Self-exams, clinical breast exams, MRIs, and mammograms are the most common screening tests used to detect breast cancer. If these tests reveal lumps or changes in breast tissue that require a closer look, the next step is often a biopsy.
In a biopsy, tissue from the area of concern is removed for examination under a microscope to see if cancer has developed. Stereotactic breast biopsy is one type of biopsy.
What is stereotactic breast biopsy?
Stereotactic breast biopsy is a specific kind of biopsy. Radiologists use specialized mammography machines to help them pinpoint any suspicious areas. These machines provide radiologists with X-rays taken from two different angles.
In a stereotactic breast biopsy, radiologists use two sets of images to guide them.
Radiologists use the two sets of images to guide them to the area of concern and remove tissue samples. The samples are then analyzed to see if cancer is present.
This kind of biopsy is used after a mammogram or other examination finds:
- small deposits of calcium that could be signs of cancer
- abnormal changes in breast tissues
- a suspicious lump
- changes in an area where surgery took place
- irregularities in breast structure
When unusual masses are found, or a routine mammogram detects changes in breast tissue, it's important to find out if they are signs of cancer. With a stereotactic breast biopsy, physicians can analyze tissue samples to understand the health of the breast better.
Benefits and risks
Stereotactic breast biopsy is widely regarded as a highly effective diagnostic procedure. Doctors find it a very useful method for determining whether or not a suspicious area in the breast is cancerous. It is easier on the individual than surgery and less expensive.
Compared to surgery, a stereotactic breast biopsy is:
- simpler, faster, and much less invasive
- usually not as painful
- easier on remaining breast tissue
- causes very little scarring
- captures problems that don't show up on ultrasounds, such as calcium deposits
- has a shorter recovery time
- can be done in an outpatient setting
- costs about one-third as much
- has fewer side effects
There are risks associated with any medical procedure. Risks for stereotactic breast biopsy include the following:
- Radiation can be harmful to fetuses, and pregnant women should avoid this procedure
- Some individuals find the procedure quite painful, although discomfort is usually managed with over-the-counter pain relievers
- Less than 1 percent of individuals may develop a collection of blood or a hematoma, where the biopsy was done
- There is a 1 in 1,000 chance of developing an infection due to the incision
- In rare cases, the biopsy needle can go through the chest wall and cause complications
- It is not very effective in cases near the chest wall, where there are widely distributed calcium deposits, or with masses that are not well-defined
What to expect
Mammography equipment is designed so that X-rays only reach the breasts being examined.
Before having a stereotactic breast biopsy, a person should speak with their doctor. Women need to tell their doctor if there is any chance they may be pregnant, and review all the supplements and medications they use. This includes prescription drugs, herbal remedies, vitamins, minerals, and over-the-counter medications such as aspirin.
Many people take blood thinners or small doses of aspirin on a doctor's recommendation. It's usually suggested that they stop using these medications several days before the procedure.
Comfortable clothing is recommended for the day of the exam, although patients may wear a hospital gown for the procedure itself.
People should not use deodorant, talcum powder, perfume, or body lotion around their armpits or breast. It is also recommended that they do not wear jewelry.
Dental appliances, glasses, and anything else made of metal that could interfere with the X-rays may also need to be removed.
Mammography equipment uses X-rays to examine the breast. It is designed to make sure X-rays only reach the breasts that are being examined.
The machine is able to hold, compress, and move the breast into different positions. This allows radiologists to take images of the breast from different angles.
Stereotactic breast biopsies use a special kind of mammogram machine, similar to the one used in routine mammograms. The machine helps radiologists make sure they get the needle in the right place before taking samples.
Two different kinds of needles are used to collect samples of breast tissue:
- A vacuum-assisted device (VAD) can suck out several cell samples with only one insertion.
- A large hollow needle known as a core needle (CN) collects one sample of breast tissue per insertion
Having the biopsy
Most stereotactic breast biopsies are done on an outpatient basis. Individuals remain awake throughout the procedure, which takes about an hour.
Patients generally report little or no pain during the biopsy and no scarring of the breast after. It is a good idea to ask friends or relatives for transportation to and from the appointment.
The procedure is usually done with the person lying face down on a moveable examination table. The breast that will be examined hangs through an opening in the table.
Some find lying down and turning the head to the side the most uncomfortable part of these biopsies. Cushions can help reduce this discomfort.
The table is raised, and the procedure is performed underneath it. In some facilities, patients sit upright in a chair in front of the mammography machine.
It's important to remain still during a stereotactic breast biopsy. Whether the person is sitting up or lying down, their breast will be stabilized and compressed. An initial set of images will be taken to make sure the proper area is selected for examination.
A pathologist analyzes the tissue removed during the biopsy and shares the results with the patient's doctor.
The breast is then numbed with a local anesthetic, which may feel like a slight prick. A small cut is made in the surface of the skin where the biopsy needle will go. A radiologist then steers a needle through the incision and directs it to the area of concern.
During the process, the radiologist is guided by two images of the affected area and computer-generated coordinates.
When the needle is in place, more mammogram images are obtained, to make sure the needle is properly positioned to get a good sample. Clicking or buzzing sounds may be audible while breast tissue samples are gathered.
If a VAD needle is used, 8-12 samples are vacuumed into a collecting chamber. If a core needle is used, part of the needle moves forward, which cuts breast tissue and stores it in the needle. This process is repeated three to six times.
Once all the samples have been collected, the needle is removed. Radiologists may place a marker where the biopsy was done for future reference. This will not affect the shape or appearance of the breast. Final mammogram images are then taken.
No stitches are needed after this kind of biopsy. The incision area is bandaged, and pressure is applied to stop any bleeding.
Some bruising, swelling, and soreness is common after the procedure. Ice and over-the-counter pain relievers usually take care of the discomfort for most patients.
If redness, heat, or draining develop in the breast area, or if the swelling and bleeding seem severe, the person about consult their doctor. People should also avoid strenuous activity for at least 24 hours after having a biopsy but can resume normal activities after that.
Results and how doctors read them
The breast tissue removed during the biopsy is analyzed by a specially trained doctor called a pathologist. They will determine whether or not cancerous or pre-cancer cells are present. The doctor who ordered the biopsy will speak with the pathologist and then share the diagnosis with the patient.
Indications of results
Examining the tissue samples obtained through a biopsy gives doctors a great deal of information.
If breast cancer is detected, the pathologist's report will describe what kind of cancer it is and if it is hormone receptor-positive. These insights help doctors and their patients to develop treatment plans designed to address individual needs.
If the breast tissue was normal, or a lump was found to be noncancerous, further study may be needed. Doctors, radiologists, and pathologists will discuss the results and plan their next steps. More biopsies and medical images may be needed to confirm the condition of the breast or monitor questionable areas over time.