Tru-Cut, Ultrasound or CT-Guided Needle Biopsy for Soft Tissue Masses The CT-guided biopsy is done by our intervention radiologist, using a CT scanner. Example of a foot soft tissue mass that is a candidate for a TruCut Needle Biopsy, which is done in our office by a surgeon. The area is prepped in sterile fashion and a local anesthetic is given. The needle enters the skin and, just like a pen is clicked opened and closed, the needle penetrates the mass. Fine pieces of tissue are collected for our pathologists. Example of an ultrasound-guided biopsy
The trucut needle is the standard biopsy method used today in the breast and has a very high diagnostic rate. The old needle biopsy that was once performed by surgeons in the past with simple injectors should be completely abandoned. This biopsy method has the following important drawbacks:
1. Since the trucut (core) biopsy is performed by imaging devices such as ultrasound, mammography and MRI, it can be assured that the needle is inserted into the mass and biopsy has been taken from the right place. In contrast, old needle biopsy is performed by trying to feel the mass by hand without seeing it on ultrasound. Therefore, one can never make sure that the samples have been taken from the appropriate place.
2. With the trucut biopsy needle, original tissue fragments are obtained from the suspicious mass. With the old technique, only the cell clusters can be taken, and thus, the diagnostic value is low. Therefore, cancer may be missed in many patients with this type of needle biopsy.
3. With the old needle biopsy, the pathologist can only say whether the tumor is cancer or not, and further information can not be provided. With the trucut technique, the pathologist may give additional information such as the type of cancer, the rate of growth, whether it is spread to the vessels and nerves, and the amount of hormone receptors, which may change treatment decision.
For these reasons, if the breast biopsy is to be performed, imaging-guided cutting needle biopsy should be used and simple needle biopsy should be abandoned.
Video information “How to make a needle needle biopsy in the breast?”
In some cases, it may be preferable to take all or a large portion of the suspicious mass in the breast. Or sometimes, the suspicious area may not be as sharply limited as a mass, it may be a wide region with unclear boundaries and it may be necessary to take the entire region. The classical method applied in such cases is the removal of the suspicious area or mass by surgery. To do this, the suspicious mass or area is usually marked with a wire first, and then the surgeon takes out this area through a large incision by following the wire. Although widely used, this surgical method has some disadvantages:
1. Two procedures (first wire marking and then surgery) are often required to remove the mass.
2. If the suspicious mass proves benign, which is generally the case, the patient is operated unnecessarily. The scar tissue of the incision site may cause confusion during the regular follow up by mimicing cancer on ultrasound and mammography controls.
3. If the mass proves cancerous, a second surgery may be required and results of the armpit sentinel lymph node biopsy may be impaired due to previous surgery.
For these reasons, methods that may be an alternative to surgical biopsy have been developed in cases where the whole tumor or a large tissue must be removed in the breast.
These methods are known as BLES and vacuum biopsy. In BLES or Breast Lesion Excision System, a 4-5mm thick needle is inserted from the skin and when the tumor is reached under ultrasound guidance and the device is activated, special wires come out from the tip of the needle. These wires heat and cut the surrounding tissue with radiofrequency energy and grasp the mass like a scoop. The mass is then taken out through a 4-5 mm incision in one intact piece.
Daily Incision Care
Leave the dressing on for 24 hours after the procedure.
Remove the dressing and assess the site for redness, swelling, drainage or bleeding.
Replace the dressing with a Band-Aid for coverage, or leave uncovered if there is no drainage.
You may shower.
Activity after the Procedure
Limit activities if the site remains sore or tender.
Use sling or crutches if prescribed by your surgeon/nurse practitioner.
Elevate the extremity to decrease throbbing, swelling and/or tenderness.
Diet
You may continue with your regular diet.
Medicine
Continue to take all your regular medications.
Please note: These are general guidelines to help answer the most common questions patients have after
their biopsy. The photos in these guidelines WILL NOT necessarily match your exact biopsy site. If necessary, take prescribed pain medication (narcotics) as directed.
DO NOT drink alcohol or drive while taking narcotic pain medication.
If you are taking narcotics, you should take some type of laxative to prevent opioid-induced constipation.
If you are not given a prescription for narcotic pain medication, take Tylenol, aspirin, Advil, Aleve, Motrin
or another over-the-counter anti-inflammatory medication if necessary.
Common Problems
Sometimes the needle used in this procedure can irritate the sensory nerves at the needle insertion site. If
you experience pain and/or swelling, try elevating your extremity (arm, leg) for relief. Putting ice on the
site may also help.
Call your surgeon/nurse practitioner if you experience the following:
o Persistent swelling that does not go away with elevation
o Persistent numbness or tingling in your extremity
o A lump at the needle site
o Persistent bleeding at the needle site
Follow-up
Schedule a follow-up appointment with your surgeon 1 week after the date of the biopsy to discuss
biopsy results and a treatment plan.
Questions/Concerns
For any questions, call your surgeon/nurse practitioner.
These instructions are basic post-procedure guidelines. Your surgeon/nurse practitioner may give you more
specific instructions.
For Details: Contact your Operating Surgeon
Copyright: Dr. Ramjee Bastola ( Breast Onco-Surgeon)
MS – General Surgeon , FMAS – Laparoscopic Surgeon
