When breast tissue abnormalities have been identified, diagnostic testing is needed. Testing can be broken-down into two distinct categories:

Imaging: Provides more visual information about tissue abnormalities, and includes Diagnostic Mammography, Ultrasound, and Breast MRI.

Procedures: Provide diagnostic information through the use of aspiration or biopsy. These procedures include Fine Needle Aspiration, Stereotactic Core Needle Biopsy, Core Needle Biopsy of Palpable Masses, Ultrasound-Guided Core Needle Biopsy, Needle (Wire) Localization Biopsy, and Surgical Biopsy.

The Carol Ann Read Breast Health Center works closely with each patient to help them select a procedure that's right for their individual health needs. Meeting patient preferences is always a top goal of the center.

• Diagnostic Mammography
• Ultrasound
• Breast MRI
• Fine Needle Aspiration
• Core Needle Biopsy for Palpable Breast Masses
• Stereotactic Core Needle Biopsy
• Ultrasound-Guided Core Biopsy
• Needle (Wire) Localization Biopsy
• Surgical Biopsy

Diagnostic Mammography

If a breast problem or an abnormality is found in the images from a screening mammogram, additional pictures are taken. The images obtained during this appointment will help your doctors pinpoint the exact size and location of a breast abnormality and the surrounding tissue. The examination takes approximately 20-30 minutes. A radiologist who is a specialist in breast imaging reviews the images. Other types of diagnostic testing may be necessary following a diagnostic mammogram. The radiologist will discuss this with you.

Digital Mammography
Women now have access to the best screening and diagnostic tool available for breast cancer detection. Our new General Electric Senographe DS digital mammography system, in conjunction with state-of-the-art ultrasound equipment, offers clearer imaging, faster processing, greater accuracy, and improved patient convenience. This new technology also allows for lower dose radiation exposures than the traditional film mammography. Radiologists can easily see through dense breast tissue that may hide suspicious masses or calcifications.

Digital mammography takes seconds for the images to be viewed, reducing the patient's exam time. Images can be stored in the hospital's computer, and even burned to a disc allowing the patient and physicians to easily view and share information.

Other benefits:

• Patient-friendly design
• Ergonomic paddle shapes to the breast for better comfort
• Easy positioning
• Easy access for women using wheelchairs

Disabled women can be accommodated through our Breast Health Access for Women with Disabilities Program.

Most insurance plans pay for this exam. The California Detection Program, Every Woman Counts pays for mammograms for women who are low-income California residents and meet the program’s criteria. Find out more about Every Woman Counts .

Appointments
To make an appointment for a diagnostic mammogram, please call the Breast Health Center at (510) 869-8377, or call the Imaging & Mammography Center at (510) 204-1880. The Imaging & Mammography Center has extended hours on Mondays and Thursdays and some Saturdays.

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Ultrasound

High frequency sound waves are used to evaluate any abnormalities shown on mammography. This procedure shows whether a lump is solid or filled with fluid, and provides a different view than is possible with mammography. It is the best way to determine if a lump may be a cyst.

During an ultrasound, a technologist holds the ultrasound transducer (this looks like a microphone) against the skin to get a computerized image that can be seen on a computer monitor. You may feel slight pressure but won’t hear any high frequency sound. This examination usually takes 20-30 minutes. Afterwards, a radiologist uses these images and the mammogram images to make a determination whether further testing is needed. There is no radiation with this procedure.

Most insurance plans pay for this exam. The California Detection Program, Every Woman Counts pays for mammograms for women who are low-income California residents and meet the program’s criteria. Find out more about Every Woman Counts .

To make an appointment for an ultrasound, please call the Breast Health Center at (510) 869-8377, or call the Imaging & Mammography Center at (510) 204-1880. The Imaging & Mammography Center has extended hours on Mondays and Thursdays and some Saturdays.

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Breast MRI

One of the methods we use to measure the extent of breast cancer after it is diagnosed, and the response to treatment, is Magnetic Resonance Imaging (MRI). This exam involves injecting a medication called gadolinium into the bloodstream, which helps us identify and observe the character of lesions in the breast. This exam produces hundreds of images of the breast which are reviewed by a radiologist. MRI may be recommended as part of a surveillance program for women who are known carriers of breast cancer genetic mutations.

