Stereotactic Breast Biopsy

What is a stereotactic breast biopsy?

A stereotactic breast biopsy is a special mammogram used to guide a biopsy. You may also hear this referred to as a tomosynthesis-guided biopsy. A mammogram takes low-dose X-rays of your breast that can reveal abnormal tissue or “suspicious” areas that may be cancer. During a biopsy, a healthcare provider removes the suspicious tissue so it can be tested for cancer cells. A biopsy is the only way to know if someone has cancer.

Stereotactic biopsies have been around for a little over 35 years. They’re a reliable and relatively noninvasive way to confirm whether or not a person has breast cancer.

What is a stereotactic biopsy used for?

Your healthcare provider may order a stereotactic biopsy if they find abnormal (potentially cancerous) tissue on a breast ultrasound, mammogram or MRI. While imaging can show abnormalities inside of your breast, a stereotactic biopsy can confirm whether the abnormality is a sign of cancer, a benign (noncancerous) growth or something else.

You may need a stereotactic biopsy if an imaging procedure finds:

• A lump, or tumor.
• Collections of calcium deposits, called microcalcifications.
• Changes to your breast tissue (especially in an area where you previously had surgery).

If the tissue turns out to be cancer, a stereotactic biopsy can help your healthcare provider plan treatment.

Who performs this procedure?

A radiologist with special training in stereotactic breast biopsies performs the procedure. A separate provider, called a pathologist, examines the tissue sample underneath a microscope to check for cancer cells.

How does the test work?

Stereotactic biopsy uses a special mammography machine to locate suspicious tissue and guide a biopsy. The machine takes X-rays of your breast from multiple angles and sends this information to a computer. The radiologist selects the abnormal area to biopsy. Based on this, the computer uses calculations to guide the radiologist to place the biopsy device in the correct area. The radiologist then uses the device to collect the samples from the area.

Throughout the procedure, the radiologist will use this technology to verify that they’re sampling tissue from the correct spot. They’ll ensure they’ve collected enough tissue for a sample that can produce accurate results.

How do I prepare for a stereotactic biopsy?

Your healthcare provider will ask questions to ensure the procedure is safe and timed correctly. They’ll ask about:

• Your medical history: Including your biological family’s medical history and your past and current conditions and treatments. Let your provider know if you have any allergies, especially to local anesthesia.
• Medicines you’re taking: Including prescriptions, over-the-counter medications and supplements. As there’s a risk of bleeding, it’s especially important to let your provider know if you’re taking blood thinners, like aspirin. Follow your provider’s guidance about continuing or stopping medications before the procedure.
• Pregnancy: Your provider will need to know if you’re pregnant because too many X-rays may be harmful to a fetus. Some types of local numbing medication also shouldn’t be used during pregnancy. These can be avoided in the case of pregnancy. Follow your healthcare provider’s guidance about how to proceed if you’re pregnant.

It’s also a good idea to plan for a close friend or family member to drive you home. Most people are physically able to drive after a stereotactic biopsy. Still, having a procedure to determine if you have cancer can be emotionally draining and stressful. It can help to have someone you trust close by.

What should I expect on the day of the procedure?

Plan for the procedure to take about an hour in total. The biopsy part should only take a few minutes. On the day of your biopsy:

• Wear comfortable clothes so you can easily change into a hospital gown.
• Bring a sports bra (tight and supportive) to wear after the procedure.
• Don’t wear deodorant or use lotions, powders other related products on your arms, underarms or breasts. They can distort the X-ray and interfere with the results.
• Come prepared to remove glasses, dentures, jewelry (including earrings) or other metal objects. They can also interfere with the X-ray.
• Be aware that you’ll be instructed not to shower for 24 hours after the procedure.

What should I expect during a stereotactic biopsy?

You’ll be awake for the entire procedure, but your breast will be numb, so you won’t feel pain.

