Technical Challenges in Image-Guided Breast Biopsy

Strategies and procedural modifications are offered to aid in successful completion of breast biopsy when patient factors or lesion factors might otherwise pose technical challenges.

Course ID: Q00538 Category:
Modalities: , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:

Breast Sonography: 2.00
Procedures: 2.00
Breast Interventions: 2.00

Mammography: 2.00
Procedures: 2.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Body: 2.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Thoracic Section: 2.00

Sonography: 2.00
Procedures: 2.00
Superficial Structures and Other Sonographic Procedures: 2.00


  1. Introduction
  2. Planning Image-guided Breast Biopsy
  3. Technical Challenges: Patient Factors
    1. Patient Comorbidities
    2. Anticoagulation
    3. Thin Breast
    4. Brest Implants
  4. Technical Challenges: Lesion Factors
    1. Conspicuity of Target
    2. Location of Target
      1. Posterior or Deep Target
      2. Superficial Target
      3. Axillary Target
      4. Subareolar Target
  5. Multimodality Target Correlation
  6. Cancellation of Image-guided Breast Biopsy
  7. Conclusion


Upon completion of this course, students will:

  1. compare open surgical breast biopsy to image-guided breast biopsy
  2. list the types of image-guided breast biopsies that can be performed
  3. list the basic steps involved with stereotactic breast biopsy
  4. state the patient position for stereotactic breast biopsy
  5. state the patient position for US-guided breast biopsy
  6. describe the patient’s arm position for US-guided breast biopsy
  7. recall the most expensive modality for breast biopsy
  8. explain the importance of pre-procedural review of diagnostic images and clinical information
  9. recall the best stereotactic approach for targets seen in the craniocaudal projection
  10. list the reasons making US the most commonly used modality for breast biopsy
  11. match the imaging modality that must be used for targets seen only at MR breast imaging
  12. list the factors that may limit a patient’s ability to have an image-guided breast biopsy
  13. recall the minimum breast thickness for standard needle use in stereotactic breast biopsy
  14. recall the minimum breast thickness for a shortened sampling chamber needle in MR-guided breast biopsy
  15. choose the best breast specimen option for thin-breasted women
  16. list the options utilized during stereotactic breast biopsy that can help thicken the breast
  17. state the position of the sampling chamber for vacuum-assisted needle biopsy
  18. recall the techniques used to ensure an adequate vacuum seal for safe needle-guided biopsy
  19. explain the necessary location for breast implants to avoid rupture
  20. list the tools used to help identify small or subtle targets before breast biopsy
  21. list landmarks used in MR breast imaging to help identify the intended target for biopsy
  22. state the important success factors when targeting a lesion in the posterior breast when using prone stereotactic-guided biopsy
  23. choose the technique used to better access lesions in the posterior breast and axillary tail
  24. list the advantages of a stereotactic breast biopsy “fitting”
  25. recall the technique used in MR breast biopsy for accessing a posterior lesion
  26. state the entry site for US breast biopsy of posterior targets
  27. choose the needle device best suited for superficial breast targets being accessed via US guidance
  28. state the sampling chamber size required for stereotactic or MR guided biopsy of a superficial breast target
  29. list the structures to be avoided in the axilla during axillary breast biopsy
  30. compare cost and comfort of US-guided biopsy to MR-guided biopsy
  31. state the percent of accuracy of accessing sub-areolar calcifications when utilizing a high-frequency US probe
  32. list imaging characteristics of lesions found at MR imaging that increase the likelihood of identifying a US correlate
  33. describe follow up needed for nonspecific benign concordant pathology results when the MR imaging lesion was biopsied under US guidance
  34. state the MR sequence that helps increase confidence in the correlation of lesions initially identified at MR imaging and biopsied with stereotactic or US guidance
  35. state the cancellation rate for stereotactic-guided breast biopsy
  36. name the most common reason for stereotactic-guided breast biopsy cancellation
  37. state the options when stereotactic-guided breast biopsy cannot be performed
  38. state the overall cancellation rate for MR imaging-guided biopsy for lesion non-identification at the time of biopsy
  39. recall the most common MR imaging finding that is not identified at the time of MR imaging-guided biopsy
  40. state alternate techniques to help visualize targets not previously enhanced at attempted MR imaging-guided biopsy