Stereotactic Core Needle Breast Biopsy Research Articles

Stereotactic core needle breast biopsy marker migration: An analysis of factors contributing to immediate marker migration.

To evaluate breast biopsy marker migration in stereotactic core needle biopsy procedures and identify contributing factors. This retrospective study analyzed 268 stereotactic biopsy markers placed in 263 consecutive patients undergoing stereotactic biopsies using 9G vacuum-assisted devices from August 2010-July 2013. Mammograms were reviewed and factors contributing to marker migration were evaluated. Basic descriptive statistics were calculated and comparisons were performed based on radiographically-confirmed marker migration. Of the 268 placed stereotactic biopsy markers, 35 (13.1%) migrated ≥1 cm from their biopsy cavity. Range: 1-6 cm; mean (± SD): 2.35 ± 1.22 cm. Of the 35 migrated biopsy markers, 9 (25.7%) migrated ≥3.5 cm. Patient age, biopsy pathology, number of cores, and left versus right breast were not associated with migration status (P> 0.10). Global fatty breast density (P= 0.025) and biopsy in the inner region of breast (P = 0.031) were associated with marker migration. Superior biopsy approach (P= 0.025), locally heterogeneous breast density, and t-shaped biopsy markers (P= 0.035) were significant for no marker migration. Multiple factors were found to influence marker migration. An overall migration rate of 13% supports endeavors of research groups actively developing new biopsy marker designs for improved resistance to migration. • Breast biopsy marker migration is documented in 13% of 268 procedures. • Marker migration is affected by physical, biological, and pathological factors. • Breast density, marker shape, needle approach etc. affect migration. • Study demonstrates marker migration prevalence; marker design improvements are needed.

4–16 Add–on Device for Stereotactic Core–Needle Breast Biopsy: How Many Biopsy Specimens Are Needed for a Reliable Diagnosis?

4–16 Add–on Device for Stereotactic Core–Needle Breast Biopsy: How Many Biopsy Specimens Are Needed for a Reliable Diagnosis?

Learning curve for add-on stereotactic core needle breast biopsy

To evaluate the learning curve for an add-on 14 G stereotactic core needle biopsy (SCNB). A total of 231 non-palpable breast lesions that had undergone add-on SCNB were evaluated in this prospective study. Five radiologists performed their first three biopsies under supervision. Subsequent, independently performed, biopsies were also evaluated. The samples were collected in three different containers: the first sample in container A, the second and third samples in container B, and subsequent samples in container C (available for four radiologists from the first biopsy on). Technically successful biopsies and false-negative rate in three container combinations (A, A+B, A+B+C) were reported as a function of operator experience. Technically unsuccessful biopsies occurred significantly more often in microcalcifications than in masses (14.9% versus 3.8%; P=0.04). For microcalcifications, the rate of successful biopsies was 75% (18/24) for the first 5 biopsies and 87.8% (79/90) for the subsequent biopsies (P=0.335); rates for the masses were 95.7% (22/23) and 96.3% (79/82) (P=1.0), respectively. A tendency was noted for the false-negative rate to be higher for the first five biopsies in three container combinations than in subsequent cases. Our results support the existence of a learning curve, especially in the biopsy of microcalcifications. More than three mentor-guided biopsies are needed.

Multitarget stereotactic core-needle breast biopsy (MSBB)—an effective and safe diagnostic intervention for non-palpable breast lesions: A large prospective single institution study

Multi-target stereotactic core-needle breast biopsy (MSBB) with large core needles is a modern and effective method to quickly determine the histologic nature of non-palpable breast lesions in an easy ambulatory setting. The number of patients with mammographically detectable, suspicious breast lesions is constantly increasing due to enhanced breast cancer awareness in Western female populations and with expanding screening mammography activities. MSBB is a minimally invasive diagnostic procedure, performed on an ambulatory basis under local anaesthesia in the prone position on a specially constructed stereotactic biopsy table. The patient is able to resume normal activities 1 h after the biopsy procedure. Technical and medical complications are extremely rare. In our study, we analysed the histological results of 426 MSBB procedures in 389 consecutive female patients during the years 1998-2002, and in 91 cases we were able to compare the histologic results of MSBB with the definitive histology of subsequent excisional biopsies. MSBB was technically successful in 415 out of 426 procedures (97.4%). The sensitivity for malignancy was 94.6% (87 out of 92). MSBB, therefore, is to be qualified as a remarkably reliable, patient-friendly and economic diagnostic breast intervention and was well tolerated and highly accepted by virtually all female patients involved in this single-institution feasibility and effectiveness study.

Add-on Device for Stereotactic Core-Needle Breast Biopsy: How Many Biopsy Specimens Are Needed for a Reliable Diagnosis?

