Stereotactic excisional breast biopsy performed by interventional radiologists using the advanced breast biopsy instrumentation system.

Abstract

The Advanced Breast Biopsy Instrumentation (ABBI) system, which uses surgical cannulas up to 20 mm in diameter, is an alternative to conventional surgical biopsy for the diagnosis of non-palpable breast lesions. Since the need for radiological skill outweighs the surgical content of the technique, we evaluated the feasibility of complete management of the procedure by interventional radiologists. 35 of the 111 patients originally scheduled for the procedure were excluded, three because the lesion could not be visualized and 32 because of insufficient thickness of the compressed breast. The procedure had to be abandoned in one case due to a technical failure. 77 stereotactic excisional breast biopsy procedures were performed using the ABBI system in 75 patients with suspicious non-palpable mammographic lesions. The procedure was carried out under local anaesthesia in the radiology department, using a dedicated Lorad (R) radiographic system. 31 (40%) masses without calcifications, 11 (14%) masses with calcifications and 35 (46%) clusters of microcalcifications without tumour mass were sampled. 43 (56%) benign lesions and 34 (44%) malignant lesions were diagnosed. The overall mean diameter of the lesions was 8.7 mm (range 3-22 mm). All 34 patients with malignancies and lobular carcinoma in situ subsequently underwent surgery, the results of which are reported. Three (4%) haematomas were detected and aspirated percutaneously. Two technical problems occurred: an ABBI cannula malfunction, and a computer failure of the digital imaging system during the procedure. The average procedure time was 80 min and the cost of each procedure was 2,800,000 Italian lire (1555 US$). It is concluded that tissue sampling with the ABBI system can be performed entirely by radiologists without significant problems. The procedure was well tolerated by all patients. The quality of the biopsy specimen was identical to that of a surgical specimen but with the advantages of stereotactic precision for localization of the lesion.

An experience with the Advanced Breast Biopsy Instrumentation (ABBI) system in the management of non-palpable breast lesions

“…In this context it is important to determine the role of the ABBI system in the management of non-palpable breast lesions. The literature reviewed shows the current status of controversy: except for Damascelli et al [16], the remainder of the radiologists are sceptical or clearly adverse to the procedure [2,3,4,5,6]. Surgeons are divided: some of them are enthusiastic about the procedure [17,18,19,20,21,22,23,24,25,26,27,28,29], but others not [7,8,9].…”

En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?

“…Consequently, the majority of lesions operated on in the United States are found to be benign [1,2,3]. In our department, according to a previously published algorithm which includes multiple image-guided needle biopsies [4], 50 % of surgically excised NPBL are found to be benign.…”

“…High accuracy is reassuring when a benign lesion is completely excised, especially in the presence of suspicious microcalcifications or in the case of radial scar [7,9]. Theoretically, in selected cases of malignancy it can be therapeutic, but the few reported rates of adequate excision with systematic surgical re-excision of the biopsy site are poor (28±44 %) [1,8,9,10]. Although the acquisition of a large, unfragmented specimen may be advantageous for diagnosis, the ABBI system has significant limitations when compared to large-core needle biopsy [2,3,16].…”

Percutaneous tissue acquisition: a treatment for breast cancer? Vacuum-assisted biopsy devices are not indicated for extended tissue removal

“…Macrobiopsies in the range between 14 and 8 gauge give tissue samples with the same diagnostic accuracy as open surgery and have the advantages of stereotactic precision for localization of the lesion and outpatient application at decreased costs (Damascelli et al, 1998). Tissue samples can be obtained for complete diagnosis from one single sample or a few samples provided the samples come indeed from the suspected lesion.…”