How a Stereotactic Breast Biopsy Is Different
Medically reviewed by Archana Sharma, DO, FAAP
A stereotactic breast biopsy is a procedure done on the breast tissue to check for cancer. The stereotactic breast biopsy uses a needle to take a sample. Before and after taking the sample, the healthcare worker will do a mammogram to ensure they’re sampling the abnormal area.
A healthcare provider would order a stereotactic breast biopsy over another type of breast biopsy when they want to check suspicious calcium deposits, small breast masses, or other abnormal areas found on a mammogram that can’t be seen clearly on an ultrasound.
A stereotactic breast biopsy may find cancer or another abnormality in the breast tissue, like calcifications or ductal carcinoma in situ.
This article will cover whether a stereotactic breast biopsy is painful and how this biopsy differs from fine needle aspiration and ultrasound-guided biopsies. It will describe what happens during a stereotactic breast biopsy, how long a breast biopsy takes, the role of clips, and the best sleeping positions after a breast biopsy.
Julia Kiseleva / Getty Images
Stereotactic Breast Biopsy: What Does It Remove?
Biopsies are standard tests used to remove a tissue sample for testing. Tissue samples can be from any body part and are taken in several ways. Biopsy procedures can differ in how the sample is collected, the area where it is collected, and whether the provider uses any special equipment to image the area.
A breast biopsy takes a tissue sample of an abnormal area inside the breast, typically to check if it is cancer. Three major biopsy procedures are used to take a breast tissue sample. They include:
Fine needle aspiration (FNA): An FNA uses a skinny needle and syringe to pull cells and fluid from the breast. The thinner needle makes for a less-invasive procedure than others, but there isn’t always enough tissue and information in the sample to give a definitive diagnosis.
Core needle biopsy (CNB): A core needle biopsy uses a larger needle. It’s often guided with imaging to ensure the sample is taken from the right spot. A CNB leaves the structure of the tissue sample intact, enabling the pathologist to get a better idea of how invasive a growth may be. A stereotactic breast biopsy is a type of core needle biopsy.
Surgical (open) biopsy: If surgery is done to remove all or part of the lump, your surgeon will take samples for testing at this time. Surgery is more invasive than a needle biopsy, involving cutting open the breast.
During a needle biopsy, a healthcare professional will often use imaging technologies to check that they’re sampling the right area of the breast. This makes it more likely that the tissue sample doesn’t miss the abnormal area, especially if it’s small or can’t be felt.
Imaging used for a breast biopsy includes:
Two-dimensional (2D) or three-dimensional (3D) mammogram used during a stereotactic breast biopsy
Ultrasound
Magnetic resonance imaging (MRI)
The most common reasons a healthcare provider would order a breast biopsy are that either they or you feel a lump, you notice a suspicious change in your breast, or they see an abnormal area during a screening mammogram or ultrasound.
The type of breast biopsy your healthcare provider orders for you depends on the following:
The nature of the suspicious change
How suspicious the change is
How big the lump or abnormal area is
Where the abnormal area is in the breast
If there is more than one abnormal area
Your general health
Your preference
Often, a provider will order a stereotactic breast biopsy if they’ve found a small growth or abnormal area on a mammogram that they don’t see on a breast ultrasound. The biopsy will remove only a small piece of the abnormality. If you have cancer or a calcification, you may need further surgery to remove it.
Should I Expect Pain During a Stereotactic Breast Biopsy?
A stereotactic breast biopsy may be uncomfortable. You may feel some pain. You’ll likely feel the sting of a needle while being numbed. The needle biopsy and accompanying mammograms will feel uncomfortable and cause pressure.
Depending on how the test is performed, you may need to lie down on your stomach for an hour, which may become uncomfortable.
If it hurts a lot, mention that to the biopsy provider. They can give you more numbing medicine. Additionally, you may request antianxiety medicines before the procedure if you’re worried about the pain or discomfort. Talk to the healthcare provider who will perform the procedure about their policies.
Several factors can influence how much pain you feel during a stereotactic breast biopsy. Where on the breast the biopsy is taken, the complexity and depth of the biopsy, and your personal pain tolerance can influence how much discomfort you feel.
Ask your healthcare provider about options if you think you’ll be worried about the pain or discomfort during the procedure. Let your care team know if you’re anxious about this or other procedures.
Risks and Contraindications
Biopsies are generally low risk. Needle biopsies are much less invasive than surgical biopsies, making them less risky. A stereotactic breast biopsy may bruise and have a slight chance of infection, but it is not likely to bleed excessively.
A few factors may influence your ability to have a breast biopsy:
You may need to stop taking medicines such as anticoagulants (blood thinners) like Jantoven (warfarin) if you’re getting a biopsy.
Because of the radiation risk from X-rays, stereotactic breast biopsies should be avoided during pregnancy.
The tables used for some stereotactic breast biopsies have a weight limit.
If you’re lactating, there is a small risk of developing a milk fistula (an abnormal connection from a milk duct through the skin) from a biopsy.
Stereotactic Breast Biopsy Process
A stereotactic breast biopsy is done at an imaging center, hospital, or medical provider’s office. A radiologist or surgeon usually performs the procedure.
Before
Before getting a breast biopsy, tell your healthcare provider and the provider doing the procedure about any prescriptions, over-the-counter drugs, or supplements you’re taking. They may want you to stop taking some in preparation for the procedure. You’ll also want to let them know if you may be pregnant.
On the day of the biopsy, avoid putting lotion on your breasts, and skip deodorant and antiperspirant under your arms. Avoid perfumes and powders in the area as well.
