Stereotactic Breast Biopsy
When a mammogram shows a growth in the breast, it’s not always possible to tell whether it’s benign or cancerous. In these cases, it is necessary to obtain a tissue sample for examination under a microscope.
A stereotactic breast biopsy is a procedure that uses mammography to locate a breast abnormality and remove a sample of tissue for examination. These abnormalities usually cannot be felt on an examination by yourself or a primary care physician. The procedure is simple, safe, requires little recovery time, and has no significant scarring to the breast.
How Does a Stereotactic Breast Biopsy Work?
A stereotactic breast biopsy is a specific kind of biopsy that can help physicians analyze tissue samples to better understand irregularities in the breast. Radiologists use specialized mammography machines that provide x-rays from two different angles. The two sets of images help the radiologist guide a biopsy needle to the area of concern so they can remove tissue samples. The samples are then sent to a pathologist to analyze if cancer is present.
A doctor may recommend this kind of biopsy if a mammogram or other examination finds:
- Small deposits of calcium that could be signs of cancer
- Any abnormal changes in breast tissues
- A suspicious lump
- Changes in the area of a previous surgery site
- Abnormalities in breast structure
How Do I Prepare?
A stereotactic breast biopsy is minimally invasive, but there is always a risk of bleeding whenever the skin is penetrated. Therefore, your doctor may advise you to stop taking aspirin, blood thinners, or certain supplements 7 days before the procedure. Also, inform your doctor of any other medications you are taking and any recent illnesses.
Some procedures are not performed using imaging guidance during pregnancy because radiation can harm the fetus. If there is any possibility of pregnancy, women should tell their doctor.
You may need to remove some clothing and change into a gown for the exam. Remove any jewelry, temporary dental appliances, eyeglasses, and other metal objects or clothing that may interfere with the x-ray images. You should wear comfortable, two-piece clothing and avoid the use of underarm powder, deodorant, lotion, or perfume before the procedure. You can eat a light meal before the procedure.
What Will I Experience During My Exam?
Breast biopsies are usually performed as an outpatient procedure. You will lay face down on a specially designed table. There is an opening in the table where the breast to be biopsied will be placed through and compressed. This holds it still to ensure accuracy during the procedure. Preliminary x-rays are taken and reviewed by the radiologist to identify the location of the abnormality. The computer then generates coordinate information and sends it to the biopsy device.
Then, an antiseptic will be used to clean your breast, and the radiologist will use a tiny needle to numb the biopsy area by injecting a local anesthetic. Once the anesthetic has taken effect, the radiologist will make a tiny incision for the biopsy needle. The needle is inserted, and the radiologist advances it to the computer-generated coordinates’ location. Mammogram images are retaken to confirm the placement of the biopsy needle. After placement is confirmed, a vacuum-assisted device begins to remove tissue samples.
After all the desired samples are retrieved, a tiny metal clip may be placed in your breast to mark the biopsy site. The clip is a surgical-grade, titanium-based device designed to identify the area if another procedure is necessary. If nothing further is needed, the clip will remain in place. You won’t be able to feel it and should not cause any problems.
Finally, sterile gauze will be held against the area for several minutes once the procedure is completed. Polysporin ointment will be put on the incision and then covered with a band-aid. To help minimize swelling, an ice pack will also be applied. Each biopsy site typically takes around an hour.
Are There Any Special Precautions Needed After the Procedure?
Before leaving, the radiologist, nurse, or technologist will discuss and provide written post-biopsy breast care instructions. Strenuous activities should be avoided for the first 24 hours after the procedure. Most patients can return to their usual activities the next day.
Temporary bruising and minor swelling are expected, and your doctor may tell you to take an over-the-counter pain reliever and use a cold pack. However, contact your doctor immediately if you experience excessive swelling, bleeding, drainage, redness, or heat in the breast.
How Do I Get My Results?
Although the radiologist will perform the procedure, a pathologist will be the one who will examine the sample taken from the procedure and make the final diagnosis. The radiologist will then evaluate the results of the pathology analysis and the biopsy to make sure that the findings are in agreeance with each other.
If the findings do not agree, then removal of the entire biopsy site or additional testing will be required for a conclusive diagnosis.
The result will either be shared by the radiologist or the referring physician. In any case, follow-up exams are recommended to track any changes in the issue over time.
What Are the Benefits and Risks of a Stereotactic Breast Biopsy?
Benefits:
- Less invasive than surgical biopsy, with little or no scarring, and can be completed in less than an hour.
- An excellent method for evaluating calcium deposits or masses not visible on ultrasound.
- Performed as an outpatient procedure.
- About one-third of the cost when compared to an open surgical biopsy.
- Minimal recovery time is required.
- The procedure is not very painful in general.
- Stereotactic needle biopsy does not cause a defect or distort the breast tissue, which can cause difficulty when reading future mammograms.
- X-rays are typically done at a diagnostic range for this exam, so there are usually no side effects, and no radiation stays in your body.
Risks:
- There may be some pain, but it is typically very manageable with over-the-counter pain medication.
- Fewer than 1 percent of patients can develop a hematoma (a collection of blood) where the biopsy was done.
- Incisions always carry some risk of infection. There is a 1 in 1,000 chance with this procedure.
- The biopsy needle can go through the chest wall and lead to complications, though extremely rare.
- Breast biopsy procedures can occasionally miss an abnormality or miscalculate the extent of disease present. When there is still uncertainty about the diagnosis, your doctor may recommend a surgical biopsy to confirm.
Stereotactic Breast Biopsy Limitations
The stereotactic breast biopsy may not be possible in some situations, including if:
- The target abnormality location is near the chest wall or directly behind the nipple.
- The patient is a pregnant woman because radiation can harm an unborn fetus.
- The mammogram shows only vague changes in tissue density with no definite mass or nodule. These findings may be too subtle to identify at the time of biopsy.
- The breast is too
- Diffuse calcium deposits are scattered throughout the target area of the breast, which can make it difficult to target effectively.