Mo Salhab MD, MS, PG Dip, FRCS 

Oncoplastic & Aesthetic Breast Surgeon

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​Clinic Bookings: 01274550615

What is a core biopsy of the breast?

A core biopsy of the breast takes a small specimen of tissue.  It is a method that avoids taking the specimen by means of an operation. The obtained tissue can then be examined under a microscope. Core biopsy is usually taken under ultrasound or mammogram guidance. Occasionally, core biopsies are taken if clinical examination indicates breast abnormality despite normal findings on the mammogram and/or ultrasound scan.

A vacuum biopsy is a variant of a core biopsy where a suction machine is used to help obtain the sample of tissue. This is a slightly longer procedure that takes place under a mammogram or ultrasound guidance. A larger sample of tissue is taken. 

What does a core biopsy entail?

The skin over the lump will be cleaned and numbed by a local anaesthetic, which may sting briefly. A small nick may be made in the skin to assist in placing the biopsy needle close to the lump. The needle is generally attached to a small device, or ‘gun’, which quickly fires the needle into the lump with a loud clicking noise and takes a narrow tubular core of tissue from it. The needle is then withdrawn from the breast and the specimen removed from it. The process may be repeated. The radiologist usually uses the ultrasound probe at the same time to make sure that the correct area is sampled. If the abnormal area can only be seen on the mammograms, then the procedure needs the mammogram machine to help guide the needle. This is called a stereotactic-guided biopsy. For this, the breast needs to be compressed in exactly the same way as for a mammogram, but for a longer period of time while the needle is put into the breast.

What is an ultrasound scan of the breast?

An ultrasound scan builds up a picture of the inside of the breast. It uses sound waves of a frequency above the range at which the human ear can hear. A small hand-held probe is pressed against the skin surface. It both generates sound waves and detects any echoes reflected back off the surfaces and tissue boundaries of internal organs. The probe can be moved over the skin to view the breast from different angles. The pictures are displayed on a monitor and recorded for future review.

Are there any risks in having an ultrasound scan?

No, there are no known risks and it is considered to be very safe. It is a commonly used method of breast imaging.

What does the ultrasound scan entail?

The radiologist or sonographer will generally ask you about the breast problem you have. Once you are lying on the couch, your breast will be examined, for example, to check the position of any lumps. A gel will be applied to your skin over the area of the breast to be scanned. This gel allows the probe to slide easily over the skin and helps to produce clearer pictures. The lights in the room will be dimmed so that the pictures on the screen can be seen more clearly. The radiologist or sonographer will be beside you, slowly moving the probe over your skin while viewing the images on the screen. Records of selected images will be made so that they can be viewed later. Upon completion, the gel will be wiped off and you will be free to get dressed. The actual scan does not cause pain and should take around 5-10 minutes.

What is a mammogram?

A mammogram is a name for an X-ray carried out on the breast. This will result in a picture that shows internal structures of the breast. It is produced by exposure to a controlled source of X-rays and is generally recorded digitally.  Despite all the newer, more sophisticated forms of scanning (such as an MRI or a CT scan), a mammogram remains one of the most accurate ways of breast imaging.

What does mammogram involve?

Once you are in the X-ray room, your breasts will, in turn, be positioned against part of an X-ray machine. Each breast needs to be compressed between the X-ray machine and a flat X-ray plate. A certain amount of heavy pressure is felt briefly. Remember this pressure is important to get good results – the pressure reduces the movement of the breast so there is no blurring of the picture and the flattening of the breast reduces the amount of radiation required to produce the picture. Two X-ray views are taken of each breast from different angles. The radiographer goes behind a screen, but at all times you are in view of the radiographer, and can be heard, should you have a problem. You need to keep still. You may hear a slight whirring from the X-ray machine.

The following video shows how a mammogram is done

Are there any risks in having a mammogram?

The amount of radiation involved in having a mammogram is generally negligible, it is equal to that which we receive naturally from the environment over a period of a few months to a year. All risks are relative, and the possible benefits of the examination have to be taken into account as well. If you do have a breast lump or other significant problem, then the risk of not having the examination will be much greater than the risk associated with the radiation.

