Minimally invasive breast biopsies are rapidly replacing open surgical biopsy. Percutaneous breast biopsy can be performed with several possible guidance technologies. Other chapters in this book describe techniques for ultrasound-guided minimally invasive biopsy of lesions detected with ultrasound, and for percutaneous biopsy of palpable breast lesions based upon palpation. Stereotactic breast biopsy is a minimally invasive technique for the sampling of nonpalpable breast lesions detected on mammography.1,2 If the lesion is only visualized on one imaging modality, that modality should be used for guidance during the biopsy procedure. In cases where the lesion is visualized by more than 1 imaging modality, the modality utilized for guiding the biopsy device should be the modality expected to afford the least complicated biopsy. Stereotactic breast biopsy technology was introduced into the United States by Dr. Kambiz Dowlat, a surgeon at Rush University Medical College, in the late 1980s (Fig. 29-1).3
First stereotactic table in the United States. (Used with permission of Dr. Kambiz Dolatshahi.)
This technology enables the surgeon to consistently obtain sufficient tissue for the pathologist to establish a diagnosis, as well as allowing for the determination of any relevant receptors in malignant lesions.4,5 In contrast to open surgical breast biopsy, stereotactic biopsy takes less time, needs only local anesthetic, requires only a minimal incision without the potential for significant parenchymal and skin scarring, and is more cost- effective. Following stereotactic biopsy, there is essentially no recovery period, and there is no breast deformity at the biopsy site. An additional advantage of stereotactic biopsy over traditional needle localization and open surgical biopsy is that stereotactic biopsy can be performed on a lesion seen in only one mammographic view, in contrast to traditional needle localization, which is only possible for a lesion seen in 2 orthogonal mammographic views. (It is possible to use stereotactic guidance for needle localization of a lesion seen in only 1 mammographic view.)
The term "stereotactic" comes from the same root as the terms "stereophonic" and "stereoscopic." The word "stereophonic" refers to the presentation of sound from 2 speakers to create the illusion of 3-dimensional sound, and the word "stereoscopic" refers to the presentation of 2 images simultaneously to create the illusion of a 3-dimensional image. Stereotactic breast imaging involves taking 2 digital x-ray images of the breast from different angles and using a computer to analyze the information from these 2 images to reconstruct the location of a breast lesion in 3-dimensional space. The computer then uses the data to help the physician guide a needle to the precise location of the lesion in the breast.
The principle of stereotactic imaging can best be understood by analogy to human vision and depth perception. The basis of experiencing 3-dimensional vision is depth perception. Depth perception gives humans the ability to ...