Advanced Breast Biopsy Instrumentation Research Articles

Experience of using the ABBI biopsy procedure in the diagnosis of non-palpable breast masses

The Advanced Breast Biopsy Instrumentation procedure the improved biopsy csystem of the mammary gland was performed in 13 women aged 34 to 72 with nonpalpable mammographic lesions. It is a stereoscopic table making it possible to perform biopsy of the mammagraphic lesions of the mammary gland tissue by cannulas diameter up to 2 sm in under X-ray control. Microcalcinates are found in 3 patients (22,8%), the local tissue change in 3 patients (22,8%) focal shadows in 7 patients (53,2%).
 The lesion size 5 mm is found in 16% of the patients, from 5,1 to 10 mm in 25% of the patients, from 10,1 to 20 mm in 59% of the patients. The cancer was diagnosed in 3 cases (22,8%) on the 7 and 10 mm sites, the atypical hyperplasia in 2 cases (8,3%), other benign pathology in 53,2% of the cases. In all the cases the foci removal nas corfirmed by histology. The high efficiency of the biopsy stereotaxic method of the mammary gland which removes the roentgenosus-picious site as the single tissue preparation.

Breast cancer surgery: an historical narrative. Part III. From the sunset of the 19th to the dawn of the 21st century

The 20th century is marked by significant advances regarding the management of breast cancer. A clear trend towards less aggressive surgical operation was constantly noted. Modified radical mastectomy gradually replaced radical mastectomy during the second half of the 20th century, while during the last two decades breast-conservation therapy became the treatment of choice for the treatment of breast cancer. This type of therapy includes segmental mastectomy (either quadrantectomy or lumpectomy) with axillary lymph node dissection, followed by postoperative irradiation. Other significant advances during the 20th century include the introduction of systemic therapy (chemotherapy, hormonal therapy) and radiation therapy. Better patient follow-up, statistical analysis, development of staging systems and the introduction of frozen section, the development and wide use of mammography (including screening mammography), breast reconstruction following mastectomy and the development of newer diagnostic methods [including breast magnetic resonance imaging and the advanced breast biopsy instrumentation (ABBI)] are other advances that contributed to a better management of breast cancer patients. Sentinel lymph node biopsy has been introduced during the 1990 s in an attempt to reduce morbidity due to axillary lymph node dissection. Despite these advances, breast cancer remains a significant problem and represents a field of active and intense research.

The Use of Stereotactic Excisional Biopsy in the Management of Invasive Breast Cancer

Stereotactic breast biopsy techniques minimize the surgical trauma associated with conventional wire-guided open breast biopsy for non-palpable breast lesions (NPBLs). Advanced breast biopsy instrumentation (ABBI) allows for a 2-cm core of breast tissue to be excised under stereotactic guidance in an outpatient setting. We report our initial experience with ABBI. Hospital charts from 89 ABBI procedures between 10/1996 and 07/2002 were retrospectively reviewed for patient characteristics, ABBI parameters, radiographic appearance, pathology, complications, and clinical follow-up. Data are presented as percentage/median (range). Median age was 59 years (range: 39-80 years), mammographic lesions were classified as calcifications 49% (44/89), soft tissue 39% (35/89), or mixed 11% (10/89). Median radiographic size was 7 mm (1-60 mm). Final pathology revealed ductal carcinoma in situ (DCIS) in 7% (6/89) and invasive cancer in 22% (20/89). Microscopically clear margins were obtained in 55% (11/20) of patients with invasive cancer. Of these, 82% (9/11) chose not to undergo further local surgical therapy. Eight patients remain disease free at 56 months (range: 41-95 months) follow-up. The ninth patient was deceased at 6 months from an unrelated cause. The overall complication rate was 3% (3/89). A definitive diagnosis was obtained in 100% of malignant and 87% of benign cases. Median waiting time was 19 days (range: 0-90 days). Our experience demonstrates that ABBI is an effective diagnostic tool for NPBLs. It is associated with minimal complications, and provides negative margins in over half of malignant cases. In selected patients with invasive cancer and negative margins, ABBI may obviate the need for further local surgical treatment. ABBI merits additional investigation as a therapeutic modality for early breast cancer.

