Stereotactic Biopsy of the Breast: How It Works

Stereotactic biopsy meaning and principle

Stereotactic means three-dimensional localisation. Two images are acquired at different angles, typically plus and minus 15 degrees, and the software calculates the depth of the target from the shift between them. The system then positions the needle holder to the calculated coordinates.

This is why it is also described as a mammogram guided biopsy: the mammography unit itself provides the imaging. The accuracy of the mechanical targeting system matters. For the Villa Melody line the manufacturer lists a biopsy targeting accuracy of ±0.1 mm, and Villa offers an optional stereotactic biopsy system for the Melody IIID.

Stereotactic biopsy procedure: the workflow

In outline, the breast is compressed and immobilised, a scout image is taken, the lesion is marked on the two stereo images and the system calculates the position. A radiologist then positions the needle, takes a pre-fire image to confirm, obtains the samples and usually places a marker clip. Post-procedure images document the position.

Samples are sent for pathology. The workflow requires a sterile procedure area, radiologist and technologist, vacuum-assisted or core needles, markers and a reporting process for radiology-pathology correlation. Our comparison of vacuum-assisted and core needle biopsy covers device choices.

Stereotactic biopsy for calcifications and other indications

Microcalcifications are the classic indication because they are seen on mammography and are often invisible on ultrasound. Architectural distortion and some masses that are visible only on mammography are also targeted. Specimen radiography confirms that calcifications have been retrieved.

The choice between this approach and other guidance methods depends on lesion visibility and local protocols; see stereotactic versus ultrasound-guided biopsy. The decision for a particular patient always belongs to the treating clinical team.

Equipment a breast centre needs

A centre needs a mammography unit with a biopsy-capable platform, the stereotactic add-on and a compatible biopsy device, a sterile procedure set-up, a specimen radiography method and a marker policy. Processing images quickly on the acquisition station shortens the procedure.

The Melody IIID TS supports tomo-guided biopsy with the optional SBD DMD 3D device, which is relevant when lesions are better seen with tomosynthesis. Review how this fits your tomosynthesis-guided biopsy plans, and how the choice of biopsy chair or prone table affects room layout.

• Mammography unit with a biopsy-capable platform
• Stereotactic add-on with accurate targeting
• Vacuum-assisted or core biopsy device
• Specimen radiography and marker clips
• Sterile set-up and radiation-protection measures

Planning, training and quality

Procedure volume, training and a documented quality programme affect outcomes. Radiologists and technologists need procedure-specific training, and the centre should audit sampling adequacy and targeting accuracy. Check licensing requirements for the service with MOHAP, DHA or DOH as applicable.

If you are planning a biopsy-capable breast unit, Beckfinity's specialists can discuss the configurations and options available in the UAE.