To make an appointment for a Breast MRI, please call Medical Center Magnetic Imaging located at 3000 Telegraph Avenue in Oakland at (510) 869-8777, or call Magnetic Imaging Affiliates located at 5730 Telegraph Avenue in Oakland at (510) 204-2744.

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Fine Needle Aspiration

Fine Needle Aspiration is another way to determine what a lump is. A very fine needle is used to sample fluid from the lump. This procedure may be performed by a radiologist, pathologist, or a surgeon. Because the needle is very fine, the puncture is similar to having a routine blood test. The entire visit may be 15-20 minutes, but the sampling takes only 10-20 seconds. Usually, two to three samples are taken. The samples are put onto microscope slides that are examined by a pathologist. The results will be shared a couple of days after the test sample is read. If the fine needle aspiration test does not give a definitive answer to what the lump is, then other types of biopsy procedures may be needed.

Most insurance plans pay for this exam. The California Detection Program, Every Woman Counts pays for mammograms for women who are low-income California residents and meet the program’s criteria. Find out more about Every Woman Counts .

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Core Needle Biopsy for Palpable Breast Masses

If you have a mass or thickening in your breast which is palpable (capable of being felt), a core needle biopsy can be performed to accurately obtain tissue samples from your breast to determine the reason for the mass. The biopsy can be performed in your surgeon's office using local anesthesia. The entire procedure takes only a few minutes, afterwhich a dressing will be applied and you will be able to resume most normal activities right away. There may be bruising at the biopsy site, but normally there is no remaining scar.

Before your Biopsy: Do not take any aspirin type medications for three days before your biopsy appointment. This includes Advil, Aleve, Ibuprofen, Motrin, Excedrin, Vitamin E and herbal supplements. You may take Tylenol (Acetominophen). Also, do not take any blood thinning medications for five to seven days before your biopsy. Wear a two-piece, comfortable outfit with a loose blouse. Bring or wear a supportive bra. This will hold an ice pack in place and support the breast after the procedure. Make sure you eat and drink something before your appointment.

After your Biopsy: Limit your physical activities for 48 hours after the procedure. No heavy lifting or stretching of the area. You may drive yourself to and from the appointment if you like. You will receive only local anesthesia for this procedure.

Print the following core biopsy aftercare instructions for your use:

Core Biopsy Aftercare (English, PDF)
Core Biopsy Aftercare (Spanish, PDF)
Core Biopsy Aftercare (Chinese, PDF)

The PDFs above require Adobe Acrobat Reader. If you are unable to open the PDF files you may need to Download Adobe Reader .
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Stereotactic Core Needle Biopsy

Less invasive than a surgical biopsy, a Core Needle Biopsy is another way to obtain tissue samples from your breast. If a mass or an area of calcification is seen on your mammogram, but cannot be felt and cannot be seen on ultrasound, the radiologist may decide to use a Stereotactic machine to image the area. This machine uses a computer to pinpoint the exact location of a breast mass. This involves lying down on the Sterotactic table, your breast is positioned through a round opening in the table. The radiologist and technologist elevate the table and work from below. Your breast is anesthetized, and then compressed like during a mammogram.

Once numb, a biopsy needle will be inserted into your breast. The location is confirmed through imaging. Once the placement of the needle is confirmed, the tissue samples are gathered. The entire procedure takes only a few minutes. The technologist will then apply pressure to the biopsy area for 5-10 minutes in order to prevent bleeding. A dressing will be applied, and you will be able to resume your normal activities right away. There may be some bruising but normally no scarring.

Before your Biopsy: Do not take any aspirin type medications for three days before your biopsy appointment. This includes Advil, Aleve, Ibuprofen, Motrin, Excedrin, Vitamin E and herbal supplements. You may take Tylenol (Acetominophen). Also, do not take any blood thinning medications for five to seven days before your biopsy. Wear a two-piece, comfortable outfit with a loose blouse. Bring or wear a supportive bra. This will hold an ice pack in place and support the breast after the procedure. Make sure you eat and drink something before your appointment.

After your Biopsy: Limit your physical activities for 48 hours after the procedure. No heavy lifting or stretching of the area. You may drive yourself to and from the appointment if you like. You will receive only local anesthesia for this procedure.