Management of Nonpalpable Breast Lesions in a Modern Functional Breast Unit

During the last 20 years an ever increasing number of nonpalpable breast lesions (NPBL) have been identified. A cytohistological definition is required to establish the correct diagnostic classification of these lesions and the suitable therapy to be used. The Fine-Needle Aspiration Cytology (FNAC), the Advanced Breast Biopsy Instrumentation (ABBI) system or the Vacuum Assisted Core Biopsy (VACB) represent valid alternatives to the surgical excision with needle localisation. 591 NPBL have been included in the present study. The suspected grade of each lesion was then assigned according to the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology. All the BI-RADS 4 and 5, and all the BI-RADS 3 lesions, which after 6-month follow-up showed altered morphology, were sampled for cytological and/or histological examinations by FNAC, VACB or biopsy by ABBI system. The diagnostic algorithm used in this study obviated a surgical procedure in 574 women (97.1%), yielding a 73.9% decrease in the cost of diagnosis compared with surgical biopsy, and a 48.1% decrease in cost if all lesions had been histologically tested using ABBI or VACB procedure. Compared to surgical biopsy, VACB and ABBI system are less expensive, and have smaller emotional and aesthetical impact on patients; however they retain the same sensitivity and specificity.

Experience of Stereotactic Breast Biopsy Using the Vacuum-assisted Core Needle Biopsy Device and the Advanced Breast Biopsy Instrumentation System in Hong Kong Women

Stereotactic breast biopsy of non-palpable lesions using the vacuum-assisted core needle biopsy (CNB) device and the large core excision biopsy system is a reliable biopsy method when compared with open biopsy. Its use in Western countries is well accepted. This study aimed to assess the feasibility and results of using these systems to perform stereotactic biopsy in Asian women. A total of 114 patients with non-palpable mammographic lesions underwent stereotactic breast biopsy using the vacuum-assisted CNB device and the large core excision biopsy system between November 1999 and December 2002. The indications for biopsy were mammographic abnormalities considered indeterminate or suspicious that were not palpable or visible on ultrasound. The methods adopted for biopsy in Asian women were reviewed and the results including the final pathology, complications, scarring and acceptance by patients were recorded. Stereotactic breast biopsy was performed using the vacuum-assisted CNB device in 107 patients and the large core excision biopsy system in seven patients. Of those who underwent biopsy using the vacuum-assisted CNB device, 15 (14%) had moderate to severe bleeding during the procedure and seven (6.5%) had severe bruising afterwards. Carcinoma was detected in 31 of the 114 patients (27.2%). Although Asian women in general have smaller and denser breasts than their Western counterparts, stereotactic breast biopsy using the vacuum-assisted CNB device and the large core excision biopsy system was feasible with modification of the individual steps during the procedure. Our results are comparable with those published previously and the procedure was well accepted by patients.

Prise en charge des lésions infracliniques du sein : expérience à propos de 176 cas consécutifs

Objective. – To propose a rational attitude to treat infraclinic breast lesions about a 176-case retrospective analysis. Patients and methods. – Between January and December 2000, 176 patients were addressed for an infraclinic breast lesion. The epidemiologic and mammographic data, diagnostic management and histological results were collected. Results. – Patients were addressed for an ACR 2 lesion in 0.8% of cases, ACR 3: 34.8%, ACR 4: 43.2% and ACR 5: 21.2%. One hundred and sixteen patients underwent a stereotactic macrobiopsy: 55 Advanced Breast Biopsy Instrumentation (ABBI ®), 61 Minimal Invasive Breast Biopsy (MIBB ®). Histologically, 59.5% were benign, 33.6% malignant, 2.6% borderline and 4.3% suspicious or non contributive. Forty-two patients underwent an open surgical biopsy. Histologically 56.1% were benign, 41.5% malignant and 2.4% borderline. Eighteen patients were controlled by mammography. Among ACR 3s there were 90% of benign lesions and 46% of malignancy in ACR 4s. Patients with malignant, borderline or suspicious result in stereotactic biopsy, underwent one-time surgery in 97% vs 55% in surgical biopsy ( P < 0.0001). Discussion and conclusion. – Infraclinic breast lesions must be radiologically classified with the ACR classification. Stereotactic macrobiopsies are reserved for ACR 4 and ACR 5 lesions. Because of their reliability, practice of macrobiopsies avoids surgery in about 50% of ACR 4 lesions which correspond to benign lesions. When the result is malignant, it allows most of times surgical procedure one-time.

