Stereotactic Breast Biopsy Procedure
Overview
A stereotactic breast biopsy is a special test doctors use to take a small sample of breast tissue for closer examination. It helps determine whether abnormal changes seen on a mammogram are cancerous or benign, without needing surgery. This procedure uses mammography—a special kind of X-ray—to precisely locate the spot that needs to be checked.
The technologist gently presses the breast between two plates, and the machine takes images from different angles. This helps the doctor target the exact area of concern. A small sample of tissue is removed and sent to a lab for analysis.
Key Features:
- Quick recovery time
- Uses special X-ray images (mammograms)
- Targets a specific area of the breast
- Minimally invasive, no surgery needed
Doctors often recommend this test if a mammogram shows a spot or change that needs a closer look. The radiologist may leave a tiny marker (also called a clip) at the biopsy site. This helps doctors find the area again later if follow-up testing or treatment is needed.
Many people feel nervous when told they need a breast biopsy, but understanding the process can make it feel less stressful. The test is typically done in an outpatient setting, and most patients go home shortly afterward.
Types of Stereotactic Breast Biopsies
Doctors most often perform stereotactic breast biopsies using core needle biopsy techniques. They use a hollow needle to remove small cores of tissue from the area in question. There are two main types of stereotactic-guided biopsies:
- Stereotactic Core Needle Biopsy: This is the most common method. A radiologist uses images from a mammogram to guide a hollow needle to the targeted spot. The radiologist collects several small samples of tissue for further testing.
- Stereotactic Vacuum-Assisted Biopsy: In this version, a vacuum-powered tool collects tissue with the guidance of mammogram images. This tool can collect more tissue in one insertion, which may lower the need for multiple needle entries.
Both biopsy types use mammography images taken from at least two angles. This allows the doctor to pinpoint the exact location of the area to biopsy. Here is a simple comparison:
| Type | How It Works | Amount of Tissue Taken |
|---|---|---|
| Core Needle Biopsy | Hollow needle, tissue cores | Small samples |
| Vacuum-Assisted Biopsy | Vacuum tool, removes more tissue per entry | Larger samples |
Doctors perform these procedures on an outpatient basis. Patients do not need general anesthesia. The medical team numbs the area to keep the patient comfortable during the biopsy.
Indications for Stereotactic Breast Biopsy
Doctors use stereotactic breast biopsy when they need to collect tissue from areas in the breast that seem abnormal on imaging tests, especially mammograms. This method is especially useful when the area cannot be felt during a physical exam. These are some main indications for this test:
- Microcalcifications: Small calcium deposits that appear as tiny white spots on a mammogram. These are often too small to feel but may be an early sign of breast cancer.
- Suspicious Non-Palpable Lesions: Abnormal areas seen on a mammogram or digital breast tomosynthesis that cannot be felt by hand.
- Areas Not Seen by Ultrasound: Some breast changes only show up on mammograms, not on other imaging tests like ultrasound.
- Abnormal Tissue After Previous Tests: If prior imaging, like a mammogram, found changes that might be cancer, the stereotactic biopsy helps get a clear diagnosis.
This test is not used for all breast abnormalities; it’s mainly chosen for hard-to-reach or precisely located areas. Doctors sometimes use this test before surgery to help guide the removal of very small or hard-to-find areas. Stereotactic guidance can also be used for procedures other than biopsy, including needle localization before surgery.
Preparing for the Stereotactic Breast Biopsy Test Procedure
Patients getting a stereotactic breast biopsy should follow specific instructions to ensure a safe and effective test. Knowing how to prepare and what to expect helps reduce stress and confusion during the visit.
Pre-Procedure Guidelines
Patients should share a list of medications, including blood thinners or aspirin, with their doctor. Some medications may need to be paused to help lower the risk of bleeding. Doctors may ask patients to avoid using deodorants, powders, or lotions on the day of the test, as these can appear on mammogram images and affect the results.
Patients should also tell the staff about any allergies, especially to latex or local anesthetics. Fasting is usually not required for this procedure, though some doctors may give special instructions in rare cases. Comfortable, two-piece clothing is recommended, as the top will need to be removed for the biopsy.
What to Expect Before the Procedure
Before the biopsy, the patient checks in at the imaging center or hospital. A nurse or technologist reviews the patient’s medical history and checks for allergies or past reactions to anesthesia. The patient changes into a gown and removes jewelry or objects that may interfere with imaging.
The staff explains the steps of the procedure in simple terms and answers questions. A consent form is signed before moving forward. Some facilities offer a support person to stay with the patient until the test begins. The team makes sure the patient is comfortable and understands each step before starting.
Step-by-Step Stereotactic Breast Biopsy Procedure
A stereotactic breast biopsy uses special imaging to target and collect tissue from a specific area in the breast. The process is organized to help ensure accuracy, patient comfort, and sample quality.
Imaging and Localization
First, the radiologist locates the targeted breast area using mammography or a similar imaging method. The radiologist takes digital images from different angles to pinpoint the exact spot where tissue needs to be collected.
These images help guide the needle to the right location. Sometimes, x-ray markers are put on the skin to mark the area. The radiologist may compare new images to previous ones for better accuracy. Continuous imaging may be used to ensure accuracy throughout the biopsy.
Patient Positioning and Comfort
The technologist may ask the patient to lie on a special table face down, with their breast placed through an opening in the table. In some cases, the patient sits upright. The choice depends on the area of the breast being biopsied and the equipment used.
The technologist assists the patient into the correct position and ensures that they are as comfortable as possible. Pillows or supports may be used to help the patient stay still.