Print the following core biopsy aftercare instructions for your use:

Core Biopsy Aftercare (English, PDF)
Core Biopsy Aftercare (Spanish, PDF)
Core Biopsy Aftercare (Chinese, PDF)

The PDFs above require Adobe Acrobat Reader. If you are unable to open the PDF files you may need to Download Adobe Reader .

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Ultrasound-Guided Core Biopsy

If there are suspicious changes on a mammogram that are cannot be felt, a radiologist may recommend an ultrasound-guided biopsy. First, the area is anesthetized with a local anesthetic. After placing an ultrasound probe over the site of the breast lump, the radiologist views the image on the screen and guides a biopsy needle directly into the mass. This allows the radiologist to remove a small amount of tissue using a vacuum device for examination by a pathologist.

A small clip (about half the size of a paper staple) may be placed at the site to mark the spot. A mammogram will be done after the clip is placed. A dressing will be applied to the area. This is a minimally invasive procedure which takes about 90 minutes. Your doctor will receive a report within 48 hours of the biopsy if the procedure is performed Monday through Wednesday. If it is done on a Thursday or Friday, it will not be ready until the following Monday.

Before your Biopsy: Do not take any aspirin type medications for three days before your biopsy appointment. This includes Advil, Aleve, Ibuprofen, Motrin, Excedrin, Vitamin E and herbal supplements. You may take Tylenol (Acetominophen). Also, do not take any blood thinning medications for five to seven days before your biopsy. Wear a two-piece, comfortable outfit with a loose blouse. Bring or wear a supportive bra. This will hold an ice pack in place and support the breast after the procedure. Make sure you eat and drink something before your appointment.

After your Biopsy: Limit your physical activities for 48 hours after the procedure. No heavy lifting or stretching of the area. You may drive yourself to and from the appointment if you like. You will receive only local anesthesia for this procedure.

If you have any questions about the information here, please call our Breast Health Nurse at (510) 869-6628.

Print the following core biopsy aftercare instructions for your use:

Core Biopsy Aftercare (English, PDF)
Core Biopsy Aftercare (Spanish, PDF)
Core Biopsy Aftercare (Chinese, PDF)

The PDFs above require Adobe Acrobat Reader. If you are unable to open the PDF files you may need to Download Adobe Reader .

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Needle (Wire) Localization Biopsy

If you have a breast abnormality that can be seen on your mammogram but can not be felt during your clinical breast exam, this type of biopsy can be performed. There are two steps to this procedure that are done on the same day as an out-patient.

Step 1 will take place in the mammography area of the Center. Your breast will be positioned for a mammogram or ultrasound with the suspicious area as the focus. The radiologist will numb your breast with a local anesthetic. The radiologist will then insert a needle that has been threaded with a small wire or dye to mark the suspicious area. A mammogram or ultrasound will be done to make sure it is accurately placed. The wire is taped in place and covered with a dressing so that it is not moved when you move. Some women experience a sensation of pulling and/or pressure. You can inform the technologist or radiologist of any unusual sensations or symptoms you may be experiencing.

Step 2 of the procedure will take place in Same Day Surgery. The abnormality seen on the mammogram is surgically removed under anesthesia that you and your surgeon have decided on beforehand. The wire marks the spot and guides the surgeon to the area of concern. This usually takes 60 minutes. Once the specimen is removed, it is examined by the radiologist with an X-ray to confirm that the suspicious area seen on the mammogram has been removed. The radiologist and the surgeon will discuss the result. There may be swelling or a lumpy feeling at the surgical site. Your surgeon will be able to tell you if you can expect scarring. There is usually not much noticeable change to the appearance of your breast. Most women can resume their regular activities the following day.

To make an appointment for a Needle Localized Biopsy, please call your surgeon who will coordinate an appointment with the radiologist.

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Surgical Biopsy

A Surgical Biopsy, sometimes called an Open Biopsy, is the way that your surgeon will evaluate a breast lump or suspicious area that was located on your mammogram. A surgical biopsy can be performed on an area that can be felt or only seen on a mammogram or ultrasound. The procedure is performed by a surgeon in the operating room at the hospital, and is most often an outpatient procedure.

If you are having an excisional biopsy, your doctor is going to remove all of the suspicious area. If you are having an incisional biopsy, your doctor is going to remove only part of the suspicious area. The tissue collected will be sent to a pathologist who is an expert at analyzing breast tissue. The results will be available within a couple of days, given directly to your surgeon by the pathologist.

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