Stereotactic Biopsy: Did the Radiologist Get it Right?

There is a skill and science to doing a complex procedure like stereotactic biopsy. To become proficient at it requires practice and doing a high volume of these procedures.

It also requires special equipment. Do we rely on trust that the right area was, in fact, sampled? No, we rely on an x-ray of the removed specimen to make sure the radiologist indeed removed the suspicious area that was targeted for biopsy.

The most important contributor to success is getting an adequate sampling of tissue from the area in question. This can mean that anywhere from 6 to 15 samples of tissue may be removed through the tiny opening where the stereotactic needle is inserted into the breast.

One or more titanium or stainless steel clips are then placed to mark the spot where the tissue was removed. The clips are necessary because, in a matter of weeks, fatty breast tissue will fill in the hollow area. Without marking the area internally, there would be no accurate way to know where the biopsy was actually done.

Before placing these clips, the radiologist wants to know that he or she has hit the bulls-eye. This is done by x-raying the tiny strips of tissue that are removed. If there are calcifications in the tissue, then the x-ray will show them.

Tiny irregularly shaped specs that are tightly clustered together may be a sign of cancer. This provides a high sense of confidence that the targeted area was indeed sampled and that an adequate number of calcifications were obtained for pathology to review.

Before having a stereotactic biopsy, ask the radiologist the following questions, and make sure you get the answers:

• How many of these procedures have you personally performed? (You want an answer in the 100s.)
• How many samples do you plan to take? (You want to hear a number between 6 and 15.)
• Do you x-ray the tissue you remove before sending it to pathology? (Yes)
• Do you place a clip inside my breast to mark the place from which the tissue was removed? (Yes)
• Will you then do another mammogram to ensure that the clip shows the area that was in fact biopsied? (Yes)

If you get different answers, ask more questions. Or ask to speak with a more senior radiologist. If you have a doctor who refuses to answer these questions, pack up your breasts and yourself, and go to another breast center.