Stereotactic-Guided Vacuum-Assisted Core Biopsy

A breast lump or an abnormality in the breast is often detected by physical examination, mammography or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous.

A breast biopsy is performed to remove some cells—surgically or through a less invasive procedure involving a hollow needle—from a suspicious area in the breast and examine them under a microscope. Image-guided needle biopsy is not designed to remove the entire abnormality, just a small portion for testing.

An image-guided biopsy is performed when the breast’s abnormal area is too small to be felt, making it difficult to locate by hand. In an MRI-assisted breast biopsy, a high-powered magnet is used to help guide the radiologist’s instruments to the site of the abnormal growth.

What Are Some Common Uses of the Procedure?

A stereotactic breast biopsy is performed when a mammogram shows a breast abnormality such as:

  • A suspicious solid mass
  • Microcalcifications (a tiny cluster of small calcium deposits)
  • A distortion in the structure of the breast tissue
  • An area of abnormal tissue change
  • A new mass or area of calcium deposits present at a previous surgery site

Stereotactic breast biopsy is also performed when the patient or physician strongly prefers a non-surgical method of assessing a breast abnormality. Stereotactic guidance is used in two biopsy procedures:

  • Core needle (CN) uses a large hollow needle to remove one sample of breast tissue per insertion
  • Vacuum-assisted device (VAD) uses a vacuum-powered instrument to collect multiple tissue samples during one needle insertion

How Should I Prepare?

You may be asked to remove some or all of your clothes and wear a gown during the exam. You may also be asked to remove jewelry, dentures, eyeglasses and any metal objects or clothing that might interfere with the X-ray images.

Women should always inform their physicians if there is any possibility that they are pregnant. Some procedures using image-guidance are typically not performed during pregnancy because radiation can be harmful to the fetus. You should not wear deodorant, powder, lotion or perfume under your arms or on your breasts on the day of the exam.

Before a needle biopsy, you should report to your doctor all medications you are taking, including herbal supplements, and if you have any allergies, especially anesthesia. Your physician will advise you to stop taking aspirin or blood thinners three days before your procedure.

Also, inform your doctor about recent illnesses or other medical conditions.

You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you will have to be sedated.

How Is the Procedure Performed?

A specially trained radiologist most often will perform your stereotactic breast biopsy. You will lie face down on a moveable exam table and the affected breast or breasts will be positioned into openings in the table. The table will then be raised and the procedure performed beneath it. The breast will be compressed and held in position throughout the procedure. A local anesthetic will be injected into the breast to numb it.

Several stereotactic pairs of X-ray images will be taken. A tiny nick will be made in the skin at the site where the biopsy needle is inserted. The radiologist will then insert the needle and advance it to the location of the abnormality using the X-ray and computer-generated coordinates. X-ray images are again obtained to confirm that the needle tip is actually within the lesion.

Tissue samples are removed using one of two methods:

  • In a core needle biopsy, the automated mechanism is activated, moving the needle forward to obtain “cores” of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.
  • With a vacuum-assisted device (VAD), vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, eight to 10 samples of tissue are collected from around the lesion.

After the sampling, the needle will be removed and a final set of images will be taken.

A small tissue marker may be placed at the site to locate it in the future, if necessary. Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin will be covered with a dressing. No sutures are needed. A mammogram may be performed to confirm that the marker is in the proper position. This procedure is usually completed within an hour.

What Can I Expect?

Before the procedure, a nurse will meet with you to complete an assessment, explain the process and provide the appropriate paperwork. The radiologist then meets with you to answer any questions and has you sign consent forms for the procedure.

The nurse will review the discharge instructions with you before you leave. A copy of the discharge instructions will be provided for you to take home for reference. 

Schedule An Appointment

To schedule an appointment at one of the Northside Hospital Gwinnett or Duluth locations, call 678-312-3444.

To schedule an appointment at a Northside Hospital Atlanta, Forsyth or Cherokee location, call 404-851-6577.