Since its inception in Sweden and introduction into the United States, stereotactic technology has undergone several major changes. The first one was the introduction of digital imaging [12, 13]. This change was incorporated in the stereotactic devices even before their application in routine mammography. The change facilitated the biopsy procedure significantly by shortening the operation time. Furthermore, the high resolution capability together with magnification and rapid image processing features enabled the operator to visualize minute parenchymal changes for sampling. The second development was computerization of the system which allowed rapid transfer of the data from the monitor screen to the mechanized platform. Third was the emergence of vacuum-assisted cutting probes which once appropriately positioned in the breast removed multiple samples from the targeted lesion with one instead of multiple passes as was the case with mechanized needles [14, 15]. Thus with the combination of high-resolution digital screening mammography resulting in detection of smaller cancers and larger needles removing 10–15 core samples, one is witnessing complete percutaneous removal of some breast tumors as documented on ensuing excisional biopsy.

In late 1980s Fischer Corporation based in Denver CO acquired the license and production rights of the stereotactic table in the United States. Soon afterwards LoRad/Hologic Corp. in Danbury CT introduced their version of breast stereotactic table whereby the biopsy unit including the X-ray arm could be rotated 180° around the breast, thus enabling the operator to biopsy the lesions from all directions. This was a technical advantage partially cancelled by slight disadvantage of the technology being based on Cartesian principle, meaning that the platform could be raised parallel with the table undersurface, limiting visualization of lesions in the far posterior 2–5 mm part of the breast close to the chest wall because the X-ray beam travels parallel with the undersurface of the table. This problem could in some cases be resolved, in rare occasions, by bringing the patient’s arm through the table opening.

Both Fischer and LoRad tables have to be secured onto the floor although their “mobile” versions can be transported to a medical facility in an especially equipped truck on a prearranged date for performance of breast biopsies. In 2006, Siemens introduced yet another stereotactic table into clinical practice. This was an upright device which could be attached to a regular mammographic unit, thus lowering the cost and obviating the need for a dedicated space. The biopsy is done with the patient sitting upright, which is an advantage as lying prone on the traditional table for up to an hour causes neck discomfort in some patients. On the other hand the dedicated table allows the gravity to pull the breast away from the chest wall allowing access to the posterior targets. Additionally, patients are unlikely to faint in a prone position and the operating surgeon has a better sense of control.

During the past decade there has been a dramatic improvement in the resolution of breast sonography. Soft tissue densities as small as 5 mm in diameter and even clusters of microcalcifications may be visualized by ultrasound. Miniaturization of the technology has made the device small enough to be portable and to be used in the office, at the bedside, as well as in the operating room. Ultrasound differentiates cystic from solid breast lesions. Its acoustic properties demonstrate homogeneity of the lesion, thus differentiating benign from malignant tumors. Additionally, color Doppler ultrasound demonstrates the vascularity of the suspected tumor.

Ultrasound has truly become the 21st-century stethoscope of the surgeon. In clinical practice ultrasound-guided needle biopsy has replaced most breast biopsies previously performed on a stereotactic table [16]. The emergence of three-dimensional ultrasound makes this breast imaging technology even more appealing.