Mammographically Guided Procedures

Abstract

Most breast lesions are biopsied under ultrasound guidance. However, there are some lesions (masses, architectural distortion, and calcifications) that are only seen mammographically. In these cases, a mammographic guidance system is needed for needle core biopsy sampling. The concept and design of a stereotactic breast biopsy system was developed more than 30 years ago to solve this clinical scenario. Now, there are improvements and diversity among the different stereotactic biopsy systems and needles to optimize targeting and patient care. Stereotactic needle core biopsy has become an efficient alternative to an open surgical biopsy to obtain pathology. With its high diagnostic accuracy, stereotactic needle core biopsy has contributed to reducing the costs and risks associated with a surgical procedure. This chapter will review the principles of stereotactic core biopsy and detail the procedure, complications, outcomes, and pathologic correlation. Challenging cases will be discussed to familiarize the reader to these uneasy situations. In addition, a brief review of mammographically guided needle localization is included in this chapter. The goal of the chapter is to help the readers optimize their practice and to achieve a 100% success rate with this type of biopsy.