Stereotactic breast biopsy is an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound. Stereotactic core needle biopsy is a simple procedure that may be performed in an outpatient imaging center.
Compared with open surgical biopsy, the procedure is about one-third the cost. Generally, the procedure is not painful and the results are as accurate as when a tissue sample is removed surgically. No breast defect remains and, unlike surgery, stereotactic needle biopsy does not distort the breast tissue or make it difficult to read future mammograms. The use of a vacuum-assisted device may make it possible to remove the entire lesion.
Recovery time is brief and patients can soon resume their usual activities. No radiation remains in a patient's body after an X-ray examination. X-rays usually have no side effects. Risks Because the vacuum-assisted device removes large pieces of tissue, there is a risk of bleeding and forming a hematoma, or a collection of blood at the biopsy site. The risk, however, appears to be less than one percent of patients.
An occasional patient has significant discomfort, which can be readily controlled by non-prescription pain medication. Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1, Doing a biopsy of tissue located deep within the breast carries a slight risk that the needle will pass through the chest wall, allowing air around the lung that could collapse a lung.
This is a rare occurrence. There is always a slight chance of cancer from radiation. However, the benefit of an accurate diagnosis far outweighs the risk. These lesions should be approached with sonographically guided biopsy. Lesion Location --Depending on the type of stereotactic biopsy equipment used, the location of some lesions can make them difficult to biopsy because of the inability to place the lesion in the field-of-view of certain types of equipment.
With digital imaging equipment, some faint calcifications and areas of asymmetric density or architectural distortion can be difficult to identify so that they can be biopsied.
Because of the geometry of the biopsy needle and the need for some types of needles to travel through the breast in order to obtain tissue, some lesions that are very close to the skin or located in breasts that are very thin when compressed or in thin areas of the breast may be unable to undergo stereotactic core biopsy. Some of these lesions can be biopsied under sonographic guidance, for which these issues are not important, or can be biopsied using fine-needle aspiration techniques, in which the needle travels only a few millimeters while cells are being dislodged for analysis.
Lesion size can be a criterion for the exclusion of patients from stereotactic core biopsy. This is especially true when a vacuum-suction biopsy needle is used. If it is possible that the entire lesion may be removed during stereotactic core biopsy and a localizing clip cannot be placed at the biopsy site see below , it may be disadvantageous to perform stereotactic core biopsy. If the lesion is found to be malignant and a wide surgical excision of the tumor site is necessary, it may not be possible to localize the site after removal of the lesion.
Therefore, it may be necessary to remove a larger volume of tissue than would otherwise have been needed, and cosmetic deformity of the breast may result. In this situation, it may be desirable to perform a needle-localized surgical biopsy rather than stereotactic core biopsy. Small lesion size is never a contraindication to stereotactic core biopsy because of the inability of the technology to accurately direct the needle into the lesion.
In fact, lesions well below 5 mm in size can be accurately targeted and biopsied with stereotactic core biopsy technology. Certain medical conditions can contraindicate the performance of stereotactic core biopsy. Women who are unable to remain in position for the duration of the procedure should not be selected for stereotactic core biopsy.
This may be a problem for those with severe arthritis of the neck, shoulders, or back. Patients with coagulopathies may develop significant hemorrhage during stereotactic core biopsy and may be better cared for with surgical biopsy, during which bleeding may be more easily controlled. For women taking an anticoagulant medication or a platelet-inhibiting agent, such as aspirin, the drug can be discontinued for the length of time required for its anticoagulant effect to abate.
Patient selection and results of the biopsy procedure depend, in part, on the equipment available at each facility. The two most important pieces of equipment used during stereotactic core biopsy are the stereotactic guidance unit and the needle that obtains the tissue for histologic examination.
The stereotactic biopsy unit operates on the principle of triangulation. The lesion is localized within the breast by calculating its position on the horizontal x and vertical y axes, as well as its depth within the breast, or z-axis.
The x- and y-axes are evident on any frontal radiograph showing the lesion. When two images are taken at equal angles from this frontal image, the extent of shift of the lesion on these two pictures is a function of its depth within the breast. A computer within the stereotactic unit calculates the depth of the lesion z-axis from the surface of the breast. The unit then positions the biopsy needle at the appropriate site within the breast to obtain tissue from the abnormal area.
Stereotactic units are of two designs. In one, the patient lies prone on a table with her breast hanging through a hole in the table Figure 1 , and the biopsy is performed under her Figure 2. Alternatively, an "add-on" device can be attached to a standard mammography unit. With such a device, the patient sits during the procedure, and the biopsy is performed in front of her.
Not surprisingly, the patient is more likely to experience a vasovagal reaction when the add-on type of unit is used. However, add-on units may be more successful at positioning the patient so that lesions in the axilla or near the chest wall can undergo stereotactic core biopsy.
A variety of needle designs are available to perform core biopsy. Needles should be at least gauge in order to obtain sufficient tissue for accurate diagnosis Figure 3 , as diagnostic accuracy decreases with needle size less than gauge. In this study, the success of the larger, gauge needle appeared to due to the larger volume of tissue available for the pathologist to examine. Gun-Needle Combinations --Even when gauge needles are used, the gun-needle combinations from various manufacturers have varying levels of success in obtaining tissue.
