Procedures

A stereotactic biopsy used a special table that has digital mammography integrated into the table allowing the mammographic images to be used to guide/target needle placement for a biopsy. It is used primarily to biopsy microcalcifications or a mammographic density without an ultrasound correlate. The patient lies on the table on her stomach. The breast in question is positioned through a hole or portal in the table and into gentle compression (usually not quite as tight as for a mammogram but held there for the length of the procedure - 15-20 minutes). Images are taken and once the target is identified on the computer monitor, it can be marked and coordinates calculated by the computer. With the patient in this position, local anesthetic is injected into the skin and deeper breast. A vacuum assisted core biopsy device is then inserted up to the calculated coordinates. Images are taken to confirm that the device is in the proper location. Samples are then taken followed by images to prove that the area was adequately sampled. If sampling microcalcifications, the cores/tissue samples can also be imaged to show some were removed and are in the specimen. A marker is then deployed into the biopsy site/cavity with further images to document appropriate deployment/placement. The patient is then taken out of compression, pressure held to decrease bruising, and steristrips applied to the biopsy puncture site. A stereotactic biopsy used a special table that has digital mammography integrated into the table allowing the mammographic images to be used to guide/target needle placement for a biopsy. It is used primarily to biopsy microcalcifications or a mammographic density without an ultrasound correlate. The patient lies on the table on her stomach. The breast in question is positioned through a hole or portal in the table and into gentle compression (usually not quite as tight as for a mammogram but held there for the length of the procedure - 15-20 minutes). Images are taken and once the target is identified on the computer monitor, it can be marked and coordinates calculated by the computer. With the patient in this position, local anesthetic is injected into the skin and deeper breast. A vacuum assisted core biopsy device is then inserted up to the calculated coordinates. Images are taken to confirm that the device is in the proper location. Samples are then taken followed by images to prove that the area was adequately sampled. If sampling microcalcifications, the cores/tissue samples can also be imaged to show some were removed and are in the specimen. A marker is then deployed into the biopsy site/cavity with further images to document appropriate deployment/placement. The patient is then taken out of compression, pressure held to decrease bruising, and steristrips applied to the biopsy puncture site.

A stereotactic biopsy is a form of needle biopsy. "Stereotactic" refers to method in which we will image the finding, in order to guide the needle. A stereotactic biopsy is the way we biopsy a mammogram finding, it is not used for ultrasound or MRI findings. If the finding is a cluster of calcifications found on mammography, this will be the preferable mode of biopsy. Nodules are often seen both on mammography and sonography and then an ultrasound guided biopsy is faster, cheaper, and more comfortable for the patient. When we refer to a stereotactic biopsy most facilities are using a vacuum-assisted devise (needle) but this is not part of the definition of stereotactic. A vacuum-assisted devise is particularly beneficial when sampling calcifications, as quantity of tissue retrieved will contribute to accuracy of the diagnosis. This is not necessarily the case for masses. A stereotactic biopsy is a form of needle biopsy. "Stereotactic" refers to method in which we will image the finding, in order to guide the needle. A stereotactic biopsy is the way we biopsy a mammogram finding, it is not used for ultrasound or MRI findings. If the finding is a cluster of calcifications found on mammography, this will be the preferable mode of biopsy. Nodules are often seen both on mammography and sonography and then an ultrasound guided biopsy is faster, cheaper, and more comfortable for the patient. When we refer to a stereotactic biopsy most facilities are using a vacuum-assisted devise (needle) but this is not part of the definition of stereotactic. A vacuum-assisted devise is particularly beneficial when sampling calcifications, as quantity of tissue retrieved will contribute to accuracy of the diagnosis. This is not necessarily the case for masses.

For almost all findings found by imaging (mammography, sonography, or MRI) a needle biopsy is the preferred next step. Firstly, most of the findings (nodules and calcifications) which we identify are benign, so surgery can be avoided. Sometimes we are quite certain that the finding is malignant but still a needle biopsy is performed so that the surgeon performs surgery knowing what s/he is going after. For example, if the surgery is removal of a biopsy-proven cancer (lumpectomy) then they should remove larger margins. In this day and age it is fairly unusual to go to surgery to remove a nodule that the surgeon does not know what it is. Furthermore, if the diagnosis of cancer has been established in advance, then the surgeon will do the evaluation of axillary lymph nodes (sentinal node biopsy) at the time of the initial surgery (a one-step procedure). Also, they will be planning for the best cosmetic result.

When a lump is felt, but no abnormality is identified on imaging studies, a surgeon may still opt to remove it. In that scenario s/he does not know what they will find at surgery. A needle biopsy may or may not be done first. If a needle biopsy is being done, it is based on the palpable finding (feeling the lump) this would be done by the surgeon, not the radiologist. For almost all findings found by imaging (mammography, sonography, or MRI) a needle biopsy is the preferred next step. Firstly, most of the findings (nodules and calcifications) which we identify are benign, so surgery can be avoided. Sometimes we are quite certain that the finding is malignant but still a needle biopsy is performed so that the surgeon performs surgery knowing what s/he is going after. For example, if the surgery is removal of a biopsy-proven cancer (lumpectomy) then they should remove larger margins. In this day and age it is fairly unusual to go to surgery to remove a nodule that the surgeon does not know what it is. Furthermore, if the diagnosis of cancer has been established in advance, then the surgeon will do the evaluation of axillary lymph nodes (sentinal node biopsy) at the time of the initial surgery (a one-step procedure). Also, they will be planning for the best cosmetic result.

When a lump is felt, but no abnormality is identified on imaging studies, a surgeon may still opt to remove it. In that scenario s/he does not know what they will find at surgery. A needle biopsy may or may not be done first. If a needle biopsy is being done, it is based on the palpable finding (feeling the lump) this would be done by the surgeon, not the radiologist.