To prospectively determine whether there is a minimum number of cores required for histopathologic diagnosis of mammographically detected nonpalpable breast lesions with an add-on 14-gauge stereotactic core-needle biopsy device. The study was approved by the ethics committee of the hospital; informed consent was obtained. Biopsy was performed in 197 patients with 205 lesions (97 masses, 108 microcalcifications). The first sample (from the center) was collected in container A; second and third samples (2 mm from center), in container B; and additional samples, in container C. Malignancies, atypical ductal hyperplasia (ADH), and radial scars were excised. Benign lesions were followed up mammographically (mean, 24 months). Strict sensitivity and working sensitivity were calculated separately. Stereotactic biopsy with diagnosis of a nonmalignant lesion that, after surgery, proved to be malignant was considered false-negative when strict sensitivity was calculated. Stereotactic biopsy with diagnosis of ADH or radial scar was considered true-positive if the findings at surgery corresponded to the results at biopsy or indicated malignancy and was considered false-positive if the findings at surgery were benign when working sensitivity was calculated. Sensitivity, specificity, and overall accuracy of stereotactic biopsy were determined for masses and microcalcifications in all three containers by using surgical samples and findings at mammographic follow-up as reference. At chi2 analysis, P < .05 was considered to indicate significant difference. Strict sensitivity of the first sample was 77% (66 of 86) (90% [35 of 39] for masses, 66% [31 of 47] for microcalcifications). Results of the first sample were false-negative significantly more often in microcalcifications (n = 16) than in masses (n = 4) (P = .010). Combined results of containers A and B (ie, three samples) yielded higher strict sensitivity than those with first sample alone (95% [37 of 39] for masses [P = .196], 91% [43 of 47] for microcalcifications [P < .001]). With multiple samples, strict and working sensitivity were both 100% (39 of 39) for masses and 91% (43 of 47) and 98% (46 of 47), respectively, for microcalcifications. Four false-negative diagnoses (ADH, three cases; lesion with discordant mammographic and stereotactic biopsy findings, one case) were microcalcifications. More than three samples are needed (a minimum number was not determined) for a histologic diagnosis of a mass lesion by using an add-on stereotactic biopsy device.

Combined Galactography and Stereotactic Core Needle Breast Biopsy for Diagnosis of Intraductal Lesions

Hijaz, Tarek A. M.D.; Shaw de Paredes, Ellen S. M.D.; Sydnor, Malcolm K. M.D.; Massey, Davis H. M.D., Ph.D. Author Information

Minimally invasive techniques in breast cancer treatment

We reviewed our experience with stereotactic core needle breast biopsy (SCNBB) for accuracy, complication rate, and staging profile of malignancies diagnosed.Since March 1993, 530 stereotactic biopsies were performed. Of these, 25 cases underwent stereotactic core needle biopsy with subsequent wire-guided biopsy.In 25 patients with stereotactic and open biopsy, there was an accuracy for SCNBB of 96%. The number of biopsies rose from 100 to 250 biopsies annually, with an equivalent pre-test positive predictive value for mammography (17% to 19% historical versus 20% with SCNBB). The total number of de novo cancer diagnoses have increased from a mean of 57 to a mean of 71 annually. The percentage of tumors in situ, stage I or stage II, has increased from 60% to 69%.Stereotactic core needle biopsy combines a high accuracy with a low complication rate. Its aggressive application for tissue diagnosis in suspicious nonpalpable mammographic lesions has increased the proportion of early (in situ and T1 or T2) tumors discovered, and increased the total number of breast cancers diagnosed.

Marking the cavity site after stereotactic core needle breast biopsy.

Marking the cavity site after stereotactic core needle breast biopsy.

Advances in the Diagnosis and Excision of Breast Cancer

Until recently little advance in the diagnosis and excision of breast cancer has been made since the inception of needle localization breast biopsy (NLBB). Stereotactic core needle breast biopsy (SCNBB) can avoid most NLBB especially for calcifications. However, when open biopsy is necessary NLBB has been the standard of care. As many as 50 per cent of nonpalpable lesions can be seen by ultrasound (US) to avoid the unpleasantness and complications associated with NLBB. Further SCNBB leaves a blood-filled cavity that can be easily seen by US. Intraoperative US can be used to direct the excision while improving margin negativity. MRI has improved sensitivity in detecting suspicious breast lesions and techniques such as hematoma-directed US-guided breast biopsy can facilitate excision of such masses. Clearly new technologies have improved the ability to diagnosis and excise breast cancer. The onus on the surgeon is to incorporate them into standard practice to improve outcomes.

Add-on stereotactic 14-G core needle breast biopsy: how many passes are enough to detect malignancy?

