What is a Stereotactic Breast Biopsy? 

Radiologists specialized in Women’s Imaging look for subtle tissue changes in the breast including small microcalcifications

There are many findings that a radiologist looks for on a screening or diagnostic mammogram to distinguish normal tissues from subtle changes of pre-cancer or cancer. These changes may be as obvious as a mass or as subtle as tiny white spots as small as grains of sand called microcalcifications. The term “microcalcifications” refers to the microscopic size of deposits that are actually composed of many kinds of minerals, not just calcium. If this finding is noted on a screening mammogram, then further radiology imaging of the calcifications is necessary. This added evaluation is called a diagnostic mammogram and uses a specialized mammogram technique called “magnification”. 

What Are Magnification Views? 

These special mammogram views are performed on the same mammogram machine that performs a 3D screening mammogram. However, the regular plastic paddles and part of the mammogram machine are changed out to allow for a tall plastic stand to be situated called a “magnification stand”. The focal spot of the mammogram machine also changes. This combination of imaging the breast on a higher stand and changing parameters of the machine allows fine details in the breast like calcifications to be ‘magnified”. 

Although the mechanism is different, think of the process as similar to a “magnifying glass for the breast”. 

Who Interprets These Closer Look Images? 

A specialized radiologist with many years of training in Women’s Imaging or Breast Imaging interprets the magnification images to distinguish the different patterns of calcifications and whether there are any associated findings. 

The more experience the radiologist has, the more confident we can be if a particular finding can be followed or if it needs to be biopsied. 

Some patterns of calcifications can be followed while others may require a needle biopsy to determine if they are benign or cancerous or in between (atypical or precancer). Calcifications are described and categorized by the American College of Radiology under a special lexicon called the Breast Imaging – Reporting and Data System, called BI-RADS for short. 

What Do Breast Calcifications Indicate?

The appearance of breast calcifications, the distribution, and any other associated findings may signal early changes in the breast tissue. We know that some patterns of calcifications are more suspicious than others. For example, diffusely scattered vague calcifications throughout the breasts are usually benign (noncancerous). However, other patterns such as irregular microcalcifications forming a small tight cluster or growing along a larger segment of the breast may suggest an early pathologic (atypical, precancer, or cancerous) abnormality. 

How is a Stereotactic Breast Biopsy Performed? 

The calcifications may be so subtle that they need to be seen with magnification so they can not be felt. They are also not typically visible under breast ultrasound or Magnetic Resonance Imaging (MRI) because they do not have any measurable mass and are not vascular. Therefore, special means of performing a minimally invasive breast biopsy have been developed, called the Stereotactic Breast Biopsy.  Using magnified high-resolution radiology imaging and triangulation techniques you learned in geometry, the calcifications are localized in 3D. 

A special x-ray tube inside the stereotactic table takes low-dose radiology images of the calcifications from various angles. These images taken from three angles allow the calcifications to be localized in 3D space. 

What Should I Do to Prepare before the Stereotactic Biopsy?

This procedure is usually scheduled for a different day than the diagnostic mammogram workup to give you time and instructions to prepare. We ask that you do not take medicines that can thin the blood unless you are directed to continue taking them by your referring physician. Some patients may have special reasons they need to stay on their blood thinners such as a recent metal bore cardiac stent or clotting disorder. Always listen to your referring clinician regarding those decisions. We advise against taking aspirin if you are solely on it for prevention reasons. 

• Do not use deodorant or body lotions or powders on the breast as this may produce false alarms as small aluminum or metallic particles may mimic calcifications. 
• We ask that you refrain from any rigorous activities for one to two days after the procedure. So plan your tennis match either before or several days after your stereotactic breast biopsy. If you are planning an active vacation to include swimming, rigorous hiking, skiing, you may want to postpone the biopsy until you return. Even though there will be only a tiny nick on the skin, we want to minimize the chance of soreness, infection, or bleeding at the site. 

What Should I Expect on the Day of the Procedure? 

On the day of the procedure, you will lie on your abdomen on a special padded x-ray protected padded table which looks like a massage table.  Like all of our procedures, you will see several assistants to help with the procedure- the Technologist, the Radiologist, and a Patient Navigator. The technologist will obtain a few low-dose mammography magnification views for targeting. The radiologist will anesthetize the skin with a tiny numbing needle and use Stereotactic Guidance to see exactly where the calcifications are located in 3D space. Another special needle called a “probe” is then inserted at the target site, more anesthetic is given through that probe, and a light vacuum is directed to the calcifications. A sample obtained is x-rayed and is picked up by the Pathologist. 

What Should I Expect After the Biopsy? 

You will likely experience slight bruising of the breast for a few days. Some women may complain of feeling a lump under the biopsy site for up to a week. When we remove tissue samples containing the breast calcifications, the body sends serum and blood to that area. If a small lump develops, this is the body’s way of healing that area. However, if the lump is larger than the size of a small plum, please call our Clinical Care Team at The Women’s Imaging Center and select the physician/ patient pathology phone option to discuss any changes to your protocol. 

Infection is extremely rare, but if you have any redness at the biopsy site that does not follow the line of the tape, or any fevers or chills, please call us or return to The Women’s Imaging Center for evaluation. Direct contact sensitivity from the tape on the skin can be common in some people and often is associated with a geographic non-warm, non-streaking area that fits the line of the tape perfectly. So if the tape is itchy or burning, remove it and wear a tight sports bra instead. Call us or your referring clinician or if you have any concerns at any time. 

How Do I Obtain My Biopsy Results? 

Results are available in 1-2 working days after the stereotactic breast biopsy. Note that if the stereotactic breast biopsy is performed on a Thursday or a Friday, for example, then results will be available on Monday or Tuesday respectively. The Women’s Imaging Center Patient Navigator and the Radiologist correlate the results and coordinate any follow-up care or management indicated. Follow-up magnification images after biopsy may be recommended even for benign biopsies. If the biopsy proves to be atypical, precancer, or cancer, then contrast Breast MRI will be recommended at The Women’s Imaging Center to help in treatment planning. We will work with your referring clinician to coordinate an individualized treatment plan with surgeons or oncologists to fit your particular needs.