hospital: 6930 6000
KK Women’s and Children’s Hospital: 6692 2984
National Cancer Centre Singapore: 6436 8288