Stereotactic Biopsy: What You Need to Know

I just had a stereotactic biopsy. How do they know they sampled the right area in my breast?

If I got a nickel for every time this question is posed to me via the Internet, I could likely retire right now. So, if you find yourself wondering, or if you have a girlfriend who is or will be having a core needle biopsy, here is the process that the medical technician should follow to ensure that the right area is captured in the biopsy tissue that is removed. And what are the crucial components of this process?

• Specialization
• Quality control

Here is how this biopsy must be done:

1. A breast-imaging radiologist (and not a general radiologist) should be doing the procedure. Why? Because this is a time for specialization. Why would you go to a radiologist who reads chest x-rays and the images of broken arms and fingers? Let's face it: There are no bones in breast tissue.
2. The procedure is done while using mammography as a visual guide. After injecting the area with numbing medicine, the radiologist inserts a large-gauge needle and then uses the mammogram equipment (known asstereotactic mammography equipment) to bulls-eye the area that needs to be sampled. What the radiologist is looking for in the magnified views of the x-ray machine are clusters of tiny microcalcifications (or "calcs"), which are also irregular in their individual shapes when looked at on magnification. These tiny calcs ("microcalcs") are sometimes called pleomorphic-appearing calcifications.
3. Using the large needle, the doctor samples 5 to 7 bits of tissue that he or she can see contain microcalcs.
4. After the doctor has finished sampling the microcalcs, he or she then places a tiny titanium clip at exactly the places where tissue was removed.
5. The tissue samples that were removed are then x-rayed (using mammography in another room) to ensure that adequate samples of the microcalcs were in fact captured.
6. Then, another mammogram machine is used to image the breast itself, to also confirm that the calc sampling was adequate, that the right area was sampled, and that the clip is located where it belongs.
7. Then, and only then, are the tissue samples sent to Breast Pathology for analysis.

So, if you are going to have a stereotactic biopsy of microcalcifications that were originally found on a mammogram, make sure that a breast-imaging radiologist is on duty that day, and that the above procedure is followed. You can make sure of this by asking about these two crucial details when you arrive for the procedure. Your vigilance will help ensure that the bulls-eye gets hit and that what was intended to be sampled for biopsy was in fact sampled.

Finally, remember that not all of the calcs must be removed via this biopsy. If cancer is found, then the breast-cancer surgery to be done will get them all out, along with more tissue around them. And if they are benign, then the clip provides a marker that will appear in future mammograms, so that healthcare personnel will know that this area was sampled and that these calcs are in fact benign calcium deposits and nothing more. Pretty nifty, huh?

©1996-2014, Johns Hopkins University. All rights reserved. Disclosure: The information provided here is compiled by The Johns Hopkins University School of Medicine with editorial supervision by one or more of the members of the faculty of the School of Medicine pursuant to a license agreement with Yahoo! Inc. under which the School of Medicine and its faculty editors receive licensing fees and payment for services rendered within the scope of the License Agreement. Johns Hopkins subscribes to the HONcode principles of the Health on the Net Foundation.

http://health.yahoo.net/experts/breastcancer/stereotactic-biopsy-what-you-need-to-know