In a study comparing the size of specimens obtained from large-core ie, gauge biopsy guns from seven manufacturers, specimens varied in size from The study was unable to determine whether differences in the ability to make an accurate diagnosis resulted from these differences in tissue retrieval.
Gun-needle combinations remove tissue by firing a cutting needle through the breast, slicing through tissue to obtain the specimen. These needles can be designed to travel at varying distances through breast tissue.
The "long-throw" devices, which travel 22 to 23 mm at the time of biopsy, are most successful at obtaining a diagnostic sample. However, these devices require thicker breast to accommodate the longer distance that they travel, as compared with shorter-throw needles.
In thin breasts or thin areas of the breast, such as the periareolar region, it may not be possible to use the long-throw needles, and tissue sampling may be less successful. Adequate tissue sampling of areas of calcifications is particularly difficult with gun-needle combinations. This may be due to the difficulty in accurately targeting a single calcification when many calcifications have a similar appearance.
It may also be due to problems in retrieving tissue from a disease process that is more dispersed than is the case with a focal breast mass. The success of stereotactic core biopsy diagnosis of lesions that appear to be calcifications on mammography depends on the ability to obtain calcification at the time of biopsy. Calcification in the core may be adjacent to the lesion of importance in the biopsy specimen, but the ability to obtain calcification at the time of stereotactic core biopsy indicates that the worrisome site within the breast has been accurately targeted and sampled.
Therefore, it is necessary to perform specimen radiography on tissue obtained during stereotactic core biopsy when the targeted lesion is characterized by calcification Figures 4A, 4B, and 4C,. Vacuum-Assisted Core Biopsy --Recently, percutaneous vacuum-assisted core biopsy has been developed as an alternative to large-core gun-needle biopsy. The probe is positioned within the breast in proximity to the area to be sampled. Through a side hole within the probe, the vacuum draws tissue into the lumen of the probe.
Then they can discuss the next steps. If the biopsy finds breast cancer cells, it will also show:. This information can help doctors and patients to develop treatment plans that will address individual needs.
If the breast tissue is normal, or it shows that an existing lump is not cancerous, the person may still need more tests to confirm that cancer is not present or to help the doctor to monitor the breast tissue over time.
A review of the effectiveness of stereotactic breast biopsies published in notes that it is highly accurate and sensitive. This makes it very useful for determining whether or not a suspicious area in the breast is cancerous.
It is not very effective in cases near the chest wall, where there are widely distributed calcium deposits, or with well-defined masses. If a mammogram or physical examination shows an unusual lump in the breast, a doctor may recommend a biopsy. In the past, surgery was the only option. Now, a doctor will only recommend surgery if they know that tissue also needs removing.
The stereotactic breast biopsy uses mammography equipment to guide the needle as it takes a tissue sample. It is considered an effective procedure. According to the American Cancer Society , Nearly percent of people who have stage 0 or stage 1 breast cancer will live for at least another 5 years.
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Breast biopsy procedures will occasionally miss a lesion or underestimate the extent of disease present. If the diagnosis remains uncertain after a technically successful procedure, surgical biopsy will usually be necessary. Please type your comment or suggestion into the text box below. Note: we are unable to answer specific questions or offer individual medical advice or opinions. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician.
To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database. This website does not provide cost information. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the Radiological Society of North America RSNA and the American College of Radiology ACR , comprising physicians with expertise in several radiologic areas.
Outside links: For the convenience of our users, RadiologyInfo. Toggle navigation. What are some common uses of the procedure? How should I prepare? What does the equipment look like? How does the procedure work?
How is the procedure performed? What will I experience during and after the procedure? Who interprets the results and how do I get them? What are the benefits vs. What are the limitations of Stereotactic Breast Biopsy? A stereotactic breast biopsy may be performed when a mammogram shows a breast abnormality such as: a suspicious mass tiny clusters of small calcium deposits microcalcifications a distortion in the structure of the breast tissue an area of abnormal tissue change a new mass or area of calcium deposits in a previous surgery site.
Tissue sample is obtained using: A vacuum-assisted device VAD , a vacuum powered instrument that uses pressure to pull tissue into the needle. This instrument rotates positions and collects multiple tissue samples through one needle insertion. Mammography is a low-dose x-ray system designed to evaluate breast tissue.
Breast biopsies are usually done on an outpatient basis. The breast is compressed and held in position throughout the procedure. After the sampling is complete, the needle will be removed from the breast. A final set of images will be taken.
This procedure is usually completed within an hour. The area will become numb within a few seconds. You must remain very still while the doctor performs the imaging and the biopsy. Benefits The procedure is less invasive than surgical biopsy, leaves little or no scarring, and can be performed in less than an hour. Stereotactic breast biopsy is an excellent way to evaluate calcium deposits or masses that are not visible on ultrasound. Stereotactic core needle biopsy is a simple procedure that may be performed in an outpatient imaging center.
Compared with open surgical biopsy, the procedure is about one-third the cost. Very little recovery time is required. Generally, the procedure is not very painful.
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