# Image-guided core needle biopsy of the breast and liver: preparation and aftercare

Source: https://onco.cc/protocols/image-guided-core-biopsy-preparation-and-aftercare/  
OnCo record `image-guided-core-biopsy-preparation-and-aftercare` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A core biopsy uses a hollow needle, guided by ultrasound or a scan, to take thin strips of tissue so a pathologist can say what an abnormality is. Breast biopsies are done under local anaesthetic in clinic, sometimes leaving a tiny marker. Liver biopsies need a plan for blood thinners and a few hours of observation; call the hospital for fever, breathlessness, heavy bleeding or bad pain.

## Summary

Breast. The NHS Breast Screening Programme assesses significant abnormalities by core or vacuum-assisted biopsy, with ultrasound as the guidance of choice, a permanent image of the needle in the lesion, a marker clip where the lesion may be hard to find again or there are several, and review of every needle biopsy at the multidisciplinary meeting. Fine needle aspiration may be added to, not substituted for, core biopsy. Every woman with a non-operative diagnosis of invasive cancer has axillary ultrasound, with core biopsy of the most suspicious abnormal node preferred to fine needle aspiration where safe (NHSBSP 2026). B3 lesions of uncertain malignant potential are managed by the MDT, usually by vacuum-assisted excision.

Liver (BSG, RCR and RCPath 2020, GRADE). Give risk information in advance, verbally and in writing, in the form "of 1000 people like you" (Strong, high quality). Use image guidance for focal lesions (Strong). Bleeding occurs in up to 10%, major bleeding in under 2%, and death in fewer than 1 in 1000. Anticoagulants and antiplatelets are stopped by table 2: warfarin 5 days with an INR check, direct oral anticoagulants 2 days (longer for dabigatran with impaired kidney function), clopidogrel, prasugrel or ticagrelor 7 days, and aspirin 3 to 7 days for elective biopsies, considered against why it is taken (Moderate). An INR of 1.5 to 2.0 is not a contraindication to a targeted biopsy in stable liver disease, fresh frozen plasma is not used to correct an INR of 2.0 or less (Strong), and a platelet count below 50 x 10^9/L calls for a transvenous route where possible (Strong). Observe for at least 3 hours with pulse and blood pressure (Strong, weak evidence). People with a strong suspicion of malignancy are not biopsied as a day case, because they may bleed more. At discharge: rest the remainder of the day, no driving that day, no strenuous activity for 48 hours, and call the hospital for chills, fever, breathlessness, bright red bleeding, severe chest, shoulder or abdominal pain, blood in the stool or a swelling abdomen.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: core biopsy; core needle biopsy; needle biopsy; ultrasound-guided biopsy; breast biopsy; liver biopsy; percutaneous liver biopsy; vacuum-assisted biopsy; biopsy aftercare; biopsy marker clip

## Connected records

- protocols: [Anticoagulants and antiplatelet drugs around elective endoscopy and endoscopic biopsy](https://onco.cc/protocols/anticoagulants-and-antiplatelets-before-endoscopy/)
- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/)
- technologies: [CT (computed tomography)](https://onco.cc/technologies/ct/), [Ultrasound](https://onco.cc/technologies/ultrasound/), [Vacuum-assisted breast biopsy systems (Mammotome, EnCor, Eviva, Brevera)](https://onco.cc/technologies/vacuum-assisted-breast-biopsy/)
- terms: [Biopsy](https://onco.cc/terms/biopsy/), [Core needle biopsy and fine-needle aspiration (FNA)](https://onco.cc/terms/core-needle-biopsy/)

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