The team uses local anesthetic to numb the area, so the patient should not feel pain, only slight pressure. The team checks on the patient throughout the procedure and gives instructions to help them remain still, which improves the accuracy of the biopsy.
Tissue Sampling Process
After numbing, the radiologist inserts a biopsy needle through a small cut in the skin. Using the imaging guidance, the radiologist moves the needle to the target area.
The radiologist removes a small amount of breast tissue, often using a vacuum-assist system that gently pulls tissue into the needle. This may be repeated several times to collect enough samples.
Once the samples are collected, a tiny marker may be placed to help locate the biopsy site in future imaging. The team applies pressure to limit bleeding and places a bandage. Most people experience only mild discomfort during this process.
Post-Procedure Care and Recovery
After a stereotactic breast biopsy, patients should keep the bandage in place until the next day. Thin strips of tape may be used and can stay for up to three days unless they come off sooner.
It is safe to shower 24 hours after the biopsy, but the area should be kept dry before this time. If possible, patients should avoid baths or swimming until the bandage has been removed and the site has closed.
Mild swelling, bruising, or tenderness is common and usually resolves in a few days. Patients may use over-the-counter pain medicine if needed, but it’s best to avoid aspirin or blood thinners unless advised by a doctor. Patients should take it easy for the rest of the day.
Activities that move or bounce the breast, like jogging or vacuuming, should be avoided. Heavy lifting, especially items over about a gallon of milk in weight, is not recommended for a day or so. The care instructions may be summarized in this table:
| Care Step | Details |
|---|---|
| Remove bandage | Next day after biopsy |
| Remove the thin strips of tape | In 3 days if not fallen off |
| Shower | After 24 hours |
| Avoid heavy activity | For 1-2 days |
| Watch for infection signs | Contact provider if symptoms arise |
Risks and Complications of Stereotactic Breast Biopsy
A stereotactic breast biopsy is usually safe. However, as with any medical procedure, some possible risks and complications exist. The most common side effects are mild and go away on their own. These can include:
- Bruising
- Swelling
- Soreness at the biopsy site
Some patients may experience mild bleeding during or after the test. In rare cases, more serious bleeding may require medical attention. A small chance of infection exists at the site of the biopsy. Signs of infection include redness, warmth, discharge, or fever.
This risk is very low, and doctors can often manage it with antibiotics if needed. Rare risks include damage to nearby tissues, allergic reaction to the anesthetic, or the formation of a lump called a hematoma.
Possible Risks Table
| Risk | How Common | What To Look For |
|---|---|---|
| Bruising/Swelling | Common | Blue skin, tenderness |
| Mild bleeding | Sometimes | Small bleeding, oozing |
| Infection | Rare | Redness, fever, discharge |
| Allergic reaction | Very rare | Rash, itching, swelling |
| Hematoma | Rare | Hard lump, pain |
Most risks resolve within a few days and doctors can manage them. If symptoms worsen or do not improve, patients should contact their healthcare provider.
Understanding Your Test Results
After a stereotactic breast biopsy, results indicate if cancer cells are present in the sample. The report will state if the tissue is benign, malignant, or if more testing is needed.
Pathologists examine the cells under a microscope. They check if the cells are normal or if there are signs of cancer or other changes. Sometimes, they find cells that are not clearly cancerous but are not normal either.
Common Report Terms
| Term | Meaning |
|---|---|
| Benign | No cancer is found |
| Malignant | Cancer is present |
| Atypical | Abnormal cells, not clearly cancer |
| Inconclusive | Not enough information, further tests needed |
Some reports include the type and grade of cancer if found. Grade describes how much the cancer cells look like normal cells. Lower grades often grow slower than higher grades. Test results may also recommend checking the area again in the future or suggest surgery.
If the results are not clear, the doctor might suggest another biopsy. It can take several days to get biopsy results. Patients should talk with their doctor to understand what the results mean for their treatment options.
Comparison With Other Biopsy Methods
Stereotactic breast biopsy is one of several ways to sample breast tissue. Other common methods include ultrasound-guided biopsy, MRI-guided biopsy, and surgical biopsy.
Stereotactic vs. Ultrasound-Guided Biopsy
Mammography images help clinicians find and target abnormal areas during stereotactic biopsy. Clinicians use sound waves to guide ultrasound-guided biopsy. If ultrasound reveals a lesion, clinicians typically prefer ultrasound-guided biopsy because it is quicker and more comfortable.
Stereotactic vs. MRI-Guided Biopsy
Clinicians use MRI-guided biopsy when a lesion only appears on MRI scans. Stereotactic biopsy works better for areas seen on mammograms but not ultrasound. MRI-guided procedures may take longer and can cost more.
Stereotactic vs. Surgical Biopsy
Surgeons remove more tissue during surgical biopsy and may use this method if needle biopsy results are unclear. Core needle biopsy allows most patients to require fewer surgeries compared to those who undergo surgical biopsy first.
| Method | Imaging Used | Invasiveness | Time Required | Patient Discomfort |
|---|---|---|---|---|
| Stereotactic Biopsy | Mammography | Low | Short | Mild |
| Ultrasound-Guided Biopsy | Ultrasound | Low | Short | Minimal |
| MRI-Guided Biopsy | MRI | Low | Moderate to Long | Moderate |
| Surgical Biopsy | None (Surgery) | Highest | Longest (OR time) | Highest |
Each method has specific uses based on how the abnormal area appears on imaging. The choice of biopsy depends on lesion location, size, and which imaging method best shows the abnormality.
