Biopsy Overview and Lung Nodule Procedures

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Questions and Answers

What is the primary purpose of using MRI guidance in breast biopsies?

  • To visually assist during the excision
  • To enhance the imaging quality
  • To administer local anesthesia
  • To calculate the position of the abnormal tissue (correct)

Which of the following statements about breast biopsies is accurate?

  • They are only done on patients with breast cancer.
  • They can be performed on an outpatient basis. (correct)
  • They are always performed in a hospital setting.
  • They require general anesthesia.

During the procedure, how is the affected breast positioned?

  • It is elevated above the chest.
  • It is placed under direct sunlight for visibility.
  • It is rotated to 90 degrees.
  • It is compressed between compression plates. (correct)

What is injected into the breast to numb it before the biopsy?

<p>A local anesthetic (B)</p> Signup and view all the answers

Which method does NOT involve the withdrawal of the needle during sample collection?

<p>Vacuum-assisted device (VAD) (C)</p> Signup and view all the answers

How many tissue samples are typically collected using a vacuum-assisted device?

<p>Eight to ten samples (A)</p> Signup and view all the answers

What is the role of gadolinium in the breast biopsy process?

<p>It helps in visualizing the lesions during MRI. (C)</p> Signup and view all the answers

Which professional is primarily responsible for performing MR-guided breast biopsies?

<p>Radiologist (B)</p> Signup and view all the answers

What is the primary characteristic of a traditional MRI unit?

<p>It is a large cylinder-shaped tube surrounded by a circular magnet. (B)</p> Signup and view all the answers

Which type of MRI system is specifically designed for patients who are fearful of enclosed spaces?

<p>Open MRI system (C)</p> Signup and view all the answers

How does MRI differ from traditional x-ray examinations?

<p>MRI relies on radio waves and a strong magnetic field. (D)</p> Signup and view all the answers

What is a potential disadvantage of older open MRI units?

<p>They may produce lower quality images. (D)</p> Signup and view all the answers

What is the role of the computer workstation in an MRI procedure?

<p>To process the imaging information and create images. (D)</p> Signup and view all the answers

Why is MRI often preferred for differentiating abnormal tissues compared to other modalities?

<p>MRI does not use any form of radiation. (B)</p> Signup and view all the answers

What technology in MRI units helps to send and receive radio waves?

<p>Wire coils (A)</p> Signup and view all the answers

In a majority of MRI-guided breast biopsies, which type of MRI system is typically used?

<p>Closed MRI system (A)</p> Signup and view all the answers

What is the primary purpose of a breast biopsy?

<p>To determine whether a growth is benign or cancerous (B)</p> Signup and view all the answers

Which type of biopsy is employed when the abnormal area in the breast cannot be felt?

<p>Image-guided needle biopsy (D)</p> Signup and view all the answers

What imaging technique is used to assist in MRI-guided breast biopsies?

<p>Magnetic resonance imaging (MRI) (D)</p> Signup and view all the answers

Which type of biopsy uses a small needle to extract fluid or cells from the abnormal area?

<p>Fine needle aspiration (FNA) (A)</p> Signup and view all the answers

What should you inform your doctor about prior to a needle biopsy?

<p>All medications and allergies, especially to anesthesia (C)</p> Signup and view all the answers

Which of these biopsy procedures allows for the collection of multiple tissue samples during one insertion?

<p>Vacuum-assisted device (VAD) (D)</p> Signup and view all the answers

Which piece of equipment is commonly involved in needle biopsies to assist with tissue collection?

<p>Guide wire (B)</p> Signup and view all the answers

What is a precaution recommended for patients before undergoing a biopsy procedure?

<p>Stop taking blood thinners or aspirin three days prior (D)</p> Signup and view all the answers

What characterizes a lung nodule?

<p>Round lesions detected on a chest x-ray (B)</p> Signup and view all the answers

Which imaging technique is commonly used to guide needle biopsies?

<p>Fluoroscopy, CT, or ultrasound (D)</p> Signup and view all the answers

What type of needle biopsy involves using a fine gauge needle and a syringe?

<p>Fine needle aspiration (C)</p> Signup and view all the answers

What is an advantage of needle biopsies compared to open surgery?

<p>They minimize pain and scarring (A)</p> Signup and view all the answers

What is the typical complication rate for needle biopsies?

<p>Less than 1 percent (C)</p> Signup and view all the answers

When performing a needle biopsy, how should the patient be positioned?

<p>Prone or supine depending on entry site (D)</p> Signup and view all the answers

What kind of equipment aids in performing needle biopsies more accurately?

<p>Stereotactic imaging equipment (C)</p> Signup and view all the answers

What is the primary purpose of inserting a wire during a surgical biopsy?