Add-on stereotactic 14-G core needle breast biopsy: how many passes are enough to detect malignancy?

Stereotactic core-needle breast biopsy by surgeons: minimum 2-year follow-up of benign lesions.

To evaluate the reliability of stereotactic core-needle breast biopsy (SCNB) performed by surgeons to detect histologically benign tissue. Stereotactic core-needle breast biopsy is widely used to obtain tissue for definitive pathologic diagnosis of mammographically suspicious breast lesions. It has an incidence of malignancy detection similar to that of open biopsy. The potential for sampling error is a concern. Minimal data regarding follow-up and failure rate are available, especially from series performed exclusively by surgeons. Pertinent medical records of all patients who underwent SCNB between April 1995 and October 1997 were reviewed. Breast lesions were classified by mammographic Breast Imaging-Reporting and Data Systems (BI-RADS) categories before SCNB. Benign biopsy specimens were classified as nonproliferative or proliferative. Malignant lesions and those with atypical histopathology by SCNB were excluded from this analysis. All lesions initially reported as benign were followed up mammographically for at least 2 years for any suspicious change requiring repeat biopsy. During the 31-month period, SCNB was performed on 694 lesions in 619 patients. Histologic evidence of malignancy was found in 112 lesions (16%). The initial histologic diagnosis for the remaining 582 lesions was benign. Four hundred lesions were available for follow-up; of these, 373 (93%) were mammographically categorized as BI-RADS 3 (probably benign) or 4 (suspicious). Three hundred forty-three lesions were categorized as nonproliferative and 151 as proliferative (94 had combined nonproliferative and proliferative histology). Follow-up ranged from 24 to 48 months (mean 33 months). During the follow-up period, 87 lesions (21.8%) underwent either image-guided or open biopsy. At the time of follow-up rebiopsy, ductal carcinoma in situ was found in four lesions and infiltrating ductal carcinoma was found in one, for an overall false-negative rate of 4.3% (5/117) and a negative predictive value of 98.8% (395/400). For the five false-negative cases, the interval from initial SCNB to definitive diagnosis ranged from 7 to 36 months. No correlation was found between the type of initial histopathology and development of malignancy. These results support SCNB as an alternative to open biopsy and show the reliability of SCNB when benign pathology is obtained. However, given the possibility of sampling error and the nature of breast disease, close mammographic and clinical follow-up is necessary. The false-negative rate and negative predictive value in this series compare favorably with those in other reports, supporting the fact that surgeons can confidently use SCNB in the evaluation and treatment of breast disease.

Stereotactic core needle breast biopsy

The coupling of advanced computer-assisted software technology to hardware and manufacturing initiatives has ushered in an era in which percutaneous core biopsy of nonpalpable breast lesions detected by screening mammography is feasible and virtually equivalent in accuracy to radiographically localized excisional biopsy for appropriately chosen cases. Indeed, most (though not all) lesions are candidates for this procedure. Although it has not been discussed herein, ultrasound guided CNB may be another option. CNB under guidance of magnetic resonance imaging is also under investigation. To be successful, a CNB program must follow basic patterns of preferred medical practice: proper lesion selection, adequate and calibrated technology, experience in image interpretation and guidance of biopsy, and reconciliation of image and histological findings. The actual biopsy procedure may be the simplest component of the equation.

Stereotactic Breast Biopsy in a Community Hospital Setting

Our institution began using a stereotactic core needle breast biopsy system for mammographically detected breast lesions in November 1996. The system consists of a LORAD stereo imaging table and an 11-gauge vacuum-assisted mammotome (Biopsys Medical, Irvine, CA). All biopsies were performed with the combined efforts of a radiologist and a surgeon. Three hundred sixteen biopsies were attempted in 279 patients, with multiple biopsies in 31 patients. Indications included microcalcifications in 52 per cent of patients and a mass in 48 per cent of patients. Biopsy was unsuccessful in 20 patients (6.3%). Pathologic diagnoses included invasive ductal carcinoma (19 patients), invasive lobular carcinoma (2), ductal carcinoma in situ (17), atypical ductal hyperplasia (8), atypical lobular hyperplasia (1), fibroadenoma (40), lymph node (7), and benign (202). Invasive cancer, in situ carcinoma, or atypical hyperplasia was diagnosed in 46 (15.6%) lesions. Thirty-six patients had open biopsies. The core biopsy diagnosis was correct in 27 lesions, unable to be confirmed in six cases and changed in four cases, with three lesions upgraded and one case downgraded. The 11-gauge vacuum-assisted mammotome provides excellent accuracy for diagnosing mammographic abnormalities. A combined effort between radiology and surgical services is an effective way of using the stereotactic biopsy system.

