An Expert Overview of Stereotactic Breast Biopsy

Following an abnormal mammogram, women with certain types of abnormalities are typically referred for a stereotactic breast biopsy – an experience that may bring anxiety and uncertainty for many. Raleigh Radiology breast imaging expert Dr. Laura Thomas, who serves as head of Raleigh Radiology's Breast Imaging Department and is also Vice-Chair of WakeMed Cary Hospital’s Radiology Department, hopes to demystify this routine procedure – which most likely feels like anything other than routine for most women.

Here are her answers to patients’ most common questions about the stereotactic breast biopsy process.

What is a stereotactic breast biopsy and who needs one?

While there are a few types of breast biopsies, those women whose mammograms show certain abnormalities (microcalcifications or areas of architectural distortion) will need a stereotactic biopsy, which allows our fellowship-trained, MQSA-certified breast radiologists to use mammographic imaging while taking a tissue sample.

• Microcalcifications are small clusters of calcium deposits found in breast tissue and may signal precancerous changes to the tissue or breast cancer.

• Architectural distortion simply means the appearance of the breast tissue isn’t normal although a mass wasn’t detected.

A stereotactic breast biopsy helps ensure the abnormal area is sampled, which allows the pathologist to look carefully at those cells under a microscope to make an accurate diagnosis.

How should a patient prepare for a stereotactic breast biopsy?

Once scheduled, patients should line up a loved one to accompany them to their appointment. We recommend wearing a comfortable two-piece outfit. When possible, patients are asked to stop taking aspirin products, non-steroidal anti-inflammatory drugs (NSAIDs), or blood thinners 5 days before the procedure. Eating a light breakfast or lunch is perfectly fine and is probably a good idea.

What can patients expect once they arrive?

At Raleigh Radiology, you’ll be greeted by an experienced team of certified imaging technologists who will do their best to put you at ease and ensure the biopsy is completed as quickly and comfortably as possible. Patients will first meet with the imaging technologist and then the radiologist, who will each take time to explain the procedure and answer any questions. Raleigh Radiology’s Breast Imaging Department includes five interventional breast radiologists who can perform stereotactic breast biopsies and other procedural studies as well as 21 MQSA-certified breast radiologists, who are trained and certified in reading and interpreting screening mammogram studies.

During the biopsy, patients are seated in front of a mammogram machine in a comfortable chair with head, neck, and back support. Using 3D coordinates, your radiologist will find the abnormality.

You’ll feel light compression as the technologist takes a series of photos of the breast. Before the biopsy sample is taken, our team will clean and numb the breast to eliminate pain. Most patients just feel a slight tingling or burning. Once the sample is taken, the radiologist will mark with the area with a clip and take one last image to make sure the correct area was biopsied. In total, the appointment typically lasts around an hour and a half from start to finish.

What can I expect in terms of recovery?

Once the procedure is complete, you’ll be sent home with an ice pack and instructions to take it easy for a few hours – which also includes no heavy lifting for 24 hours. If there’s any pain at the biopsy site, your physician may recommend taking Tylenol or Ibuprofen.

When will results be available?

Results typically take approximately two full working days for the sample to get to the lab and be evaluated by a pathologist. Your radiologist or her designee will call you with the results and guide you through the next steps as needed in the event that you need to be referred to a breast surgeon or other provider.

What are some potential results a patient should be prepared for?

The good news is that 80% of stereotactic breast biopsies turn out to be non-cancerous. In most cases, your radiologist will explain the possibilities to you prior to the biopsy appointment, but there are generally three common scenarios that can play out depending on the results.

1. The first would be any benign (non-cancerous) issues such as fibrocystic changes or fibroadenoma. Less common scenarios include sclerosing adenosis, fat necrosis, or postprocedural changes that may occur after a surgery or trauma. In these instances, no treatment is typically indicated, and your radiologist will advise you on when to return for your next mammogram – which will most likely need to be within six months to a year.
2. The second scenario would be an atypical, pre-cancerous lesion or abnormal cells. Some examples of this could include a radial scar (which is NOT a scar but a benign tumor that is also referred to as a complex sclerosing lesion) or a papilloma. Treatments for these benign problems will vary and would require a referral to a breast surgeon who will work with the radiologist to provide a recommended plan of care. Occasionally a radiologist may feel that the results from the biopsy are discordant (that is, not what she/he was expecting), and the radiologist may then recommend consultation with a breast surgeon.
3. The third scenario would involve abnormal or cancerous cells that are diagnosed as either breast cancer or ductal carcinoma in situ (DCIS), which is a noninvasive precancerous condition. While your radiologist will tell you if either of these conditions is detected, Raleigh Radiology will partner with you at this point to refer you to a breast surgeon or specialist. From here, all answers regarding prognosis and plan of care will come from your breast surgeon who will help you determine the best course of treatment. In most cases, this could involve either a lumpectomy or a mastectomy that may be followed by radiation and/or chemotherapy. Raleigh Radiology will consult with your referring provider and help connect patients who need a referral with the surgeon best suited for your needs.

As always, our highly-specialized team of breast specialists will be here to guide you every step of the way – from mammography to biopsy and beyond.

Raleigh Radiology follows recommendations set forth by the American College of Radiology (ACR), the American Cancer Society (ACS), and the US Preventive Services Task Force which state that women at average risk of breast cancer get a mammogram every year beginning at age 40. Women who are at risk for breast cancer should consult with their OB/GYN for personalized screening recommendations. To schedule a mammogram, call our office at (919) 781-1437.