ACR issues guidance for breast biopsy needle shortage

The American College of Radiology has released mitigation strategies for breast imaging practices affected by a shortage of stereotactic breast biopsy needles. The guidance was developed with leadership from the ACR Commission on Breast Imaging.

ACR said the shortage began earlier in 2026 after a major manufacturer stopped shipments to correct an issue. Limited alternatives have not fully met clinical demand, according to the college.

FDA lists stereotactic breast biopsy needles as being in shortage, with availability estimated through Q4 2026. The agency cites shortage or discontinuance of a component, part, or accessory of the device as the reason for interruption.

Procedure-triage recommendations include increasing targeted ultrasound use before MRI or stereotactic biopsy when appropriate. ACR also recommends shifting suitable stereotactic and MRI biopsies to ultrasound-guided biopsy when feasible.

Low-suspicion lesions may be deferred to short-interval follow-up when clinically appropriate, according to the guidance. ACR also advises reducing multisite stereotactic biopsies when clinically feasible.

Needle-conservation steps include expanding supplier networks, diversifying needle gauges and lengths, using prior-generation devices where appropriate, and limiting unnecessary device opening or waste.

Inventory recommendations call for centralized tracking across breast imaging sites. ACR also recommends daily or weekly dashboards and forecasting based on scheduled biopsy volumes.

Case prioritization should favor BI-RADS 5 lesions, highly suspicious masses or calcifications, neoadjuvant chemotherapy cases, surgical planning cases, and high-risk discordant lesions, the college said.

Delayed scheduling may be considered for low-suspicion BI-RADS 4A findings and nonurgent repeat biopsies. ACR also said consensus reads, second-read protocols, or panels may help identify lesions that could be downgraded to BI-RADS 3 for short-term follow-up.

Patient-communication guidance includes transparent discussion of delays, alternative biopsy locations where needles are available, and expedited surgical consultation when biopsy delay could affect care.