[MOL] Imaging-cuided Core Biopsies in the Breast [01635] Medicine On Line


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[MOL] Imaging-cuided Core Biopsies in the Breast



Imaging-guided Core Biopsies in the Breast

Mary Scott Soo, MD, Department of Radiology, Duke University Medical Center, Durham, NC.


Abstract

Screening mammography programs have contributed to an overall decline in breast cancer mortality. The screening process, however, also results in detection and biopsy of many nonpalpable lesions that eventually prove to be benign, contributing to the burden of costs to our health care system. Percutaneous imaging-guided core biopsy has proven to be a safe and accurate technique for obtaining a histologic diagnosis in most patients who have screening-detected lesions; it is done at lower cost with lower resultant morbidity to the patient compared with traditional surgical excisional biopsy. I review the indications, techniques, method of correlating the histology with mammographic findings, and accreditation requirements for imaging-guided core biopsies of the breast done under mammographic (ie, stereotactic) or sonographic guidance. [South Med J 91(11):993-1000, 1998. © 1998 Southern Medical Association]


Introduction

Breast cancer is the most common cause of nonpreventable cancer death in women in the United States, exceeded only by lung cancer in total cancer deaths in this population. Implementation of screening mammography programs has resulted in a decline in breast cancer mortality, due to earlier detection and treatment of small invasive cancers. Recently updated guidelines from the American Cancer Society now recommend that annual mammography for women begin at age 40, and the National Cancer Institute (NCI) recommends screening every 1 to 2 years for women, beginning in their 40s.[1]

With the increase in the number of women having screening mammography, the number of mammographically detected nonpalpable lesions requiring a biopsy has also increased. Although the sensitivity of mammography for detection of breast cancer approaches 90%, the positive predictive value is much lower (15% to 30%).[2] This results in many biopsy recommendations for lesions that prove to be benign, with subsequent surgical excisional biopsies contributing to the burden of cost on our health care system. Imaging-guided percutaneous core-needle biopsy is an alternative to surgical excisional biopsy for histologic evaluation of mammographically detected nonpalpable lesions. Although palpable masses can also be sampled percutaneously, imaging guidance is not necessary in many cases, and many surgeons prefer to completely excise palpable lesions. Percutaneous core-needle biopsies have proved to be safe and accurate (94% to 97% as accurate as surgical excision) for sampling breast lesions at less than half the cost of surgical excisional biopsy.[3-6] The percutaneous biopsy results in lower morbidity; infrequent (0.2%) complications include hematoma and infection.[3] There is less scarring and disfigurement of the breast because the procedure is less invasive and does not produce confusing distortion on future mammograms.[4] Often the procedure can be done on the day the lesion is detected, resulting in earlier diagnosis.[3-6] It can be done with the patient in a prone or sitting position under mammographic guidance using stereotactic technique or with the patient in a supine position under ultrasound guidance.