Breast Biopsy (ultrasound-guided, percutaneous)

What it is

Imaging can say that something in the breast is solid, that it has an irregular edge, that it was not there two years ago. It cannot say what the cells are, and most findings that look worrying turn out not to be cancer. Settling that question means getting tissue, and ultrasound is the easiest way to do it when the abnormality is one that shows up on ultrasound in the first place. The radiologist holds the probe on the skin, watches the target on the screen, and advances a hollow needle into it from the side — continuously visible the whole way in, which is what makes the approach quick and comfortable compared with the alternatives. Several cores of tissue are taken. In most cases a tiny metal marker is left behind at the site, so that if the area ever needs to be found again, on a future mammogram or by a surgeon, there is a fixed point to aim at. This code covers the first lesion sampled; a second lesion at the same session adds a further charge.

Why it is done

• To establish what a solid mass found on ultrasound or mammography actually is, since most such masses are not cancer
• To sample an area that changed between one mammogram and the next
• To investigate a lump that can be felt but looks equivocal on imaging
• To sample a suspicious lymph node in the armpit when breast cancer is suspected or known
• To obtain tissue for the laboratory tests that guide treatment when cancer is already diagnosed

What to expect

You lie on your back or slightly turned, the skin is cleaned, and local anesthetic is injected — the sting of the numbing is the sharpest part for most people. A small nick is made in the skin so the needle passes easily. The biopsy device makes a loud click or a vacuum sound as each core is taken, which is worth being warned about. Pressure is applied afterward, usually with steri-strips rather than stitches, and an ice pack and a supportive bra help with the bruising that commonly follows. The appointment generally fits within an hour. Strenuous activity is usually deferred for a day. If a marker was placed, a mammogram is often taken afterward to record its position. Pathology results typically take a few days.

Questions worth asking

• The pathology is a separate bill from a separate entity. Ask which laboratory reads it and whether that laboratory is in your network.
• Ask whether a marker clip is being placed and whether a mammogram afterward to confirm its position is billed as a further charge.
• If more than one area is being sampled in one visit, ask how the second and subsequent lesions are billed — they are not included in the first.
• Ask whether the vacuum-assisted device is being used rather than a spring core needle, and whether that changes the charge.
• Ask whether the biopsy is scheduled in a hospital breast center or a freestanding imaging center, and whether a facility fee applies at either.