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.
