Breast biopsy - stereotactic
DefinitionA breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders. Several different types of biopsy may be done. This article discusses stereotactic breast biopsy. A stereotactic breast biopsy uses mammography to help pinpoint the spot in the breast that needs to be removed.See also:Breast biopsy - openBreast biopsy - ultrasoundLumpectomy
Alternative NamesBiopsy - breast - stereotactic; Core needle breast biopsy - stereotactic; Stereotactic breast biopsy
How the test is performedYou will be asked to undress from the waist up.You will most likely be asked to lie facing down on the biopsy table. The breast that is being biopsied will hang through an opening in the table. The table is raised and the doctor will perform the biopsy from underneath. In some cases, stereotactic breast biopsy is done while the woman sits in an upright position.A stereotactic biopsy includes the following steps:The health care provider will first clean the area on your breast, then will inject a numbing medicine. This may sting a little bit.The breast is pressed down to hold it in position during the procedure. You need to hold still while the biopsy is being performed.The doctor will make 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. Up to six or more tissue samples are taken.A small metal clip or needle may be placed into the breast in the biopsy area to mark it for biopsy, if needed. The biopsy itself is done using one of the following: Fine needle aspirationHollow needle (called a core needle)Vacuum-powered deviceBoth a needle and vacuum-powered deviceThe procedure usually takes about 1 hour, including 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. You will not need stitches after the needle is taken out. Steristrips may be placed over any wound, if needed.
How to prepare for the testThe health care provider will ask questions about your medical history and perform a manual breast exam.You must sign an informed consent form. If you are going to have general anesthesia, you may be asked not to eat or drink anything for 8 - 12 hours before the test.If you take medications (including aspirin or herbal medications), ask your doctor whether you need to stop taking these before the biopsy.Tell your doctor if you may be pregnant before having an open biopsy.Do not wear lotion, perfume, powder, or deodorant underneath your arms or on your breasts.
How the test will feelYou 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 patients are given a pill to help relax them before the procedure.After the test, the breast may be sore and tender to the touch 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) for pain relief.
Why the test is performedThis test may be done if your doctor suspects cancer due to abnormal findings on a mammogram or ultrasound of the breast, or during a physical exam.To identify whether someone has breast cancer, a biopsy must be done. Tissue and fluid from the abnormal area are removed and examined with a microscope.Stereotactic breast biopsy is often used when a small growth or calcifications are seen on a mammogram, but cannot be seen using an ultrasound of the breast.
Normal ValuesA normal result means there is no sign of cancer.Your doctor or nurse will let you know when you need a follow-up mammogram or other tests.
What abnormal results meanA biopsy can identify a number of breast conditions that are not cancer or precancer, including:AdenofibromaFibrocystic breast diseaseMammary fat necrosisBiopsy results may show precancerous breast conditions, including:Atypical ductal hyperplasiaAtypical lobular hyperplasiaIntraductal papillomaTwo 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 results of the biopsy, you may need further surgery or treatment.
What the risks areThere is a slight chance of infection at the injection or surgical cut site.Excessive bleeding is rare, but may require draining or re-bandaging. Bruising is common.
ReferencesAbeloff MD, Wolff AC, Weber BL, et al. Cancer of the breast. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 95.Kim CH, Bassett LW. Imaging-guided core needle biopsy of the breast. In: Bassett LW, Jackson VP, Fu KL, Fu YS. Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 17.