Stereotactic Core Biopsy

When a mammogram reveals a breast mass that cannot be felt upon examination, your doctor may order a biopsy to determine whether the mass is cancerous or benign. At Lutheran General Hospital, specially trained technologists may use x-ray guided, or stereotactic, breast biopsy to avoid more invasive surgical approaches.

• What is a stereotactic core biopsy?
• How do I schedule the test?
• What happens during the test?
• How do they take the tissue samples?
• What happens to the tissue samples taken during the test?
• Are there activities I won't be able to do after the biopsy?
• Will it be painful?
• How long will it take?

What is a stereotactic core biopsy?
Stereotactic core biopsy involves computerized or digital images that pinpoint the precise location of the mass, allowing physicians to remove a small piece of it with a needle.

A stereotactic core biopsy is ordered when doctors see abnormalities on your mammogram such as calcifications. Calcifications are a normal occurrence in aging breast tissues which have gone through changes that cause death of cells, such as cysts, injuries, or mastitis (infection). They can also be a sign that cancer may be present. Because of this potential, radiologists study closely the findings of microcalcifications found during mammography.

How do I schedule the test?
A nurse will schedule you for your biopsy. You will also see a surgeon, recommended by your primary care doctor, so that he or she can perform a clinical breast exam after viewing your mammogram and ultrasound images. This doctor will write the order or referral for the procedure. There are times that another procedure may be in your best interest and this will be discussed with you at your appointment.

What happens during the test?
During the procedure, you will lie on your stomach on a specifically designed table with an opening that allows access to your breast. A mammographer and nurse’s aide will assist the radiologist. As you lie on the table, the imaging unit is underneath the table. The table is raised, your breast is placed in a light compression (not as tight as a mammogram), and two x-ray images of your breast tissue are taken at two different angles. A computer uses the breast images to locate the area in question and calculates exact directions for the radiologist to place the special biopsy needle.

The skin of your breast is then cleansed with a special soap called Chloraprep and the radiologist then injects a local anesthetic, called lidocaine, into the breast. A small nick is made in the skin and a thin hollow biopsy needle is inserted through the nick. You may feel pressure in the breast but because of the numbing medicine already given, you should not feel anything sharp. Additional x-rays will be done throughout the biopsy to ensure proper placement.

After the tissue samples are taken and the needle is removed, your nurse will hold pressure to decrease the chance of bleeding and bruising. Small butterfly tapes (steri-strips) are then applied to the small skin nick and then a gauze bandage. A small gel ice pack is applied to decrease the chances of swelling and bruising. An additional ice pack will be sent home with you.

An additional mammogram will be done after the biopsy to document clip placement.

How do they take the tissue samples?
Tissue samples are taken using either an automatic or vacuum-assisted device. Usually four to eight samples are taken. A tissue marker is placed at the biopsy site to mark the area. This stainless steel or titanium clip is used to provide a landmark for watching for changes in the breast. This marker is MRI compatible. It will not set off any metal detectors either!

What happens to the tissue samples taken during the test?
The tissue samples are sent to pathology for careful study. These results are available to your surgeon in two to three business days. The breast health educator is also available to help you follow up on your surgeon’s recommendations.

It is not always possible to know whether a growth in the breast is cancerous, although the majority of breast biopsies, around 80%, are found to be negative or benign.

Are there activities I won’t be able to do after the biopsy?
Restrictions include not lifting anything over five pounds for 24 hours and no swinging or pushing with the side of the body on which the biopsy was performed. Before leaving you will be assessed by a breast health educator and provided verbal and written post biopsy instructions.

Will it be painful?
Most women have little or no pain, and there is no visible scar.

How long will it take?
Stereotactic biopsies typically take from 30 to 60 minutes to complete and no special preparation is required, but if you’re pregnant you should notify the technician to be sure you’re adequately protected from the x-rays used in the procedure.