A system for collecting a biopsy of a lesion within a patient using examination images previously collected from an examination device. An x-ray detector detects energy after passing through the patient. A compression paddle compresses the patient. A processing system generates a biopsy image based on the energy detected by the x-ray detector, accesses the examination images previously collected, and analyzes, while the patient remains compressed, the biopsy image to determine a measured x-coordinate and a measured y-coordinate of the lesion along X and Y axes, respectively. The examination images are analyzed to determine a calculated z-coordinate of the lesion along the Z axis. The location of the lesion along the X, Y, and Z axes is determined based on the measured x-coordinate and measured y-coordinate from the biopsy image and the calculated z-coordinate from examination images. The biopsy may be performed while the patient remains compressed.