Digital stereotactic biopsies for nonpalpable breast lesion.

Percutaneous biopsy (BP) is a valid alternative to open surgical biopsy. The aim of our study was to evaluate the results and diagnostic value of vacuum-assisted core biopsy (VACB; Mammotome) and advanced breast biopsy instrumentation (ABBI). From June 1999 to December 2001, 360 BPs were performed: all patients had dubious mammography lesions not confirmed by ultrasonography. Indications were as follows 264 (73.3%) microcalcifications, 64 (17.8%) nodular opacities, and 32 (8.8%) parenchymal distortions. All BPs were performed with a digital stereotactic table with a vacuum suction aspiration system for VACB and a cutting cannula for ABBI. All BPs were correctly performed. Seventy-one (19.7%) lesions were malignant, whereas 258 (71.6%) were benign: 31 (8.6%) of the lesions removed with VACB were atypical ductal hyperplasia. BP is a valid method for the diagnosis of nonpalpable breast lesions. In our experience, VACB is the method of choice because it is easy to perform and has high adaptability.

Application of image-guided biopsy for impalpable breast lesions in Chinese women.

Screening for breast cancer has resulted in an increasing number of mammographically detected lesions that require further management. The Advanced Breast Biopsy Instrumentation system is a recently added biopsy technique for the management of such lesions. The present paper will review the authors' experience in the use of this procedure in Chinese patients whose breast volume was smaller than that of Caucasians. Ninety-three patients were listed for the procedure and 78 (84%) underwent the procedure successfully. Ninety-two lesions were biopsied. Advanced Breast Biopsy Instrumentation (ABBI) was performed for clustered microcalcifications or abnormal mass/density. Minimally Invasive Breast Biopsy (MIBB), a suction-assisted core biopsy device, was employed for more scattered lesions. For small volume breasts, it may be required to bring the hand through the aperture to get the targeted lesions onto the digital image or, in the case of ABBI, to excise just beyond the deep margin of the lesion rather than the recommended depth. The ABBI was performed for 43 (46.7%) lesions and MIBB for 49 (53.3%) lesions. Nine (9.8%) were diagnosed to have ductal carcinoma in situ, two (2.2%) had ductal carcinoma in situ with microinvasion and eight (8.7%) had invasive ductal carcinoma. All the malignant lesions required further management. In addition, 19 (20.7%) were found to have atypical hyperplasia. Patients' satisfaction and cosmetic outcome are good. The ABBI and MIBB procedures can be applied satisfactorily for biopsy of mammographic lesions with good -cosmetic outcome in Chinese patients.

Percutaneous stereotactic en bloc excision of nonpalpable breast carcinoma: a step in the direction of supraconservative surgery

Recently, the advanced breast biopsy instrumentation (ABBI) system has been introduced as an alternative to conventional breast biopsy techniques. This study was prospectively conducted to evaluate the potential of the ABBI method in locoregional management of a consecutive series of patients with nonpalpable mammographically detected breast carcinomas. Sixty-one consecutive patients underwent an ABBI procedure as a first step before possible surgery for nonpalpable breast lesions that would in any case require complete excision. For the 27 patients in whom the ABBI biopsy revealed malignancy further surgery was recommended, including re-excision of the biopsy site and axillary dissection in cases of infiltrating carcinoma. We calculated the probabilities that the ABBI specimen would have tumor-free margins and that a definitely complete excision had been achieved as a function of the mammographic or pathological diameter of the cancer. For cancer with a pathological diameter less than 10 mm measured on the ABBI specimen, the probability (92%) of obtaining complete resection was significantly better than for larger lesions ( P = 0.01, Fisher's exact test). Although the therapeutic perspectives for the ABBI method are limited at present, we suggest that this approach is a first step in the direction of a surgical strategy that is better adapted to the pathological characteristics peculiar to these small tumors, whose incidence is increasing.

