NWSS: Breast Biopsy

Breast Biopsy

The increasing use of screening mammography in susceptible age groups and for those patients with higher risk factors for breast cancer has aided significantly in the detection of non palpable breast cancers. In the past these lesions required image- guided wire localization and open surgical excisional biopsy. Mammographic abnormalities, however, are relatively nonspecific and only 30% of abnormalities are truly malignancies. Thus, 70% of women undergo open biopsy unnecessarily.

We have been studying minimally invasive techniques in conjunction with our radiology and pathology colleagues to assess the accuracy and reliability of image- guided large core needle biopsy. Ultrasound and stereotactic techniques are utilized to accurately direct a special biopsy needle under local anesthesia. We recently published the results in the Archives of Surgery, August 1997; Volume 132 entitled "Histologic Correlation of Image-Guided Core Biopsy With Excisional Biopsy of Nonpalpable Breast Lesions".

Benign disease and invasive cancer of the breast can be diagnosed with a high level of confidence using image-guided large core needle biopsy. Patients with benign disease can be safely followed with clinical examination and follow up mammography, avoiding the pain, scarring, and expense of open surgery. Patients with invasive carcinoma can undergo complete preoperative counseling regarding treatment alternatives and staging, allowing a single operation for definitive treatment. Small early stage breast cancer can be treated as an outpatient with removal of the lesion and minimally invasive evaluation of the axillary nodes. Sentinel lymph node evaluation avoids axillary dissection and its' potential complications in 70% of patients.

We believe imaging-directed large core needle biopsy rather than open excisional biopsy, to be the initial procedure of choice for diagnosis of palpable or nonpalpable abnormalities detected by mammography, ultrasound or physical examination.