Background Information:

What are the other Names for the Procedure?

• MRI-Guided Biopsy of Breast
• MRI-Guided Breast Biopsy
• Needle Biopsy of Breast with MR

What is Magnetic Resonance-Guided Breast Biopsy radiology procedure? (General Explanation)

• A breast biopsy is used to determine, if a suspicious lump or cluster of cells in the breast are benign or cancerous
• The biopsy requires a collection of tissue from the breast using specialized equipment
• A magnetic resonance imaging device is one of the tools used to guide the biopsy procedure, to ensure the appropriate area of the breast is sampled

This is known as a Magnetic Resonance-Guided Breast Biopsy radiology procedure.

What part of the Body does the Procedure involve?

The Magnetic Resonance-Guided Breast Biopsy radiology procedure involves the chest area of the body.

Why is the Magnetic Resonance-Guided Breast Biopsy radiology procedure Performed?

• Commonly the MRI-Guided Breast Biopsy procedure is performed following an abnormal mammogram or breast MRI (i.e., abnormal test result)
• The procedure is used to identify a suspicious mass or any abnormal tissue in the breast

What are the Alternative Choices for the Procedure?

The alternative choices of a Magnetic Resonance-Guided Breast Biopsy radiology procedure include:

• Ultrasound-guided breast biopsy
• Surgical breast biopsy

What is the Equipment used? (Description of Equipment)

The following equipment may be used in the procedure:

• An MRI scanner, which resembles a large cylindrical tube surrounded by powerful magnets
• The patient is positioned on a specialized examination table that moves in and out of the cylinder-shaped tube
• A specialized needle is used to take a small sample of tissue from the breast. The type of needle will vary depending on the specific biopsy procedure involved; it may be a fine needle, a larger core needle, or a specialized needle (such as a vacuum-assisted device)

What are the Recent Advances in the Procedure?

There have been no recent advances to a Magnetic Resonance-Guided Breast Biopsy procedure.

What is the Cost of performing the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

The cost of the Magnetic Resonance-Guided Breast Biopsy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Magnetic Resonance-Guided breast biopsy and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another

What are some Helpful Resources?

American Cancer Society: For women undergoing a breast biopsy procedure.

https://old.cancer.org/acs/groups/cid/documents/webcontent/003176-pdf.pdf (accessed on 2/14/2017)

Prior to Magnetic Resonance-Guided Breast Biopsy radiology procedure:

How does the Magnetic Resonance-Guided Breast Biopsy radiology procedure work?

A Magnetic Resonance-Guided Breast Biopsy radiology procedure works in the following manner:

• The MRI machine uses magnetic fields and radio waves to generate signals
• Using the signals the body produces in the magnetic field, a computer reconstructs the image into cross-sections, as if viewing slices of bread loaves
• The radiologist interprets the image and uses it to localize a needle into the area of abnormal tissue
• The needle is then used to take a small amount of tissue sample for examination
• A pathologist examines the biopsied tissue by the radiologist, under a microscope with the assistance of special stains

How is the Magnetic Resonance-Guided Breast Biopsy radiology procedure Performed?

The MRI-Guided Breast Biopsy procedure is performed in the following manner:

• The individual lies face down on the MRI examination table
• The breast that is to be biopsied is placed into an opening in the table.
• The breasts are positioned in place and gently compressed by the scanner
• An intravenous (IV) line is inserted into the patient’s arm and contrast material injected through the IV line
• The radiologist places a plate with grid structure on the breast and determines the position of the ‘suspicious’ area and plans the placement of the needle
• The part of the breast where needle will be inserted is numbed by injecting a local anesthetic
• The biopsy needle is inserted and is guided to the target area
• Tissue samples are taken from the suspicious area and the needle is removed
• A marker is placed at the sample site for future purposes

Where is the Procedure Performed?

The MRI-Guided Breast Biopsy procedure is performed as an outpatient procedure at a hospital.

Who performs the Procedure?

The Magnetic Resonance-Guided Breast Biopsy radiology procedure is usually performed by a radiologist, with the assistance of a radiology technician.

How long will the Procedure take?

The duration of the procedure will vary, but generally takes less than one hour.

