Define Mammography- Stereotactic Breast Biopsy

A small portion of the breast tissue is removed by a non-surgical method using a mammography machine to determine if its abnormal.

When Does A Woman Have To Undergo A Stereotactic Breast Biopsy?

• A woman has to undergo a stereotactic breast biopsy if the mammogram image shows any of the following (1):

– a suspicious mass lesion

– microcalcifications (tiny calcium deposits)

– distorted structure of the breast tissue (architectural distortion)

– change in the appearance of the breast tissue (asymmetric density)

– presence of new mass/calcium deposits at a previous surgery site

Why Stereotactic Breast Biopsy Is The Chosen Method?

This method is chosen compared to other methods, when a small growth or the presence of micro calcifications is detected on the mammogram but it is not visible under ultrasound guidance. This characteristic makes the stereotactic breast biopsy the chosen method.

Who Performs The Procedure?

The stereotactic breast biopsy is a team effort between the radiologist, radiographer, nurse and most importantly a co-operative patient.

Why Do We Need To Use The Mammography Unit For This Procedure?

For this procedure to take place mammography machine is used. Using X-rays and computer coordinates (x,y and z ) the abnormal growth within the breast is precisely located. .

Is There Any Preparation Required By The Woman Prior To Undergoing The Stereotactic Breast Biopsy (2) & (3)?

• The patient is advised to not wear deodorant, perfume, lotion on her breast and under her arms as it would mimic presence of micro calcifications.
• The patient is advised to bring along her previous mammogram film(s) and report(s) when she come for the stereotactic breast biopsy
• Preferably the patient should be accompanied by a relative or friend who can accompany and drive her home.
• The patient is asked if she is on any anti-coagulant drugs (eg. Warfarin, Aspirin); If YES then she is advised to seek her doctor’s advice on how and when to discontinue her drug prior to the procedure.
• If the patient is diabetic, priority is given to her.
• The patient should inform the requesting physician / radiographer if she suspects that she may be pregnant.

What Happens In A Stereotactic Breast Biopsy Procedure?

There are three (3) phases procedure;

Pre-procedure

• The patient (if she is of child bearing capacity) is asked for her LMP (Last Menstrual Period) by the radiographer or the attending radiologist; the appropriate rule for this procedure would be the ’28 day rule’.
• The patient is asked for her prior mammography film(s) & report(s), if she is on any anti-coagulant drugs and if she has applied perfume, powder and lotion on her breast and under her arms.
• The patient is advised to wear a two piece attire and asked to undress (removing just the top portion of the attire).

During Procedure

• The patient would be positioned either sitting or lying on her side with the breast compressed. The choice of position is dependent upon the location of the suspicious lesion.
• The patient is continually given reassurance to gain her confidence and co-operation.
• A few mammography images are taken to determine the exact site of the abnormal area.
• After determining the area of interest it is cleaned and local anesthesia is administered to the biopsy site to numb the area.
• Following this, a small cut/nick is made on the site. Using a special instrument a needle is guided to the area of interest and several samples of breast tissue is taken to be sent to the laboratory.
• Sterile dressing is applied over the site that was biopsied.
• Depending on the location/ site of the suspicious lesion/ mass, the patient is positioned.

a) Lateral recumbent position                  b) Patient is seated facing the unit

Picture 1 (a), (b): Two common positions for an uprights stereotactic mammography system (3)

Picture 2: Detailed view on the stereotactic breast biopsy procedure (4).

 Post-procedure (5)

• The patient may feel giddy when she is propped up. So she is advised to rest for about 30 minutes to one hour before leaving the mammography suite.
• The patient is given pain killers such as paracetamol (panadol) and is advised to take the paracetamol every 4 hours (if pain persists).
• The patient is advised not to:

– remove the steri-strips/ bandage for at least 24 hours.

– have a shower 24 hours after the procedure.

– do any strenuous activity like lifting, cooking for at least 24 hours.

• The biopsy results will be sent to the requesting doctor.

References

1. Health Library. Breast Needle Biopsy. (http://www.winchesterhospital.org/health-library/article?id=2011020225)
2. Preparing for stereotactic breast biopsy (http://www.wakemed.org/body.cfm?id=1029)
3. Breast biopsy-stereotactic.(Images) (http://www.nlm.nih.gov/medlineplus/ency/article/007433.htm)
4. Benefits and Risks of Breast Biopsy.(Images) (http://www.imaginis.com/biopsy/benefits-and-risks-of-breast-biopsy)
5. Memorial Sloan Kettering Cancer Centre. (http://www.mskc.org/cancer-care/patient-education/resource/care-instructions-after-image-guided-breast-biopsy-ultrasound-mri-stereotactic Images on 10 days & 28 days. (http://www.google.com.my/imgres?start=388&biw=1024&bih=540&tbm=isch&tbnid=ZcA9_4B_woZ2M%3A&imgrefurl=http%3A%2F%2Fjezebel.com%2F5923069%2Ffor-a-super%2Bsmart-baby-leave-it-in-your-uterusforever&docid=ziXberDLOzafoM&imgurl=http%3A%2F%2Fimg.gawkerassets.com%2Fimg%2F17rn8x8ny78bojpg%2Fku-)
6. Radiology now. The “10-Day Rule” DOI: http://dx.doi.org/10.1259/0007-1285-46-551-933. January 28, 2014. (http://www.birpublications.org/doi/abs/10.1259/0007-1285-46-551-933)
7. The 28 Day Rule. (http://www3.ha.org.hk/qmh/department/Clinical%20Department/Radiology/xray.htm)
8. What is a Stereotactic Breast Biopsy? (http://www.wakemed.org/body.cfm?id=1029)