Zwischenbericht über die Anwendung des ‘Advanced Breast Biopsy Instrumentation’- Systems im Rahmen einer Multizenterstudie

Im Rahmen einer österreichischen Multizenterstudie wurden zwischen September 1998 und Dezember 2001 474 Eingriffe mit der Advanced Breast Biopsy Instrumentation (ABBI) dokumentiert und davon 389 in das Protokoll aufgenommen. Die stereotaktische Exzisionsbiopsie mit dem ABBI-System stellt auf Grund des Patientinnenkomforts, der radiologischen Genauigkeit und der komplikationsarmen Anwendung eine sinnvolle Alternative zur offenen Biopsie nicht tastbarer Brustläsionen dar. Es gibt jedoch technische Einschränkungen. Die Frage der therapeutischen Option beim Mammakarzinom muss vorerst noch unbeantwortet bleiben.

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

Our objective was to evaluate our experience with the Advanced Breast Biopsy Instrumentation system (ABBI) in non-palpable breast lesions in a prospective study from July 1998 to November 2000. The ABBI system was included in a protocol for BIRADS 4 non-palpable, small (<15 mm) breast lesions. Digital radiographs of both specimen and biopsy cavity were obtained to validate the procedure. A total of 255 ABBI biopsies were performed in 254 patients. In 251 cases the lesions were successfully removed (98.4%). Mammographic lesions consisted of 176 cases of microcalcifications (69%), 51 cases of architectural distortions (20%) and 28 cases of nodules (11%). Seventy-two carcinomas were diagnosed (28.2%). Affected margins were found in 41 cases (56.9%). Residual tumour was seen in 31 patients (43%). Seventeen borderline results and 33 benign architectural distortions obviated further procedures. The complication rate in 10 cases was as follows: 3 wound infections; 4 haematomas; and 3 vasovagal reactions. The main utility of the ABBI system is to allow a reliable diagnosis in complex lesions, such as small clusters of microcalcifications and especially architectural distortions. Surgery can be avoided for borderline cases if the lesion is completely removed and free margins are obtained in the pathology study. Therapeutic use is controversial and can be applied only in selected cases.

Advanced breast biopsy instrumentation (ABBI) and management of nonpalpable breast abnormalities: a community hospital experience

A range of diagnostic techniques have been in use for determining the nature of non-palpable mammographic abnormalities over the last decade, these include stereotactic and ultrasound guided cytology, core biopsy and vacuum assisted core biopsy techniques as well as open surgical breast biopsy. Recently, a less invasive alternative has been investigated; the Advanced Breast Biopsy Instrumentation (ABBI) technique (U.S. Surgical Corporation, Norwalk, CT). ABBI employs computer-guided stereotactic localization to target and excise mammographic lesions under local anesthesia, without the need for an operating theatre. We conducted a prospective review of all cases involving the use of the ABBI system during the first 17 months' of its use in a community hospital. One hundred and twenty six patients were referred for an ABBI procedure. One hundred fourteen ABBI procedures were performed on 113 patients (average age, 53 years; range, 33–82). The lesion was removed successfully in 113 of the 114 cases. Of the 114 lesions removed with the ABBI system, 88 were microcalcifications and 26 were masses. Cancer was diagnosed in 21 patients (18%). Of the patients who had carcinoma, 11 (52%) had ductal carcinoma in situ, 9 (43%) had infiltrating ductal carcinoma, and 1 (5%) had infiltrating lobular carcinoma. Postprocedural complications occurred in 7 patients (6%); 4 had small haematomas, 2 had superficial wound infections, and 1 had an abscess. We conclude that the ABBI system, is an excellent alternative (to open biopsy after needle localization or large-core biopsy) for nonpalpable breast abnormallities. It has a relatively low complication rate and should be considered as part of the surgical armamentarium for the diagnosis of indeterminate nonpalpable mammographic lesions.

Advanced breast biopsy instrumentation device: percentages of lesion and surrounding tissue removed.

