Comprehensive breast diagnosis in a supportive environment is performed by Madison Radiololgists at the Dean Clinic, 1313 Fish Hatchery Road in Madison.
Our experience is extensive. As of the end of 2001, over 2,200 breast biopsies have been performed on over 1,800 patients. Our team of doctors is limited to provide the maximum in experience level of the physician performing the biopsy. Our core biopsy physician team consists of: James Anderson, M.D., Marta Bogdanowicz, M.D., Gregg Bogost, M.D., and Michael Cullenward, M.D. Each physician has performed hundreds of biopsies.
The technical staff have similar extensive experience and are critical elements in the team approach. Two technicians assist with each case. One technician assists the physician while the other attends directly to the patient during the procedure.
Questions regarding our core biopsy program can be addressed to:
Both stereotactic digital mammographic and ultrasound guidance techniques are available. The method chosen depends on the most reliable way to visualize and safely perform the procedure.
The stereotactic equipment consists of a Lorad prone digital machine, with choice of 14 gauge Manan or 11 gauge Mammotome vacuum assisted biopsy devices. Ultrasound guided biopsies are perfomed with state of the art, high resolution Acuson Sequoia ultrasound.
With stereotactic technique, the procedure takes 30-45 minutes typically. Patients lay on their stomach during the procedure. Localizing x-rays are then taken. The radiologist then calculates the biopsy approach based on these images.
Procedures performed with ultrasound are typically faster, approximating 15 minutes. Patients lay on their back during the procedure.
During both types of procedures, local anesthesia is used to minimize discomfort during the procedure. A small incision is made that does not require stitches.
The bioipsy devices remove sliver-like pieces of tissue from the breast. Experienced pathologists at St. Mary’s Hospital then examine the tissue. Results of the biopsy are given to the referring surgeon’s office, and are commonly available 48 working hours after the biopsy.
A 3 millimeter metallic marker may be placed into the breast at the biopsy site at the end of the procedure to mark the region of the breast in case an operation for cancer is necessary. This has proven to be safe and effective.
The small incision at the biopsy site is usually sealed with surgical tape (Steri-strips), not requiring stitches. Some tenderness in the breast for 2-7 days is common, but is usually well tolerated. Patients can usually resume normal activities within a day or two after the procedure. Significant bleeding or infection is rare.
There are some breast lesions that may not be amenable to core biopsy. Such situations include: if the lesion is too close to the chest wall, if the lesion cannot be seen well enough at the time of the procedure, or if the breast thickness at the time of compression does not allow enough thickness for the needle passes. This situation is encountered about 5% of the time.
Followup of Benign Breast Lesions
In order to detect breast cancer at its earliest stages, radiologists identify lesions on mammograms that have any significant chance of being cancer. Because many cancers share mammogram features of benign, non-cancerous breast disease, most (about 75%) of the biopsy results are not due to cancer. Per national standard, we perform close mammographic or ultrasound surveillance of all such patients with benign diagnosis at 6, 12 and 24 months. We have had less than 10 cases out of over 2200 that have demonstrated change in this follow up period, requiring a second biopsy. All of these lesions were benign (results as of December, 2001). Thus, we know of no cancers that have become apparent at the biopsy site of any patient having a benign biopsy result.
The need for an immediate second biopsy after the core biopsy is rare. Needle misses are rare and can usually be identified at the time of pathologic diagnosis. Occasionally, the core needle biopsy needs to be followed with an open surgical excisional biopsy if a diagnosis called atypical hyperplasia is obtained. A second biopsy is needed in these cases since up to 50% of these lesions have cancer at or immediately adjacent to the core biopsy site.
This caring, team approach has resulted in patient satisfaction with an otherwise potentially stressful procedure. Typical examples of feedback from patients include:
“Thank you both for all your kindness and concern last week during my biopsy. You really made me feel very comfortable and at ease with the procedure. Your field of expertise was definitely proven to me.”
“Thanks to all of you for your sensitivity and kindness to me. You made a difficult experience more bearable.”
“Thank you for your kindness and professionalism during my recent core biopsy. Your, as well as the radiologist’s sensitivity and thoughtfulness really made a difference.”
“You were truly a ‘Band of Angels’ caring for me during my recent core biopsy. Your combined caring, skill, teamwork and good humor helped me through an anxiety ridden experience with ease and comfort.”