How to Order a Stereotactic Breast Biopsy
Order stereotactic core needle biopsy for suspicious nonpalpable mammographic abnormalities, particularly microcalcifications, when the lesion is amenable to the procedure and classified as BI-RADS category 4 or 5. 1
Indications for Stereotactic Biopsy
Order stereotactic core needle biopsy when:
- Suspicious or highly suggestive mammographic findings (BI-RADS 4-5) are present 1
- Microcalcifications are the primary finding (ultrasound cannot reliably biopsy calcifications) 2
- The lesion is nonpalpable and requires image guidance 2
Patient and Lesion Suitability Assessment
Before ordering, verify the patient and lesion meet technical requirements: 2
Contraindications to stereotactic biopsy include:
- Breast too small to accommodate the biopsy probe 2
- Inadequate breast thickness to allow full throw of the device 2
- Lesions just under the skin or in extremely posterior locations 2
- Widely separated calcifications that pose difficulties with stereotactic coordinates 2
- Microcalcifications not tightly clustered or poorly visualized on stereotactic imaging 2
- Uncooperative patient 2
If any of these adverse factors exist, order image-directed open surgical biopsy instead. 2
Specific Ordering Instructions
When ordering stereotactic core needle biopsy, specify: 2, 1
- Multiple cores should be obtained (typically 8-10 cores) 2
- Specimen radiography must be performed to confirm adequate sampling of microcalcifications 2
- Marker clip placement at biopsy site is required, especially for small lesions likely to be completely removed, to enable localization for definitive excision if needed 2, 1
- Leave some microcalcifications at the site when DCIS is diagnosed to accurately localize for definitive excision 2
Alternative Biopsy Methods
Core needle biopsy is preferred over fine-needle aspiration (FNA) for nonpalpable lesions, as both core needle and excisional biopsy are more accurate than FNA 1
For nonpalpable masses without microcalcifications, order ultrasound-guided core needle biopsy instead of stereotactic biopsy 2
Critical Caveat
Be aware that approximately 20% of cases diagnosed as DCIS on stereotactic core needle biopsy will have areas of invasive carcinoma at surgical excision. 2 This underscores the importance of definitive surgical management following a DCIS diagnosis on core biopsy.
Follow-up Requirements
After stereotactic biopsy results: 1
- Benign and image-concordant results: return to screening or follow-up mammography at 6-12 months for 1-2 years 1
- Benign but image-discordant results: surgical excision is required 1
- Atypical hyperplasia, LCIS, or indeterminate lesions: surgical excision recommended 1
- Malignant results: proceed to definitive surgical management 1