This study reports the percentage of tissue in breast biopsy specimens from the lesion, and from the surrounding tissue, in 101 cases of Advanced Breast Biopsy Instrumentation (ABBI) biopsies. It also reports the status of the histologic margins for the malignant biopsies. One hundred one consecutive ABBI biopsies were reviewed. The ABBI specimen radiographs were used to measure the area occupied by the entire specimen, the area excluding the lesion, and the area of the lesion alone. These areas, the length, and the width of all specimens were statistically analyzed using computer software. Of the 101 biopsies, histologic diagnosis was malignant in 27 and benign in 74. Of the 27 malignancies, four had negative margins and 23 had positive margins. Of the 23 with positive margins, eight were ductal carcinoma in situ (tumor within 0.5 mm or less of the surgical margin), and 15 were not ductal carcinoma in situ (tumor at the surgical margin). The average specimen length was 5.51 cm and the average width was 1.65 cm. The average percentage of lesion tissue was 9.9%. An average of 90.1% of tissue removed by ABBI biopsies was from surrounding tissue only. Uninvolved tissue is unfortunately included because of the cylindric geometry of the ABBI cannula. The ABBI biopsy has a high percentage (85.2%) of positive margins for malignant lesions and is poor excisional tool. For diagnostic biopsies, core needle biopsy is preferable because a smaller tissue volume is resected directly from the lesion site.

Use of advanced breast biopsy instrumentation while performing stereotactic breast biopsies: review of 150 consecutive biopsies

Background: Stereotactic breast biopsies are being performed in the United States with increasing frequency. Advanced breast biopsy instrumentation (ABBI) is a recent addition to the list of available stereotactic breast biopsy devices (eg, fine-needle aspiration, automated needle cores, and vacuum-assisted devices). Indications for the ABBI procedure in the management of patients with nonpalpaple mammographic lesions have not been established. Study Design: Prospectively collected data on 150 patients biopsied with the ABBI procedure were reviewed. Results: From April 1996 to May 1997, 150 patients with indeterminate or suspicious nonpalpable mammographic lesions were biopsied using the ABBI technique. Complications were minor. One patient (0.6%) required a repeat biopsy because of insufficient tissue and one patient had repeat excision to confirm the diagnosis of atypical ductal hyperplasia. Cancer was diagnosed in 26%. Followup mammograms were obtained in 94% of the patients. Lesions were missed in three patients (2%), none of whom were later found to have cancer. One patient (0.6%) required a repeat ABBI biopsy for postbiopsy architectural distortion. Postprocedure mammographic scarring was otherwise minimal and was noted in only 16% of the patients. Of the 111 patients with benign diagnoses, 67 were seen for clinical followup; 98% had good cosmetic outcomes and were satisfied with the ABBI technique. Conclusions: The ABBI technique is a safe, reliable stereotactic breast biopsy technique that is well accepted by patients. The sensitivity and specificity of ABBI biopsy for the diagnosis of carcinoma in this series were each 100% for the 142 patients returning for followup. Indications for the technique are similar to those for traditional needle localization excisional breast biopsies.

Initial experience with breast biopsy utilizing the Advanced Breast Biopsy Instrumentation (ABBI).

The Advanced Breast Biopsy Instrumentation (ABBI) system combines a cylindrical single-use biopsy device with digital stereotactic imaging that achieves targeting of radiographic lesions to +/- 1 mm. This minimally invasive technique uses digital stereotactic imaging to perform excisional biopsies of suspicious, nonpalpable mammographic lesion. This allows complete removal of specimens in a one-step procedure that does not involve separate trips to radiology and then surgery. The authors' initial 170 cases utilizing the ABBI system were reviewed. The accuracy of specimen targeting, the success rate of lesion removal, and operative complications were some of the issues assessed. Five cases were not suitable for the procedure: the mammographic lesion was not visualized in one, and the breast was too thin on compression in four. There was successful removal of the lesion in 165 of the remaining cases. There were no local wound complications, and patient satisfaction was high in all completed biopsies. The ABBI system is an effective new form of minimally invasive breast surgery. It provides complete excision of mammographic abnormalities.

Diagnostic Utility of ABBI(R) (Advanced Breast Biopsy Instrumentation) for Nonpalpable Breast Lesions in Korea.