<p>To guide the surgeon to the suspicious area (D)</p> Signup and view all the answers

What sensation is typically reported by women during the biopsy procedure?

<p>A slight pin prick from the local anesthetic (C)</p> Signup and view all the answers

What should be done if a patient experiences swelling and bruising after a biopsy?

<p>Use a cold pack and an over-the-counter pain reliever (A)</p> Signup and view all the answers

What should patients avoid for 24 hours following their biopsy procedure?

<p>Strenuous activity (A)</p> Signup and view all the answers

What is the expected duration of the biopsy procedure?

<p>45 minutes (A)</p> Signup and view all the answers

Why is there usually no need for sutures after the biopsy?

<p>Pressure is applied to stop bleeding (A)</p> Signup and view all the answers

What should patients do if they experience excessive swelling or bleeding post-biopsy?

<p>Seek medical advice from their physician (A)</p> Signup and view all the answers

Which organization suggests that it is safe to continue breastfeeding after receiving intravenous contrast?

<p>American College of Radiology (ACR) (C)</p> Signup and view all the answers

What option can a mother choose if she is concerned about the effects of gadolinium contrast medium on breast-feeding?

<p>Temporarily abstain from breast-feeding for 24 hours and express milk. (D)</p> Signup and view all the answers

What is one of the advantages of MRI-guided breast biopsy compared to surgical biopsy?

<p>It is less invasive and can be performed quickly. (C)</p> Signup and view all the answers

What is the likelihood of experiencing a significant discomfort during an MRI-guided breast biopsy?

<p>It is rare and manageable with over-the-counter medication. (A)</p> Signup and view all the answers

What is a potential risk associated with the vacuum-assisted device used in MRI-guided breast biopsy?

<p>Bleeding and hematoma formation. (B)</p> Signup and view all the answers

Which of the following is a limitation of MRI-guided breast biopsy?

<p>It may carry a risk of the needle passing through the chest wall. (C)</p> Signup and view all the answers

What advantage does MRI-guided vacuum-assisted breast biopsy have over stereotactic biopsy?

<p>Avoids ionizing radiation exposure. (C)</p> Signup and view all the answers

Which statement about MRI is accurate?

<p>MRI is a noninvasive imaging technique. (B)</p> Signup and view all the answers

What is the risk of infection after an MRI-guided breast biopsy?

<p>Less than one in 1,000. (D)</p> Signup and view all the answers

Flashcards

Biopsy

A medical procedure where a small sample of tissue is removed from the body for examination under a microscope.

Needle Biopsy

A type of biopsy where a fine, hollow needle is used to withdraw a small sample of tissue.

Fine Needle Aspiration

A type of needle biopsy where a thin needle is used to collect a sample of fluid or cells.

Core Needle Biopsy

A type of needle biopsy where a thicker needle is used to remove a core of tissue.

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Image-Guided Biopsy

A procedure where X-ray images are used to guide the needle to the targeted tissue.

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Stereotactic Biopsy

A procedure where a computer-generated image is created to help doctors pinpoint the exact location of the abnormal tissue.

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Lung Nodule

A round lesion or area of abnormal tissue located in the lung.

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Patient Positioning

The process of positioning the patient for a biopsy procedure based on the entry site.

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Breast Biopsy

A medical procedure used to remove cells from a breast lesion for examination under a microscope to determine if the growth is benign or cancerous.

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Image-Guided Breast Biopsy

A type of breast biopsy where imaging techniques like MRI are used to guide the needle to the exact location of the suspicious growth.

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Fine Needle Aspiration (FNA)

A type of breast biopsy that uses a fine needle attached to a syringe to extract fluid or cells from the abnormal area.

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Core Needle (CN) Biopsy

A type of breast biopsy that uses a hollow needle to remove a sample of breast tissue.

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Vacuum-Assisted Device (VAD) Biopsy

A type of breast biopsy that uses a vacuum-powered instrument to collect multiple tissue samples during one needle insertion.

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Surgical Biopsy

A type of breast biopsy that involves a thin guide wire used for a surgical procedure.

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Non-Palpable Breast Lesion

A medical condition where an abnormal area in the breast is too small to be felt by hand.

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Magnetic Resonance Imaging (MRI)

A type of imaging technique that uses magnetic resonance to create detailed pictures of the breast.

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Marker placement during breast biopsy

A small, usually metallic, object placed in the breast during a biopsy to mark the site of the lesion.

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Sensations during biopsy

Numbness, slight pressure, and clicking sounds from the sampling instrument.

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Typical side effects after biopsy

Temporary bruising, swelling, and some discomfort, especially from lying on your stomach.

