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Breast biopsy - stereotactic

  • Definition
    • 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 open, ultrasound-guided, and lumpectomy. This article focuses on stereotactic breast biopsy, which uses mammography to help pinpoint the spot in the breast that needs to be removed.

  • Alternative Names
    • Biopsy - breast - stereotactic; Core needle breast biopsy - stereotactic; Stereotactic breast biopsy; Abnormal mammogram - stereotactic breast biopsy; Breast cancer - stereotactic breast biopsy

  • 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:

      • Fine needle aspiration
      • 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 catheter or 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.

      You may feel a sharp, stinging sensation when the local anesthetic is injected. 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. DO NOT do any heavy lifting or work with your arms for 24 hours after the biopsy. You can use acetaminophen (Tylenol) or ibuprofen (Advil) for pain relief.

  • Why the Test is Performed
    • Stereotactic breast biopsy is used when a small growth or calcifications are seen on a mammogram, but cannot be seen using an ultrasound of the breast.

      The tissue samples are sent to a pathologist to be examined.

  • Normal Results
    • A normal result means there is no sign of cancer.

      Your health care 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.

  • Risks
    • There is a slight chance of infection at the injection or surgical cut site.

      Bruising is common, but excessive bleeding is rare.

  • References
    • Gordon AJ, Hansen N. The role of stereotactic breast biopsy in the management of breast disease. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014.

      Katz VL, Dotters D. Breast diseases: diagnosis and treatment of benign and malignant disease. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 15.

      Wolff AC, Domchek SM, Davidson NE, Sacchini V, McCormick B. Cancer of the breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 91.