Core Needle Biopsy Techniques: Needle Selection and Image Guidance

รศ.พญ.เยาวนุช คงด่าน
14 ม.ค. 2568
ยาว 5 นาที

อัปเดตเมื่อ 1 วันที่ผ่านมา

Core Needle Biopsy

Assoc. Prof. Dr. Yaowanut Kongdan

A core needle biopsy uses a hollow, large-bore needle to remove small cores of tissue from a lump or abnormal area in the breast for laboratory examination. It gives more detailed information than fine needle aspiration (FNA) — both the cell type and biomarkers — and is performed under local anaesthetic in about 15–30 minutes, with no hospital stay required.

Core needle biopsy is an important method for diagnosing breast cancer, and there are many different techniques.

Large Needle Aspiration Biopsy Procedure

Preparation: The patient will be advised about the examination process and what to do before the examination, such as not taking anticoagulants. The doctor will perform a physical examination and assess the location of the suspicious lump.
Preparing the examination area: The patient will lie or sit in a suitable position to allow the doctor to easily access the breast area. The examination area will be cleaned and disinfected.
Local anesthesia: The doctor will inject local anesthesia into the examination area to reduce pain and discomfort during the examination.
Core needle: Your doctor will use a large needle (core needle) to insert a small needle into the lump or suspicious area to take a piece of tissue. They will use X-rays, such as ultrasound, mammogram, or MRI, to guide the needle into the correct location. The needle will take at least 5-6 pieces of tissue for pathological examination.
Biopsy: The biopsy sample is sent to a pathology lab for examination under a microscope. A pathologist will analyze the biopsy sample to determine if there is cancer.
Post-examination care: Patients will receive instructions on wound care and infection prevention. Follow-up appointments will be made to assess the examination results and plan further treatment.

Selecting Needles for Biopsy

1. Manual Core Needle: Also known as Tru-cut biopsy, this method uses hands to control the puncture and extract a biopsy sample. When the doctor inserts the needle into the Coaxial Needle until it reaches the edge of the tumor, the doctor must manually advance the needle into the tumor and cut the tissue, step by step, which requires the doctor's skills and experience in controlling the puncture. This type of needle is cheaper than other types.

2. Automated Core Needle: When the doctor inserts the needle into the coaxial needle until it reaches the edge of the lump, the needle will have an automatic system to move the needle into the lump and take a biopsy. It is fast, reduces pain and discomfort for the patient, and does not require high skills to use. However, this method may not be suitable for biopsy in some locations, such as the armpit.

3. Vacuum-Assisted Core Needle: Uses a vacuum system to help suck out and collect tissue samples. Can collect more tissue samples at a time, reducing the number of times that need to be punctured. Disadvantage is that it is 10-20 times more expensive than other types of needles. Suitable for puncturing abnormalities that are only seen on mammograms, such as small clusters of calcifications or when wanting to cut out all the tissue. Requires special equipment for use.

Using Coaxial Needles

Coaxial Needle: This is a guide needle used in puncture to guide the larger needle (core needle) into the desired position more precisely.

Usage: First, the coaxial needle is inserted into the desired position, then a large needle is passed through the coaxial needle to collect a tissue sample. This helps increase the accuracy of tissue sampling because the coaxial needle helps guide the large needle into the desired position precisely.
Reduces cancer cell contamination along the needle path through normal tissue.

Navigation techniques

1. Ultrasound-Guided Biopsy:

Uses high-frequency sound waves to create images of the tumor and surrounding tissue.
Physicians can see the position of the needle in real time, enabling highly accurate biopsy.
Advantages: No radiation, suitable for masses that can be clearly seen on ultrasound.

2. Mammographic guidance (Stereotactic Biopsy):

Uses mammogram images from two angles to calculate the precise location of the tumor.
Suitable for lumps that cannot be clearly seen by ultrasound.
Advantages: Provides a clear image of the tumor location, suitable for small tumors or areas with calcium deposits.

3. MRI-Guided Biopsy:

Use MRI images to create a 3D image of the tumor and surrounding tissue.
Suitable for lumps that are not detected on mammograms or ultrasounds.

Mass Lesions:

Appearance: The tumor is a mass that can be clearly seen on an X-ray or ultrasound.
Drilling technique: A large needle is used to collect a tissue sample, guided by ultrasound.
Needle selection: Automated Core Needle:
Advantages: Easy and clear sample collection, accurate diagnosis.

Calcifications:

Description: Calcium or calcium deposits in breast tissue, often found on mammograms.
Drilling technique: Stereotactic biopsy is used to calculate the precise location of the calculus.
Needle selection: Vacuum-Assisted Core Needle
Advantages: Can examine limestone that cannot be seen clearly by other methods, multiple samples can be collected at a time.

summarize

Core needle biopsy is an efficient and important procedure in the diagnosis of breast cancer. Proper needle selection and guidance technique increase the accuracy and efficiency of the examination. A coaxial needle should be used to increase accuracy and reduce cancer cell contamination along the needle path through normal tissue.

Frequently asked questions about core needle biopsy (FAQ)

How is a core needle biopsy different from fine needle aspiration (FNA)?

A core needle biopsy uses a larger needle to remove cores of tissue, so it reveals the cell type and biomarkers (such as ER/PR and HER2) in detail. FNA uses a thin needle to draw out cells only and suits cysts or lymph nodes.

Does a core needle biopsy hurt, and how long does it take?

It is done under local anaesthetic. You feel a brief sting as the anaesthetic is injected, after which the area is numb. The procedure takes about 15–30 minutes, and you can go home the same day — no overnight stay.

When are ultrasound, stereotactic (mammography) and MRI guidance used?

The doctor selects the guidance method based on how clearly the lump or calcification can be seen. Ultrasound is used for masses seen on ultrasound, stereotactic (mammography) for calcifications, and MRI for lesions seen only on MRI.

What is the difference between manual, automated and vacuum-assisted needles?

A manual (Tru-cut) needle is controlled by hand; an automated needle fires to take consistent samples quickly; a vacuum-assisted needle collects more tissue in a single insertion and suits calcifications or small lesions.

How soon will I get my results?

Pathology results are usually available within about 3–7 working days, depending on additional tests. Your doctor will arrange an appointment to explain the results and plan your care.

Does everyone need surgery after a core needle biopsy?

Not always — it depends on the result. If the tissue is benign and matches the imaging, follow-up may be enough; if it is malignant, suspicious, or discordant with imaging, surgery may be recommended to confirm or treat.