Accuracy of stereotactic core-needle breast biopsy in atypical ductal hyperplasia

The histologic diagnosis of atypical ductal hyperplasia (ADH) has been reported as having a high rate of malignancy, either ductal carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC). We reviewed our surgical group's experience with stereotactic core-needle biopsies (SCNB), specifically looking at the follow-up of ADH. From November 1994 through July 1997 our group performed 539 SCNB. Twenty-one patients (4%) were diagnosed as ADH. Eighteen patients had subsequent wire-localized excisional biopsies. Three patients were followed up mammographically. One patient refused follow-up. Of the 18 patients who underwent excisional biopsies, 2 patients were found to have DCIS and 1 patient had lobular carcinoma in-situ. There were no cases of IDC. Our results show a much lower incidence of malignancy in cases of ADH found on SCNB than has been previously reported. While the standard of care is still to follow up ADH found on SCNB with excisional biopsy, more data may justify following up certain subsets of patients.

Canceled stereotactic core-needle biopsy of the breast: analysis of 89 cases.

To determine reasons for cancellation of stereotactic core-needle breast biopsy and outcome in canceled cases. Among 572 scheduled stereotactic core-needle biopsies, 89 cases (16%) in 88 patients were canceled. In canceled cases, mammogram origin, mammographic abnormality, reason for cancellation, and outcome were determined. In canceled cases, 50 (57%) of 88 patients were referred from another facility. Mammographic abnormality in most cases (72 [81%] of 89 canceled biopsies) was a mass(es); calcifications occurred in 14 cases (16%). Reasons for cancellation included (a) lesion was not recognized (26 cases [29%]), (b) lesion was reassessed as benign (17 cases [19%]), (c) cysts were diagnosed with ultrasound (US) (12 cases [13%]) or aspiration (11 cases [12%]), (d) lesion location was suboptimal (12 cases [13%]), (e) patient was intolerant of procedure (seven cases [8%]), and (f) other (four cases [4%]). Numbers of canceled biopsies from another facility and those from the authors' institution differed in cases in which lesions were reassessed as benign (12 and five cases, respectively) or cysts were diagnosed with US (10 and two cases, respectively). Lesions that could not be targeted included many pseudolesions and three cancers. Complete work-up, including US examination, of breast lesions is necessary before stereotactic core-needle biopsy is scheduled. Inability to recognize a suspected lesion on stereotactic images should not preclude biopsy with another method.

Appropriate management of atypical ductal hyperplasia diagnosed by stereotactic core needle breast biopsy.

Stereotactic core needle breast biopsy (SCNBB) is a minimally invasive technique used to sample nonpalpable mammographic abnormalities. The optimal management of atypical ductal hyperplasia (ADH) diagnosed by SCNBB is unknown. We hypothesized that ADH diagnosed by SCNBB should be evaluated by excisional breast biopsy (EBB) because of the risk of identifying carcinoma in association with ADH that would be missed if a diagnostic sampling technique alone was utilized. To test this hypothesis, a prospective diagnostic protocol was created which called for SCNBB instead of EBB for patients with mammographic abnormalities considered suspicious for malignancy. If ADH was noted on histologic evaluation of the cores, patients were advised to undergo an EBB. A review of the initial 900 patients evaluated by SCNBB yielded 39 patients (4.3%) with ADH detected by SCNBB. Thirty-six of these 39 patients agreed to proceed with EBB: 19 patients demonstrated benign findings including atypical ductal hyperplasia, 13 patients demonstrated noninvasive ductal carcinoma, and 4 patients had evidence of invasive carcinoma. A 47% rate of detecting noninvasive or invasive breast carcinoma supports the hypothesis that ADH detected by a sampling technique, such as SCNBB, should be managed by EBB.

Stereotactic breast biopsy is accurate, minimally invasive, and cost effective

We reviewed our experience with stereotactic core needle breast biopsy (SCNBB) for accuracy, complication rate, and staging profile of malignancies diagnosed. Since March 1993, 530 stereotactic biopsies were performed. Of these, 25 cases underwent stereotactic core needle biopsy with subsequent wire-guided biopsy. In 25 patients with stereotactic and open biopsy, there was an accuracy for SCNBB of 96%. The number of biopsies rose from 100 to 250 biopsies annually, with an equivalent pre-test positive predictive value for mammography (17% to 19% historical versus 20% with SCNBB). The total number of de novo cancer diagnoses have increased from a mean of 57 to a mean of 71 annually. The percentage of tumors in situ, stage I or stage II, has increased from 60% to 69%. Stereotactic core needle biopsy combines a high accuracy with a low complication rate. Its aggressive application for tissue diagnosis in suspicious nonpalpable mammographic lesions has increased the proportion of early (in situ and T1 or T2) tumors discovered, and increased the total number of breast cancers diagnosed.