If you are pregnant or think you might be, it is essential that you tell the radiographer. An ultrasound scan may be used instead. If mammograms are required, then the radiographer will take special precautions such as covering your lower stomach with a lead apron. This reduces the radiation dose to your baby even though it is actually a very small dose. You must also tell the radiographer if you have breast implants so special techniques can be deployed to get good mammogram pictures.

Are there any risks in having a core biopsy?

The answer is generally no. Occasionally, there may be some bleeding inside the breast and a bruise or swelling (haematoma) will form. Obviously care has to be taken that no infection occurs. Care must also be taken that the needle does not pass beyond the breast through the chest wall (special care will be taken if the lump is at the back of a small breast). Needle procedures of this kind often require the patient’s consent.

Will the core biopsy hurt?

You will feel some stinging as the local anaesthetic goes in, but the area soon goes numb. During the actual biopsy, you will probably only notice the loud clicking of the biopsy ‘gun’. If there is bruising and swelling (haematoma) forms afterwards, this may be uncomfortable for a day or two afterwards.

What is a fine needle aspiration of the breast?

Not everyone attending a breast clinic has a fine needle aspiration (FNA) of the breast. It is a way of taking fluid or a few cells so that they can be examined under a microscope.

What does an FNA involve?

Generally, a small needle, similar to the one used for taking a blood sample, is placed into the breast and into the area being studied. A local anaesthetic may be used. Using a syringe on the end of the needle, suction is applied to draw up fluid and cells. The needle is moved up and down through the breast tissue while this is happening. The needle is then removed, and the material placed in a special bottle or on to a microscope slide. The procedure may then be repeated once or twice more. The radiologist usually uses the ultrasound probe at the same time to make sure that the correct area is sampled.

Will an FNA hurt?

If you have one, you might feel some stinging or stabbing pain while it is being done, but this does not last. Often local anaesthetic is used. If there is bruising and a hard swelling (haematoma) forms afterwards, this may be uncomfortable for a day or two. Most women do not find an FNA too painful and tolerate it very well.

When are the results available?

With a ‘one-stop’ clinic, you will get the results of your mammogram or ultrasound scan on the day of your visit. The results of core biopsy or an FNA, if these have been needed, generally take a few days to come through. If you have either of these needle tests,  you will be given another appointment in a week or so to discuss the results.

Core biopsy gun

Breast One-Stop Clinic

Mr. Salhab runs one-stop clinics at the Yorkshire Clinic, and St Luke's Hospital. NHS patients can request to be referred to see Mr Salhab via their GP  NHS Choose and Book system.

Patients who are self-funded or have Private medical insurance can arrange an appointment to see Mr. Salhab Personally at the Yorkshire Clinic by contacting 01274550615  Click here

Breast one-stop clinic is also known as a symptomatic breast clinic, It is considered the best practice for patients presenting with breast symptoms.  your GP will refer you to be assessed by a breast specialist if you have a new change in your breast. This could be a definite lump, puckering or dimpling of the skin over the breast, changes to your nipple including a rash or discharge, or severe and persistent breast pain. At the breast one-stop clinic, you are likely to spend up to three hours in order to allow time to have all the necessary assessments performed. Most patients will get the results of your assessment at the end of your clinic visit.  

What happens at the Breast one-stop clinic?

At the breast clinic, Mr. Salhab will see you first. He will take a full and detailed clinical history. This will include questions about current breast symptoms,  any family history of breast problems, any medication you’re taking, including hormone replacement therapy (HRT) or the contraceptive pill, or any previous breast surgery (including breast implants). This will be followed by a breast examination, where both breasts will be  checked. The examination involves looking at and feeling both breasts when you are sitting and when you are lying down. Mr. Salhab will also examine the lymph nodes (glands) under your arm.

Following Clinical assessment ( History and examination) you may be sent to have further tests at the Breast Radiology department. These will usually include one or more of the following:

  • Mammogram Tomosynthesis (breast x-ray)
  • Ultrasound scan
  • Core biopsy.
  • Fine needle aspiration (FNA)

The choice between mammography or an ultrasound scan for imaging depends largely on the woman’s age, although some women will have both tests. Ultrasound scanning alone is used more often for women under 40 as younger women’s breast tissue is  often very dense and unusual features may not show on mammograms

Depending on the finding of both clinical examination and mammogram and/or ultrasound scan a breast tissue sample may be required. This is usually done under local anaesthesia.

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