Patient information on magnetic resonance imaging (MRI) guided diagnostic vacuum breast biopsy

About the biopsy

When you have an area of change we cannot see on ultrasound and can only see on breast MRI we will need to use MRI to guide a special needle. The procedure is called an MRI guided diagnostic vacuum assisted biopsy.

What is MRI?

Magnetic resonance imaging (MRI) is a non-invasive medical imaging technique with no radiation (no X-rays). By using a magnetic field, radio frequency pulses, and a computer, it produces detailed pictures of the breasts.

Essential Information

Because of the powerful magnets used in MRI scanning, it is not a suitable test for everyone. Before the MRI the radiographer will go through a safety checklist with you.

It is very important that you tell us if you have:

• ever had an injury to your eye involving a metal object / fragment.
• ever been injured by a metallic object e.g. shrapnel.
• any form of surgical implant eg aneurysm clip, shunt (spinal or intraventricular), neurostimulation system, implanted pain control device, metallic stent, filter or coil.
• Cardiac (heart) pacemaker and / or internal cardiac defibrillator.
• artificial heart valves or coronary stents
• cochlear or other ear implants.
• non-limb prosthesis e.g. eye.
• insulin or other drug infusion pump.
• any other form of electronic or magnetically-activated implant, internal electrodes or wires.
• gastric or intestinal devices including feeding tubes, gastric bands or bypass, polyp clips or recent capsule endoscopy procedure.
• breast tissue expander or implants
• have had an operation in the last 6 weeks
• vascular access port and / or catheter
• tattoos
• permanent or semi-permanent make-up

If any of the above applies to you we may have to defer your MRI until we can get more information about your medical history but this is for your safety.

Marker clips are routinely used in breast imaging to mark an area in the breast at the time of a biopsy. If you have one of these clips in your breast please tell us, but it is unlikely to prevent you from having your MRI.

What happens when I arrive?

• You will be met by the MRI radiographer, who will check your personal details and go through a safety checklist with you.
• The radiographer and doctor will explain the procedure to you. Please feel free to ask any questions at this time.
• You will be asked to undress and change into a gown. A locker will be provided for your clothes.
• It is very important that you do not bring anything containing metal into the scanning room. Please leave all jewellery, credit cards, piercings, watches, mobile phones, and any other metal objects in the locker provided. Wedding bands do not need to be removed.
• Do not wear makeup on the day of the scan, as some makeup contains metal as part of the ingredients.

What happens during the procedure?

• Breast MRI uses a special contrast which helps to take detailed pictures of the breast and helps us locate the tissue to be biopsied. This contrast medium is called gadolinium-DTPA.
• The contrast medium is injected into a vein, during the MRI scan, via a small plastic cannula. The radiographer will place this in your arm before the MRI.
• You will then be asked to lie on your front on the MRI couch.
• The radiographer will place your breasts through two holes in the couch and position the affected breast between two plastic plates ready for the biopsy.
• Please let us know if you are not comfortable as it is important that you lie absolutely still during the study.
• The couch then slowly slides through the MRI scanner and the images are taken.
• We take several sets of pictures before we start to perform the biopsy. This may involve you moving in and out of the scanner a number of times.
• The radiographer operates the MRI scanner from behind a partition. They will be able to see you throughout the procedure and you will be able to talk to each other through an intercom in the MRI scanner.

What is a vacuum biopsy?

After an injection of local anaesthetic a hollow probe connected to a vacuum device is inserted through a small hole in the skin. Using MRI as a guide, breast tissue is sucked through the probe by the vacuum into a collecting chamber.

The clinician and radiographers will explain what they are doing as they go along. You will need to keep as still as possible in order for us to take accurate samples of the area.

The biopsy device is only in the breast for a few minutes but the whole procedure can take more than half an hour.

Anticoagulants or disorders of bleeding / clotting

Some medicines that thin the blood such as warfarin, edoxaban, apixaban, rivaroxaban, aspirin or clopidogrel can increase the risk of bleeding following a biopsy. If you are taking these sorts of medicines please phone the specialist breast care nursing team on 01223 586960 to discuss this prior to the biopsy appointment.