Introduction of mammography along with particular attention for the diagnosis and treatment of nonpalpable breast lesions has led to the development of nonresectional biopsies such as mammography-guided core needle biopsy, ultrasound-guided fine needle aspiration cytology, and localization and excisional biopsy. The Advanced Breast Biopsy Instrumentation (ABBI(R)) system, a recently developed device, has made it possible to remove a lesion completely under local anesthesia, thus providing a more reliable and rapid evaluation on an outpatient basis. We studied 159 patients with nonpalpable breast lesions from December 1996 to August 1998. Fifty-nine patients received core needle biopsies and 100 patients received excision with the ABBI system. The ABBI system patients had postexcisional mammography and specimen radiographs to confirm complete excision of the lesions. Pathologists examined permanent section specimens. In cases of malignancy, total mastectomy or reexcision was performed to secure a tumor-free margin. We collected malignant lesions in 23 of 159 patients, of whom 17 had ductal carcinoma in situ (DCIS). Postoperative histopathologic reports showed DCIS in 11 and infiltrating ductal carcinoma (IDC) in 2 among the 13 malignancies proven by stereotactic core biopsy. Among 10 malignancies proven by the ABBI system, there were 6 DCIS, 1 lobular carcinoma in situ (LCIS), and 3 IDC. In seven patients in whom mammography suggested malignancy but core biopsy showed benign lesion, localization and excisional biopsy confirmed DCIS in four of seven patients. The ABBI system is a more reliable and rapid method of evaluating breast lesions compared with stereotactic core biopsy. It is usually done under local anesthesia, minimizing the deformity of the breast. Therefore the ABBI system can be used as a preferred technique over conventional localization and excisional biopsy.

Initial experience with breast biopsy utilizing the Advanced Breast Biopsy Instrumentation (ABBI®)

Initial experience with breast biopsy utilizing the Advanced Breast Biopsy Instrumentation (ABBI®)

Initial experience with breast biopsy utilizing the Advanced Breast Biopsy Instrumentation (ABBI®)

Initial experience with breast biopsy utilizing the Advanced Breast Biopsy Instrumentation (ABBI®)

Advanced breast biopsy instrumentation (ABBI). Histopathologic evaluation of a new investigation method

The ABBI (advanced breast biopsy instrumentation) system has only recently been available for diagnostic excisional biopsy of small, non-palpable lesions of the breast. Between 1.1.1998 and 31.3.1999 this method was utilized in 40 patients with suspicious microcalcifications (n = 25), newly developed densities (n = 11) and a combination of microcalcifications and densities (n = 4). In 12 cases malignancy was diagnosed, in 11 cases a subsequent resection was performed. In every case sufficient tissue for diagnosis was obtained, in not a single case the diagnosis had to be revised in case of subsequent resection. Orientation within the specimen is accurate, the resection margins can be judged unequivocally. Any necessary special examinations can be performed on the resected tissue. In our experience, ABBI is a valuable and elegant tool for diagnosing small suspicious lesions of the breast.

The Advanced Breast Biopsy Instrumentation (ABBI) Experience at a Community Hospital

The Advanced Breast Biopsy Instrumentation (ABBI; U.S. Surgical Corp., Norwalk, CT) system is the newest technology available for the evaluation and diagnosis of nonpalpable breast lesions. It requires the breast imaging specialist, often a radiologist, to localize the suspicious lesion to x, y, and z coordinates in a digital mammogram unit. The coordinates are then used by the surgeon to operate and direct the ABBI biopsy device around the lesion to obtain an excisional biopsy. Mammographic confirmation of the specimen is then immediately obtained. First introduced in the United States in April 1996, the ABBI system is aimed at rivaling the previously relied upon methods of needle-localized and core needle breast biopsies. In this study, we analyzed the first 15 months of use of the ABBI system in a community hospital to evaluate its applicability and efficacy in the diagnosis of nonpalpable breast lesions. Eighteen surgeons and three radiologists performed a total of 230 cases on 223 patients (seven patients had bilateral breast biopsies). The lesions biopsied included 114 clustered microcalcifications, 115 masses, and 1 retained guidewire from a previous needle-localized breast biopsy. The average time for the complete procedure was 65 minutes. Breast cancer was identified in 36 patients (36 of 230, 15.7%) and 1 additional patient had an incidental finding of lobular carcinoma in situ. The malignancies included 20 cases of invasive ductal carcinoma, 12 cases of ductal carcinoma in situ, and four cases of invasive lobular carcinoma. Overall, 84 per cent of the patients had a definitive benign diagnosis and required no further surgical treatment of their mammographic finding. There have been no known missed lesions after use of the ABBI procedure. In conclusion, our experience has shown the ABBI system to be a valuable option in the management of selected patients with nonpalpable breast lesions.