You’ll want to wear a top that’s easy to take off and put on and a comfortable bra. When you arrive for your stereotactic breast biopsy, the provider will review your medical history and why you’re getting the test.
They will have you get undressed from the waist up, and you’ll be provided a gown to cover up. Before they start the procedure, the healthcare provider will take a look at your breast.
Empty your bladder before your biopsy begins—you won’t want to be stuck needing to urinate in the middle of the procedure.
During
You’ll be fully awake during the biopsy. You may be in one of several positions. You’ll need to be able to hold the position for about an hour while the biopsy is being done. Let your provider know if these positions may be difficult to hold for an hour.
For a stereotactic breast biopsy, you may be in the following positions:
Lying face down on a biopsy table, with your breast hanging through an opening (the provider raises the table and performs the biopsy from underneath)
Sitting in an upright position in front of a mammogram machine
Either before or after you get into position, the provider will clean the breast and inject numbing medicine. You’ll probably feel stinging when the needles enter the skin.
Before they start the biopsy itself, the provider will do a mammogram. Your breast will be pressed between two flat plates. The imaging machine uses low-dose X-rays to see the inside of your breast. These images help the provider find the abnormality and ensure they take the sample from the abnormal area. The mammogram may be uncomfortable.
The provider may make a tiny cut on your breast over the area that needs to be biopsied. There are several ways a provider might take a core needle biopsy. They may use a special machine, a hollow needle, a sheath, a biopsy device, a vacuum-powered device, or a combination of these methods.
The provider moves the device or needle to the abnormal area seen on the mammogram image. After another mammogram image to confirm they’re in the right spot, they’ll take several samples.
The provider may insert a biopsy clip to mark where the sample was taken. This way, it can be easily found later if surgery is needed. They’ll do additional imaging to confirm the marker is in the right spot.
What Is a Biopsy Clip?
A biopsy clip is a small piece of metal (titanium) placed at the biopsy site to make it easier to see on imaging or in surgery.
After the tissue samples are taken and the clip is placed, the needle or other device is removed. The provider will take a final mammogram to confirm the clip placement.
The provider will give you ice for your breast and apply pressure to the wound to stop bleeding. They may place adhesive strips on the wound and cover it with a small bandage to absorb fluid, but they typically won’t put in any stitches.
With the imaging and biopsy samples, a stereotactic breast biopsy usually takes about one hour. You can get dressed and go home soon after the procedure is finished.
After
Recovery after a stereotactic breast biopsy can take a few days. You’ll want to plan to take things easy for the first 24 hours. Your breast may be sore and tender for several days. It may take a week or two for bruising to heal. The healthcare provider doing the test will tell you what activities you can do and what to avoid.
After the biopsy, your healthcare provider will send you home with information on how to care for your wound and drugs to take for the pain. After a stereotactic breast biopsy, you’ll want to sleep on your back and wear a bra to keep pressure on the area that first night.
Call your healthcare provider if you develop a fever, start seeing a lot of bleeding, or develop any other issues with your wound.
Stereotactic Breast Biopsy Results
It may take one to two weeks before you get your biopsy results. Your healthcare provider will call you when they're ready.
Your biopsy results will likely show one of the following:
Normal tissue with no sign of cancer
A benign condition that is not cancer, like papilloma or fibroadenoma
An abnormal condition that increases the risk of cancer, like atypical ductal hyperplasia or atypical lobular hyperplasia
A precancerous condition, like ductal or lobular carcinoma in situ
Breast cancer, using words like "carcinoma" and "infiltrating" or "invasive" and which may also note a grade and stage
Most biopsies come back as noncancerous (benign). A 2019 review of results from 280 stereotactic breast biopsies taken to check calcifications for cancer at the University of Texas MD Anderson Cancer Center between 2010 and 2015 found cancer in 27.9% of cases. About 23% were cancers, while 77% were carcinoma in situ (stage 0) precancerous lesions.
Further treatment depends on the results of the biopsy. You likely won't need additional procedures for benign and normal tissue conditions. Sometimes, your healthcare provider may recommend surgery to remove even a benign growth.
If you have an abnormal result that could be precancerous, your provider will likely send you to a surgeon to remove it and perform a surgical biopsy to get a better look at the whole area and do additional testing.
Summary
A stereotactic breast biopsy is a procedure used to take breast tissue samples to test for cancer and other abnormalities. Stereotactic breast biopsies involve the use of a needle to extract tissue samples. The biopsy is guided by mammogram imaging to ensure accurate sampling.
Stereotactic breast biopsies are used when a mammogram depicts something that isn't visible on ultrasound. These abnormalities include calcium deposits, small masses, or irregularities. A stereetactic biopsy might find cancer, ductal carcinoma in situ, benign breast growths, and other irregularities.
Stereotactic breast biopsies can be uncomfortable and cause pain. Discomfort depends on the biopsy location and personal pain tolerance. Pain management options are available.
A stereotactic breast biopsy usually lasts about an hour. You'll need to stay still for the whole time. You may be lying face down, sitting upright, or lying on your side. The breast is numbed and imaged using low-dose X-rays in a mammogram machine.
A needle, potentially with a vacuum or additional device, takes a sample of the abnormal breast tissue. Needle placement is confirmed with a mammogram, and a biopsy clip marks the spot where the sample was taken.
You'll be able to go home after the test is done. Your breast may be sore for a few days but should feel better soon. The bruising should clear up in about a week. Rest when needed, but most people can resume daily activities soon after the procedure.
Your biopsy results may show normal tissue, a benign condition that is not cancer, an abnormal condition that increases the risk of cancer, a precancerous disease, or breast cancer. Most biopsies do not find cancer.
Read the original article on Verywell Health.