Who will perform my procedure?

This will be done, or be very closely supervised, by an expert clinician in the field.

Will the procedure hurt?

The compression might be uncomfortable and the local anaesthetic might sting for a few seconds until it takes effect. Most patients report that this procedure is straightforward and tolerated well.

How much breast tissue will be removed?

We will remove several small pieces of breast tissue to be sure we have enough for an accurate diagnosis.

What if all of the area of concern is removed?

We insert a titanium marker clip into the biopsied area after taking all the samples. This is in case we need to find this area again later. This marker can remain in your breast without causing future problems, for example with subsequent MRI scans or metal detector systems.

After the procedure

The team who perform the biopsy will see you before you go home. You will be able to discuss any questions or concerns. The final answer will not be available until the specimen has been examined in the laboratory.

You may eat and drink as normal following this procedure. You can leave hospital shortly after the procedure once this has been agreed by the team treating you. Usually, you can resume normal activities immediately following the procedure. Although it might be best to avoid going to the gym or heavy lifting for the next 48 hours.

A small dressing will be applied to your breast. Ideally, the gauze should be kept dry and can be removed after 24 hours. It is safe to shower and bath with the skin closures which you should keep in place for a further three or four days.

If you experience any pain and/or discomfort, we advise that you take a mild pain killer such as paracetamol. Avoid aspirin as this could encourage bleeding.

Are there any side effects?

This is a very safe procedure. The commonest side effect is some bruising or bleeding around the area. We try to reduce this by applying some hand pressure at the time. If the wound starts to bleed again, apply firm pressure for several minutes. More severe side effects or problems such as infection are extremely rare.

When will I get the result?

We try to get the result of this test ready for you within 10 to 14 days. You will be given an appointment before you leave us on the day of the procedure. This may be a telephone or face-to-face appointment.

Alternative procedures that are available

A surgical operation could be performed to remove the potentially abnormal area. However, this would leave a surgical scar, and it would necessitate a general anaesthetic and a day in hospital. To guide the surgeon to the correct site, a needle would still need to be placed in the breast before the operation. Alternatively, we could decide to actively monitor to see if this area changes or grows using regular mammography. We can discuss with you the options of not having a biopsy.

Photography, audio or visual recordings

As a leading teaching hospital we take great pride in our research and staff training. We ask for your permission to use images and recordings for your diagnosis and treatment; they will form part of your medical record. We also ask for your permission to use these images for audit and in training medical and other healthcare staff and UK medical students. These images will be completely anonymised. You do not have to agree and if you prefer not to this will not affect the care and treatment we provide. We will ask for your separate written permission to use any images or recordings in publications or research.

Students in training

Training doctors and other healthcare professionals is essential to the NHS. Your treatment may provide an important opportunity for such training, where necessary under the careful supervision of a registered professional. You may, however, prefer not to take part in the formal training of medical and other students without this affecting your care and treatment.

Use of tissue

As a leading biomedical research centre and teaching hospital, we may be able to use tissue not needed for your treatment or diagnosis to carry out research, for quality control or to train medical staff for the future. Any such research, or storage or disposal of tissue, will be carried out in accordance with ethical, legal and professional standards. In order to carry out such research we need your consent. Any research will only be carried out if it has received ethical approval from a research ethics committee. You do not have to agree and if you prefer not to, this will not in any way affect the care and treatment we provide.

The leaflet ‘Donating tissue or cells for research’ gives more detailed information. Please ask for a copy.

If you wish to withdraw your consent on the use of tissue (including blood) for research, please contact our Patient Advice and Liaison Service (PALS), on 01223 216756.

Information and support

The breast care specialist nursing team 01223 596291 / 586960 is available to answer any questions after you biopsy and while you are waiting for you results.

There are no national leaflets specifically about needle biopsy, but the Breast Cancer Care website (opens in a new tab) is easy to use with lots of general information.

Contact numbers

MRI Addenbrooke’s Hospital 01223 216559

Cambridge Breast Unit 01223 217627