1. You’ll lie facedown on an exam table that has an opening for your breast. Your breast will extend below the table through the opening. Two plates will hold your breast in place.
   *If you’re unable to lie face down, there are machines at some locations that allow you to sit, so let your healthcare provider know before the biopsy if that’s the case.
2. The table will raise so your healthcare provider can access your breast. Once you’re in position, the machine will take X-rays that show different angles of your breast and send this information to a computer. The computer will determine the locations on your breast that will guide the biopsy.
3. The healthcare provider will clean your breast with an antiseptic or soap and inject local anesthesia to numb your breast. You may feel a slight prick.
4. Once your breast is numb, the provider will make a tiny nick into your skin and insert the biopsy needle. A vacuum-assisted device (VAD) connected to the needle will use pressure to quickly remove tissue. You’ll receive more numbing medication while the samples are being taken. Your provider can take multiple samples with only a single skin nick.
5. They’ll remove the needle.
6. Your provider will insert a small metal clip into your breast to mark where the tissue was taken. It can help if you need future procedures or surgery in this area. You won’t be able to feel the clip, and it’s perfectly safe. It doesn’t set off metal detectors and you can still get MRIs.

Afterward, a healthcare provider will put pressure on the biopsy site to stop any bleeding. They’ll cover it with gauze or a bandage. They may apply an ice pack to prevent swelling.

Finally, you’ll have a gentle mammogram so the radiologist can make sure the biopsy clip is in the correct location.

What should I expect after the test?

You may need a brief recovery period before you leave, but you’ll be able to go home that same day. You may notice slight bruising or swelling and experience some soreness, but this usually improves within a few weeks at most.

If you’re uncomfortable, your healthcare provider may recommend over-the-counter pain medicine. You should apply an ice pack to the area (20 minutes on and 20 minutes off) for the first few hours after the biopsy. You’ll receive additional instructions on how to take care of the area.

It’s a good idea to avoid any strenuous activity for 24 to 48 hours after the biopsy. Most people can resume their routine after this waiting period, but some may need more time. Follow your healthcare provider’s guidance about caring for yourself while you recover.

What are the risks of this test? Are there side effects?

A stereotactic biopsy is a safe procedure. Still, any procedure that requires incisions (cuts) comes with certain risks, including bleeding, fluid or blood build-up and infection.

How painful is a stereotactic biopsy?

Most people don’t experience pain during the procedure because of the anesthesia. You may feel a slight pinch or prick when you get the anesthesia injection. You may feel pressure when the biopsy needle goes in.

Some people are more likely to experience pain or discomfort than others. For instance, if you have dense breast tissue or if the tumor is directly behind a sensitive area (like your nipple), you may be more likely to feel pain or discomfort during the biopsy.

Most discomfort relates to remaining in the same position for an hour. For example, turning your head to lie face down on the table may cause neck stiffness afterward.

What type of results do you get, and what do the results mean?

The radiologist or your primary care provider will tell you whether you’ve tested positive or negative for cancer. You might need follow-up tests if the results were unclear (inconclusive). Follow your provider’s guidance when it comes to the next steps.

When should I know the results of the test?

It can take anywhere from a few days to up to a week for results to come in. Before you leave the test, ask your provider how much time you should allow to receive your results and how you’ll receive them.

What percentage of stereotactic biopsies are malignant?

Having a stereotactic biopsy can feel stressful, as it usually follows a procedure that’s already found suspicious tissue. Most biopsies, however — including stereotactic biopsies — come back negative. A recent study found that less than 30% of people who had a stereotactic biopsy tested positive for cancer.

When should I call my doctor?

Call if you’re noticing signs that the biopsy site isn’t healing as it should. Your healthcare provider should know if you have:

• Swelling that doesn’t get better (or worsens).
• Bleeding or drainage (like fluid or pus) from the biopsy site.
• Redness, pain or warmth at the biopsy site.

A note from Cleveland Clinic

Learning that you’ll need a stereotactic biopsy can feel stressful, as it usually means you have “suspicious” tissue that could be cancer. It’s important to remember that this procedure is still about a diagnosis. Most people — including those with “suspicious” results from a screening procedure — don’t test positive for cancer. In that case, a stereotactic biopsy can put your mind at ease. If you have cancer, this procedure can detect it early, when treatment is most effective.