Breast MRI provides the breast radiologist a different and more detailed view of the breast than a mammogram or ultrasound. It is used in very specific situations. First, breast MRI may be utilized as an additional screening option for women who are at high risk for breast cancer and/or have dense breast tissue as seen on the mammogram. Second, a breast MRI is often obtained for women diagnosed with cancer prior to surgery to ensure no additional cancers are seen. Finally, depending on the clinical scenario breast MRI may be used to further evaluate women with breast symptoms when no abnormality was seen on the diagnostic mammogram or breast ultrasound.
Breast MRI has the advantage of being a more sensitive study. This means that MRI may show abnormalities that are not visible by mammography or breast ultrasound. Unfortunately, this can be a double-edged sword. On the one hand, MRI has the ability to see tiny cancers before they are seen by other imaging techniques. However, breast MRI will also see more non-cancerous abnormalities and sometimes normal tissue may have the appearance of a possible mass. If an abnormality is seen on breast MRI, a biopsy will often be needed to make a final diagnosis. In some cases, a breast ultrasound may be attempted in the specific location of the MRI abnormality. If there is a correlating suspicious abnormality on ultrasound an ultrasound-guided breast biopsy will be performed. If nothing is seen by breast ultrasound, or if the radiologist feels the finding will not be visible by ultrasound, an MRI-guided biopsy will be necessary to sample the tissue.
What to expect:
Because breast abnormalities are only seen on breast MRI with the benefit of an intravenous (IV) contrast material, an IV must be placed so that contrast can be administered for the biopsy. You will lie on your stomach on the MRI table with the breast in question placed in moderate compression. Contrast is then administered through the IV and you must hold still for the first set of images to be acquired. The images are reviewed by the radiologist to confirm the location of the abnormality. Occasionally the abnormality is not visible because the added compression necessary for the biopsy changes the blood flow to the breast and the finding no longer accumulates the IV contrast material. If this occurs, the radiologist will discuss the next necessary steps with you.
Once the abnormality is localized, the skin will be cleaned, and then a local numbing medicine will be administered at the skin edge and into the breast up to the depth of the abnormality (we use lidocaine, similar to Novocaine used by dentists). When the breast is numb a small tract will be made through the breast tissue up to the abnormality. A tubular marker that is visible by MRI will then be placed in the tract, and additional MRI images will be acquired. The radiologist will review the images to ensure that the marker is located at the targeted abnormality. If the marker is at the target abnormality, the marker will be removed, and the vacuum biopsy needle will be placed. The vacuum biopsy needle used in MRI-guided biopsy is similar to the needle used in stereotactic-guided breast biopsies. The needle will be placed to the designated position so that numerous tissue samples can be obtained. After the area has been sampled the biopsy needle will be removed and a metallic tissue marker (biopsy clip) will be placed at the biopsy site.
A final set of MRI images will then be acquired to document the position of the biopsy clip. The goal is to see the clip in the same location in the breast as the targeted abnormality. At the completion of the biopsy, compression will be held for several minutes at the biopsy site until there is no visible bleeding. A bandage will then be applied to the tiny incision. A post-biopsy mammogram will then be performed to document the position of the biopsy clip mammographically.
Prior to departure you will be given an ice pack to place over the biopsied area and you will be wrapped in an ACE bandage to help minimize swelling and tenderness. The entire appointment takes about one and a half hours and the procedure itself takes approximately thirty minutes.
What are the risks of an MRI breast biopsy?
- Temporary bruising or hematoma (blood collection at the site of biopsy) may occur.
- Bleeding or oozing at the biopsy site is possible.
- Infection is rare but is a risk with any invasive procedure.
- If implants are present, damage to the implant is possible.
How should I prepare for the procedure?
- Wear a comfortable two-piece outfit.
- Eat a light meal prior to the procedure.
- Do not wear deodorant, lotion, powder or perfume under your arms or on your breasts the day of the procedure.
What should I expect after the procedure?
- Leave the ACE bandage and underlying gauze on until the next morning. At that time, remove the bandage, leaving the steri-strip (tape over the puncture site) in place.
- Do not bathe or shower for 24 hours after the breast biopsy. Please do not go swimming or into a hot tub for 3 days after the biopsy.
- After 24 hours you may bathe/shower with the steri-strips (tape) in place. The steri-strips need to stay on until they fall off. If they have not fallen off after 10 days, you can remove them in the bath or shower. Once the steri-strips come off, they do not need to be replaced.
- Pain is normal for several days after a biopsy. You can take over the counter pain relievers containing Tylenol or Ibuprofen (IE: Advil, Aleve) and follow the instructions on the packaging. If breast pain is not controlled with over-the-counter medications, consultation with your primary care provider (PCP) will be necessary to discuss possible prescription pain relievers.
- Avoid strenuous activities or lifting heavy objects for 24 hours. If your job does not require heavy lifting, you may return to work immediately following the biopsy.
How will I learn the results?
A pathologist will examine the tissue specimens and will report the findings to your health care provider, usually within 3 to 5 working days.
You will receive the biopsy results via a phone call from a Radiology Ltd. breast patient navigator or your healthcare provider, depending on your provider’s preference. Results will also be posted on your Radiology Ltd. patient portal.
For questions or changes to your appointment please call (520) 901-6792.