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When to call the doctor after a biopsy

Contact your doctor immediately if you experience excessive bleeding, swelling, redness, or heat in the breast.

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Mammogram after biopsy

A procedure to confirm the placement of the marker by imaging the breast tissue.

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Activity restrictions after biopsy

Avoid strenuous activity for 24 hours after the biopsy.

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Breastfeeding and contrast media

Although not proven harmful, the American College of Radiology recommends avoiding breastfeeding for 24-48 hours after receiving intravenous contrast.

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Safety of contrast media in breast milk

The tiny amount of gadolinium contrast medium excreted into breast milk is unlikely to cause harmful effects to the infant.

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How does MRI work?

MRI uses a strong magnetic field to align the nuclei of hydrogen atoms, producing signals that create images.

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What is MRI?

MRI is a medical imaging technique using a strong magnetic field and radio waves instead of ionizing radiation like x-rays or CT scans.

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What does a traditional MRI unit look like?

Traditional MRI units consist of a large cylindrical tube surrounded by a circular magnet, with a moveable exam table that slides into the center.

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What are open MRI units?

Open MRI units are designed for patients who are claustrophobic or obese, with magnets that don't completely surround the patient.

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Why is MRI useful?

MRI can distinguish between diseased and healthy tissue often better than other imaging techniques like x-rays, CT, or ultrasounds.

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How are MRI-guided breast biopsies performed?

MRI-guided breast biopsies are performed with a modified exam table, allowing the breasts to hang freely within wire coils that send and receive radio waves.

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What are some important pre-MRI guidelines?

Patients must follow specific guidelines before undergoing MRI, such as avoiding metal objects and certain medications, to ensure a safe and accurate scan.

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Where is the MRI data processed?

The computer workstation that analyzes MRI data is located in a separate room from the scanner.

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What is MRI-guided breast biopsy?

MRI-guided breast biopsy is a minimally invasive procedure that uses magnetic resonance imaging to guide a needle into the breast tissue to extract a sample for analysis. It is typically performed to diagnose or rule out breast cancer.

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How does MRI-guided breast biopsy work?

The process of MRI-guided breast biopsy involves using a magnetic resonance imaging machine to create detailed images of the breast tissue. These images allow the doctor to precisely guide a needle into the specific area of concern to extract a tissue sample.

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What are the benefits of MRI-guided breast biopsy?

MRI-guided breast biopsy is less invasive than surgical biopsy as it does not require a large incision. It results in minimal scarring and can be performed quickly, often within an hour.

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What is the benefit of MRI-guided breast biopsy regarding radiation?

MRI-guided breast biopsy does not involve exposure to ionizing radiation, which can be a concern with other imaging procedures like X-rays or CT scans.

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What are the risks of MRI-guided breast biopsy?

One potential risk associated with MRI-guided breast biopsy is the possibility of bleeding at the biopsy site, leading to a hematoma (a collection of blood). This risk is relatively low, typically less than 1% of patients.

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Are there any risks of infection with MRI-guided breast biopsy?

Another risk associated with any procedure involving skin penetration is the possibility of infection. However, the risk of infection requiring antibiotic treatment is very low, typically less than one in 1,000 patients.

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What is the risk of the needle passing through the chest wall?

While rare, there is a slight risk of the needle passing through the chest wall during MRI-guided breast biopsy, potentially leading to a collapsed lung. This risk is associated with the procedure's depth.

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What are the limitations of MRI-guided breast biopsy?

The limitations of MRI-guided breast biopsy include the potential for discomfort, the need for specialized equipment and expertise, and the fact that it may not be appropriate for all patients.

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MR-guided breast biopsy

A minimally invasive procedure that uses MRI to guide a needle to remove tissue samples from a breast lesion.

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Gadolinium

A contrast material injected intravenously to enhance the visibility of tissues in MRI scans.

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Vacuum-assisted device (VAD)

A needle biopsy technique that uses vacuum suction to draw tissue samples through the needle.

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Grid structure

A grid structure placed on the breast to help the radiologist pinpoint the location of the lesion.

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MRI verification

The process of using MRI to confirm the position of the needle before extracting tissue samples.

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MRI-guided surgery

A technique for guiding surgical procedures, using MRI to visualize the area for excision.

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Study Notes

Biopsy Overview

  • Biopsy procedures aim to gather tissue samples for analysis.
  • Different types of biopsies exist, each with distinct purposes.
  • Needle biopsies are often image-guided using techniques like fluoroscopy, CT, ultrasound, or MRI, which help physicians pinpoint the exact location of the abnormal tissue.
  • These biopsies are usually performed as outpatient procedures with relatively low rates of complications.

