American Breast Cancer Guide - Stereotactic Breast Biopsy

Edythe has been a member of the nursing profession for more than 35 years, and she understands the importance of yearly mammograms. When we notified her to return for additional films of her left breast, she became concerned. Her mammogram revealed a small 1-2mm calcium deposit that was suspicious of early breast cancer.

Current estimates cite that one in eight women will experience breast cancer during their lifetime. Mammography is the best test available for finding small breast cancers, but until recently, women with an abnormality found on a mammography had to undergo a surgical biopsy. New biopsy methods now offer a safer, more reliable and less invasive alternative.

There is a common misconception that radiologists diagnose breast cancer directly from a woman’s yearly screening mammogram. Usually, the mammogram only illustrates possible abnormalities that might require further evaluation. Approximately 10% of women must return for extra mammography views or ultrasound of a particular area. Many times, the extra views show nothing wrong; however, when they confirm a suspicious finding, a biopsy of the tissue is required to determine if cancer is present. Although 70-80% of abnormalities found on mammography represent changes that are benign, a biopsy is the only way to be sure.

Stereotactic breast biopsies represent a new way to precisely and accurately sample tissue from a suspected abnormality found on a mammogram without surgery. Since the majority of women with an abnormal mammogram do not have breast cancer, but rather one of several benign breast conditions, stereotactic breast biopsy spares most women the discomfort and scarring associated with a surgical breast biopsy. Compared to surgery, stereotactic breast biopsy is also quicker, less painful, and less costly—there are fewer complications, and the procedure requires minimal recovery time. The entire biopsy is obtained through a tiny nick in the skin no more than 5mm in size. There is no need for sutures; doctors simply tape a small dressing to the site. Within days, the skin nick has healed, and there is no longer evidence of a biopsy.

At least half of the women found to have breast cancer by a surgical biopsy undergo a second surgery to ensure the entire tumor is removed or to remove lymph nodes from the armpit to determine if the cancer has spread. Stereotactic breast biopsy allows women found to have breast cancer the opportunity to receive pre-operative counseling and to arrive at a plan that involves a single surgical procedure.

With dedicated stereotactic breast biopsy instruments, the woman lies on her stomach with the breast suspended through an opening in the biopsy table. The table is then elevated so the physician can perform the biopsy from below, with the breast being compressed similarly to a conventional mammogram. At modern centers, the x-ray images are obtained using a 2-inch square digital detector instead of an x-ray film. In this way, the x-ray images used to guide the biopsy procedure are displayed on a computer monitor within seconds. Using digital imaging technology cuts the procedure time in half.

The word “stereotactic” simply means precise location in space. We use images of the breast obtained at different angles to triangulate the exact coordinates of the abnormality within the breast. With the breast still in compression, we cleanse the skin and then inject local anesthetic to freeze the area. We then use a device called the Mammotome® to obtain the tissue samples. Once placed to the proper coordinates, the Mammotome® device allows removal of multiple tissue samples without removing the needle from the breast.

It only takes a few minutes to obtain the tissue necessary for the pathologist to make a complete diagnosis. Many times, the entire abnormality is removed in this way. In this case, we place a tiny surgical clip through the Mammotome® needle to mark the spot.

Afterwards, a Steri-strip is used to close the skin nick, and for a few minutes our nurse applies compression to the area to ensure any bleeding has stopped. We then tape a small gauze dressing to the breast and apply a small ice-pack that can be slipped inside the brassiere. The procedure takes less than one hour.

Edythe was very glad she elected to undergo stereotactic breast biopsy. For her, the procedure was almost painless; her shoulder was mildly stiff from lying on the stereotactic table. The next day, she was even happier to learn the biopsy was benign. From her long nursing experience, she was familiar with surgical biopsies. She found stereotactic breast biopsy to be a vast improvement. If the radiologist reading your mammogram recommends a breast biopsy, discuss with them or your doctor if you can take advantage of this less invasive alternative.