Who interprets the Result?

A radiologist reviews the images and the tissue samples are evaluated by a pathologist.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to the contrast material used in the procedure
• The patient may be asked to stop taking certain medications, such as aspirin or other blood thinners, before such biopsies are performed
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the procedure
• It is highly recommended to inform your healthcare professional, if you are pregnant or breastfeeding
• The patient may be asked to avoid eating or drinking, several hours before the test
• Patients may be required to be driven home, after the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for a Magnetic Resonance-Guided Breast Biopsy procedure using an Informed Consent Form.

Consent for the procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the procedure:

• It takes less time to perform than a surgical biopsy
• MRI used in the procedure does not use ionizing radiation
• The procedure is minimally-invasive
• Recovery time is fast compared to a conventional surgical biopsy

Following are the risks of the procedure:

• There is a rare chance of infection after the procedure
• If biopsy is undertaken to remove deep tissues form the breast, there is an occasional chance that the needle may pass through the chest wall and cause a lung collapse
• There is a potential of bleeding and causing a collection of blood between the skin and breast tissue (hematoma)

What are the Limitations of the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

Following are the limitations of the procedure:

• An MRI-Guided Breast Biopsy is only used, if a mammography or an ultrasound-guided biopsy cannot be used. Typically, mammographies or ultrasound-guided biopsy procedures are performed easily and with less discomfort compared to an MRI-guided biopsy
• It cannot be used to perform biopsy where the suspicious mass is very small or located in the back of the breast, near the chest wall
• It cannot be used, if the MRI scan does not show the presence of the suspicious mass
• Any calcification present in the benign/cancerous nodule cannot be clearly seen in this examination
• It is possible to miss or underestimate the suspicious mass of tissue

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Magnetic Resonance-Guided Breast Biopsy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Magnetic Resonance-Guided Breast Biopsy radiology procedure:

What is expected during the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

• Some women may find the compression and positioning of their breast by the scanner uncomfortable
• One may feel a sharp prick, when the local anesthetic is being injected
• The breast may feel numb after the local anesthetic
• Generally, insertion of the biopsy needle is not painful, but a sensation of pressure may be felt
• The scanner may be quite noisy when images are being acquired
• If a core needle is used, one may hear a loud “click” associated with each sample being procured

What kind of Anesthesia is given, during the Procedure?

A local anesthetic is generally administered to numb the tissue of the breast.

How much Blood will you lose, during the Procedure?

Since Magnetic Resonance-Guided Breast Biopsy radiology procedure is a minimally-invasive procedure, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

The possible risks of the Magnetic Resonance-Guided Breast Biopsy radiology procedure include:

• Mild bleeding and bruising
• In rare cases, blood may collect between the breast tissue and the skin causing a hematoma
• As with any procedure that involves breaking of the skin, there is a slight risk of infection
• In very rare cases, the needle may be passed too deep and enter the chest cavity. In such cases, it can puncture the lung and cause a lung collapse

What Post-Operative Care is need at the Healthcare Facility after the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

Generally, there is no postoperative care necessary after the Magnetic Resonance-Guided Breast Biopsy radiology procedure, at the healthcare facility.

After the Magnetic Resonance-Guided Breast Biopsy radiology procedure:

What is to be expected after the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

The following may be expected after the Magnetic Resonance-Guided Breast Biopsy procedure:

• There may be mild bruising around the biopsy site
• The doctor may recommend taking over-the-counter pain medication, if there is mild swelling or pain after the procedure
• A marker may be left at the biopsy site, in order to locate the site for future purposes; however, this does not cause any additional pain or discomfort to the individual

When do you need to call your Physician?

If there are any signs, such as swelling, bleeding, or redness in the breast, following the MRI-Guided Breast Biopsy procedure, the physician should be informed about it.

What Post-Operative Care is needed at Home after the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

There is no postoperative care necessary after the biopsy procedure.

How long does it normally take to fully recover, from the Procedure?

In most cases, patients need no recovery time after the procedure; they may return to their normal activities, 24 hours after the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Magnetic Resonance-Guided Breast Biopsy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Magnetic Resonance-Guided Breast Biopsy procedure is performed.