Needle Biopsy of Lung Nodules

  • Lungs are conical-shaped organs for respiration.
  • They extend from the first rib to the diaphragm.
  • Lung nodules are round or abnormal tissue areas in the lung.
  • These are often detected via chest X-rays without causing pain or other symptoms.

Indications for Lung Biopsies

  • Lesions on chest radiographs are a key indicator.
  • Multiple nodules in patients without known malignancy, or those in prolonged remission.
  • Persistent focal infiltrates of lung tissue where no diagnosis can be arrived at via other methods.
  • A hilar mass is another indication to conduct a lung biopsy

Contraindications for Lung Biopsies

  • Abnormalities in lung function (e.g., respiratory failure), including mechanical ventilation.
  • Arterial and venous pulmonary hypertension.
  • Coagulation abnormalities are contraindications.

Types of Needle Biopsies

  • Fine needle aspiration uses a small needle and syringe to draw out fluid or cell clusters from the tissue.
  • Core needle biopsy involves an automated mechanism to insert the needle, filling receptacles with tissue cores. A sheath then cuts the tissue and keeps samples.

Advantages of Needle Biopsies

  • Image guidance allows for avoiding crucial nearby organs and blood vessels.
  • Minimizes pain, scarring, and the complications of open surgery.
  • Recovery times are often quicker than for open surgery.

Patient Positioning and Instructions

  • Patient positioning typically depends on the skin entry point.

Breast Needle Biopsy

  • Breast tissue samples are removed using a needle.
  • The extracted sample is looked at in a lab for diagnosis.
  • Various techniques exist for breast needle biopsies, including fine needle aspiration, ultrasound-directed needle biopsy, stereotactic core needle biopsy, MRI-guided breast biopsy, and vacuum-assisted device biopsy.

Procedure: Fine Needle Aspiration

  • The skin around the area is cleaned.
  • A small needle is inserted into the breast tissue to remove fluid or tissue.
  • The process might be repeated for a better sample.
  • Blood pressure is applied around the area before covering it with a bandage aftercare.

Procedure: Ultrasound-Directed Needle Biopsy

  • Ultrasound helps locate the area for biopsy.
  • Fluid or tissue samples are collected using a small needle.
  • Bandaging concludes the process.

Procedure: Stereotactic Core Needle Biopsy

  • The patient is positioned lying down on their stomach or by sitting.
  • Mammogram or ultrasound images help to locate suspicious areas.
  • A small cut is made, and a special probe is inserted to extract multiple core tissue samples.
  • A bandage is applied to complete the procedure.

Procedure: MRI-Guided Breast Biopsy

  • Patients lie face down on a moveable examination table.
  • Contrast medium (gadolinium) is injected intravenously.
  • The breast is gently compressed, and the radiologist uses computer software to identify the lesion and needle placement.
  • A local anesthetic is injected.
  • Tissue samples are collected using a needle.
  • A bandage is applied once the samples have been collected

Procedure: Vacuum-Assisted Device Biopsy

  • A needle is inserted, and pressure from a vacuum is used to pull tissue from the mass.
  • Tissue is placed in a sampling chamber.
  • Multiple samples can be collected without needle removal.

Biopsy Tools

  • Biopsy needle for soft tissues.
  • Local anesthetic.
  • Sheet
  • Apron
  • Ultrasound machine
  • Semi-automatic disposable devices, such as the MULTI RAM and SPEEDY RAM.

Benefits of MR Guided Breast Biopsy

  • Accurate, quick, minimal scarring, and avoids ionizing radiation.
  • Rapid, safe, accurate, and cost-effective compared with other methods.
  • Minimally invasive procedure.
  • Faster recovery compared to surgical procedures.

Risks of MR Guided Breast Biopsy

  • Bleeding and the formation of hematoma (collection of blood) at the biopsy site (low risk).
  • Infection (low risk).
  • Discomfort (can be relieved).
  • Slight risk of the needle passing through the chest wall, potentially collapsing the lung.

Limitations of MR Guided Breast Biopsy

  • Image guidance may not be sufficient to achieve accurate sampling for deep or poorly positioned lesions.
  • Can miss or underestimate lesions, potentially requiring additional procedures like surgical biopsy.
  • High cost and limited availability.

Post-Procedure Expectations

  • Minor swelling or bruising is normal.
  • Excessive swelling, bleeding, or heat in the breast warrants physician contact.
  • Avoiding strenuous activity for 24 hours is generally recommended after the procedure.

Important Considerations Before Biopsy

  • Inform the doctor about all medications (prescription/herbal) and allergies, especially to anesthesia.
  • Discontinue taking aspirin or blood thinners for a specified duration.
  • Report recent illnesses or medical conditions.
  • Consider having a companion for transport home, especially if sedated.

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