Minimally invasive stereotaxic vacuum core breast biopsy

Abstract

The purpose of our study was the assessment of the diagnostic value of vacuum core biopsy, which promises high accuracy by minimally invasive percutaneous excision of 1-2 cm3 of tissue. The materials used were a digital stereotaxic biopsy table (Fischer Imaging) and a Mammotome-gun (Biopsys). A total of 236 patients with 261 predominantly indeterminate lesions (indeterminate: 230; suspicious: 26; malignant: 5) underwent vacuum core biopsy (VCB). Verification was as follows: (a) demonstration of complete or partial removal of the lesion or replacement of the lesion by a small hematoma by comparison of the pre- and post-VCB mammogram; (b) reexcision of 45 malignant and 6 borderline lesions; (c) radiologic-histologic correlation; and (d) 6-month-follow-up mammograms in 129 cases. Two VCBs were not possible because very fine microcalcifications could not be visualized. Two puncture errors occurred which, however, were immediately recognized and VCB was repeated. Based on the above verification a 100 % accuracy was achieved. No relevant side effects occurred. Except for 2 cases mammographically hardly any scarring was visible. Based on the excellent accuracy and excellent tolerance of the procedure VCB appears to be the future method of choice for the workup of those indeterminate mammographically detected lesions that up to now have still required surgical biopsy.

Stereotactic and ultrasound-guided breast biopsy

“…Tissue adjacent to the probe can be sequentially removed by rotating the probe 360°. The probe need only be inserted once; thus, multiple specimens can be obtained from a single insertion [27,28,29,30,31,32,33,34,35,36,37,39,40,41,42,43,44,45,50]. Usually, 20 specimens are obtained with three needle rotations (Table 2); however, false-negative results could not be avoided, even with 20 specimens per lesion [50].…”

“…Although needle guidance systems are available in US, most clinicians consider free-hand positioning of the biopsy needle, with or without a coaxial technique within the breast, to be the best technique. The advantages of the free-hand technique include the ability to approach the lesion with the needle parallel to the chest wall [3,5,12,22,23,24,25,26,27,31,43]; however, independent of the chosen technique, correct needle placement should be documented an two orthogonal imaging planes.…”

“…The diagnostic accuracy achievable with these techniques is discussed, as well as the potential for new research opportunities and directions. 13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,48,49,50,51,52]. The Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology and similar systems published by other organizations are increasingly used to define and categorize a mammographic lesion [3,46].…”

“…Three imaging modalities are currently used to perform percutaneous biopsy: ultrasound; stereotactic (X-ray) imaging; and MR imaging. Acquisition of tissue is usually accomplished by fine-needle aspiration (FNA) or by removal of larger volumes of tissue through various cutting needles (automated large-core needles) and directional vacuum-assisted biopsy probes [1,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,48,49,50,51,52].…”

Underestimation of Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Stereotaxic 11-Gauge Vacuum-Assisted Breast Biopsy

“…All radiologists had prior experience in percutaneous biopsies under stereotactic and sonographic guidance. The technique of performing these biopsies has been described elsewhere (4). The average number of core specimens obtained per case was 11 (range [8][9][10][11][12][13][14][15][16][17][18].…”