Breast biopsy - stereotactic
Biopsy - breast - stereotactic; Core needle breast biopsy - stereotactic; Stereotactic breast biopsy; Abnormal mammogram - stereotactic breast biopsy; Breast cancer - stereotactic breast biopsy
A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders.
There are several types of breast biopsies, including stereotactic, ultrasound-guided, MRI-guided and excisional breast biopsy. This article focuses on stereotactic breast biopsy, which uses mammography to help pinpoint the spot in the breast that needs to be removed.
Of all the different types of cancers, breast cancer is one of the most talked about, and with good reason. One out of every eight women will develop breast cancer sometime in their life. That's why every woman should be thinking about how to protect herself from this disease. Breast cancer is cancer that forms in the breast. Usually, it begins in the tubes that transport milk from the breast to the nipple. If the cancer spreads to other parts of the breast or body, it's called invasive breast cancer. Some breast cancers are more aggressive, growing more quickly than others. Although women are 100 times more likely to develop breast cancer, men can also get the disease because they do have breast tissue. You're more likely to get breast cancer if you're over 50, you started your periods before age 12, or you have a close family member with the disease. Drinking more than a couple of glasses of alcohol a day and using hormone replacement therapy for several years also may increase your risk. The telltale sign of breast cancer is a lump in your breast or armpit. You may also notice a change in the shape, size, or texture of your breast, or have fluid coming from your nipple when you're not breastfeeding. If you notice any changes in your breasts, call your doctor. You'll probably need to have an imaging scan, such as a mammogram, MRI, or ultrasound. A piece of tissue may be removed from your breast, called a biopsy. With these tests, your doctor can tell whether you have breast cancer, and if so, determine whether or not it has spread. So, how do we treat breast cancer? That really depends on the type of cancer, and how quickly it's spreading. Your doctor may recommend that you have the cancer removed with surgery. Sometimes it's enough just to remove the lump. That's called a lumpectomy. In other cases, the doctor will need to remove the entire breast to get rid of all the cancer or prevent it from coming back. That's called a mastectomy. Other treatments for breast cancer include chemotherapy, medicines that kill cancer cells, and radiation therapy, which uses energy to destroy cancer. Women whose cancer is fueled by the hormone estrogen may receive hormone therapy to block the effects of estrogen on their cancer. Today's breast cancer treatments are better than ever. Many women who have breast cancer go on to live long, healthy lives. The outlook really depends on how fast the tumor is growing, and how far it has spread. That's why it's so important to report any changes in your breasts to your doctor as soon as you notice them. Women who are at an especially high risk for breast cancer because of their family history can talk to their doctor about taking medicine or even having surgery to reduce their risk.
How the Test is Performed
You are asked to undress from the waist up. During the biopsy, you are awake.
You are most likely asked to lie facing down on the biopsy table. The breast that is being biopsied hangs through an opening in the table. The table is raised and the doctor performs the biopsy from underneath. In some cases, stereotactic breast biopsy is done while you sit in an upright position.
The biopsy is done in the following way:
- The health care provider first cleans the area on your breast. Numbing medicine is injected.
- The breast is pressed down to hold it in position during the procedure. You need to hold still while the biopsy is being done.
- The doctor makes a very small cut on your breast over the area that needs to be biopsied.
- Using a special machine, a needle or sheath is guided to the exact location of the abnormal area. Several samples of breast tissue are taken.
- A small metal clip may be placed into the breast in the biopsy area. The clip marks it for surgical biopsy later, if needed.
The biopsy itself is done using one of the following:
- Hollow needle (called a core needle)
- Vacuum-powered device
- Both a needle and vacuum-powered device
The procedure usually takes about 1 hour. This includes the time it takes for the x-rays. The actual biopsy takes only several minutes.
After the tissue sample has been taken, the needle is removed. Ice and pressure are applied to the site to stop any bleeding. A bandage will be applied to absorb any fluid. Stitches are not needed. Adhesive strips may be placed over any wound, if needed.
How to Prepare for the Test
The provider will ask about your medical history. A breast exam may be done.
If you take medicines (including aspirin, supplements, or herbs), ask your doctor whether you need to stop taking these before the biopsy.
Tell your doctor if you may be pregnant.
DO NOT use lotion, perfume, powder, or deodorant underneath your arms or on your breasts.
How the Test will Feel
When the numbing medicine is injected, it may sting a bit.
During the procedure, you may feel slight discomfort or light pressure.
Lying on your stomach for up to 1 hour may be uncomfortable. Using cushions or pillows may help. Some people are given a pill to help relax them before the procedure.
After the test, the breast may be sore and tender for several days. Follow instructions on what activities you can do, how to care for your breast, and what medicines you can take for pain.
Why the Test is Performed
A normal result means there is no sign of cancer.
Your provider will let you know when you need a follow-up mammogram or other tests.
What Abnormal Results Mean
If the biopsy shows benign breast tissue without cancer, you will likely not need surgery.
Sometimes the biopsy results show abnormal signs that are not cancer. In this case, a surgical biopsy might be recommended to remove the whole abnormal area for examination.
Biopsy results may show conditions such as:
- Atypical ductal hyperplasia
- Atypical lobular hyperplasia
- Intraductal papilloma
- Flat epithelial atypia
- Radial scar
- Lobular carcinoma-in-situ
Abnormal results may mean that you have breast cancer. Two main types of breast cancer may be found:
- Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
- Lobular carcinoma starts in parts of the breast called lobules, which produce milk.
Depending on the biopsy results, you may need further surgery or treatment.
Your provider will discuss the meaning of the biopsy results with you.
There is a slight chance of infection at the injection or surgical cut site.
Bruising is common, but excessive bleeding is rare.
American College of Radiology website. ACR practice parameter for the performance of stereotactic-guided breast interventional procedures.
Henry NL, Shah PD, Haider I, Freer PE, Jagsi R, Sabel MS. Cancer of the breast. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 88.
Parker C, Umphrey H, Bland K. The role of stereotactic breast biopsy in the management of breast disease. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:666-671.
Last reviewed on: 3/12/2019
Reviewed by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.