Stereotactic Vacuum-assisted Biopsy Research Articles

Percutaneous Core Biopsy of Nonpalpable Breast Lesions: Utility and Impact on Cost of Diagnosis

Percutaneous image-guided core breast biopsy is faster, less invasive, less deforming, and less expensive than surgical biopsy for diagnosing nonpalpable breast lesions. Percutaneous biopsy may be performed using different imaging guidance modalities (e.g., stereotaxis or ultrasound) and different tissue acquisition devices (e.g., automated needles or vacuum-assisted biopsy probes). Stereotactic biopsy may be used for all lesion types (masses and calcifications). Stereotactic 14-gauge automated core biopsy spared a surgical procedure in 76-85% of cases, decreasing the cost of diagnosis by 40-56%. Annual national savings from use of stereotactic 14-gauge automated core biopsy rather than surgical biopsy for nonpalpable lesions would exceed 100 million dollars. Stereotactic 11-gauge vacuum-assisted biopsy yields significant improvement in diagnosis of calcifications and may be used in lesions that are not amenable to stereotactic 14-gauge automated core biopsy. Stereotactic 11-gauge vacuum-assisted biopsy spared a surgical procedure in 76% cases, decreasing cost of diagnosis by 20%. Use of stereotactic 11-gauge vacuum-assisted biopsy for calcifications and for nonpalpable masses not amenable to stereotactic 14-gauge automated core biopsy would yield annual national savings exceeding 50 million dollars. Ultrasound-guided biopsy, used primarily for masses, has several advantages including speed, comfort, lack of radiation exposure, and real-time needle visualization. Ultrasound-guided core biopsy spared a surgical procedure in 85% cases, decreasing the cost of diagnosis by 56%. Although both ultrasound-guided core biopsy and stereotactic biopsy are less expensive than surgery, cost savings are greater for ultrasound-guided core biopsy. An annual national savings over $50 million could be realized with the use of ultrasound-guided core biopsy for nonpalpable masses. Future work should include evaluating the emerging new technologies for percutaneous breast biopsy and optimizating the choice of biopsy method for different clinical scenarios. Society may benefit from cost reduction as women benefit from a faster, less invasive, and less deforming approach to diagnosis.

Nonpalpable breast cancer: percutaneous diagnosis with 11- and 8-gauge stereotactic vacuum-assisted biopsy devices.

To compare the accuracy of diagnosis of invasive breast cancer with 11- and 8-gauge stereotactic vacuum-assisted biopsy (SVAB) devices and to correlate lesion diameter and accuracy of breast cancer diagnosis at SVAB. During a 22-month period, 489 SVAB procedures were performed with an 11-gauge probe and 305 with an 8-gauge probe. SVAB and surgical pathologic results of 104 breast carcinomas were reviewed and correlated with lesion size, number of specimens obtained, and type of SVAB probe used. Four of 38 ductal carcinoma in situ (DCIS) lesions diagnosed with 11-gauge SVAB demonstrated invasion at surgery, whereas one of 23 DCIS lesions diagnosed with 8-gauge SVAB demonstrated invasion at surgery (P =.6). A mean of 12 specimens per lesion were obtained in each group. In lesions 30 mm or larger, the underestimation rate for DCIS was 43% (three of seven) with 11-gauge SVAB and 17% (one of six) with 8-gauge SVAB (P =.6). Overall, the rate of underestimation for DCIS was significantly higher in lesions 30 mm or larger (four of 13) than in smaller lesions (one of 48, P =.006). This study demonstrated no difference in breast cancer diagnosis with the 8- and 11-gauge SVAB systems, but the accuracy of breast cancer diagnosis was greater in lesions smaller than 30 mm than in larger lesions.

Reliability of Histologic Diagnosis of Breast Cancer with Stereotactic Vacuum-Assisted Biopsy

The purpose of this study was to determine the accuracy of 11-gauge stereotactic vacuum-assisted breast biopsy (SVAB) for the diagnosis of breast cancer. Percutaneous biopsies of 426 suspicious breast lesions in 365 patients using 11-gauge SVAB were performed between September 1996 and June 1998. Of these biopsies 59 (13.8%) resulted in a diagnosis of breast carcinoma and 56 (95%) were surgically excised. These 56 lesions constitute the basis of this study. Pathology of SVAB and surgically excised tissue of the 56 carcinomas as well as imaging findings were correlated. At percutaneous biopsy 34 (61%) lesions demonstrated ductal carcinoma in situ (DCIS) and 22 (39%) invasive carcinomas. Surgical excision demonstrated the presence of an invasive cancer in three lesions percutaneously diagnosed as DCIS (9%; confidence interval 2-24%). No residual carcinoma was surgically demonstrated in seven (12.5%) lesions. Sensitivity of 11-gauge SVAB for the diagnosis of invasion in breast cancer was 88 per cent. Using SVAB the diagnosis of invasive carcinoma is reliable. However, a percutaneous finding of DCIS does not exclude the presence of invasion in 9 per cent of cases as confirmed by subsequent surgery. Using SVAB 12.5% of carcinomas are completely excised.

Benign intraductal papilloma: diagnosis and removal at stereotactic vacuum-assisted directional biopsy guided by galactography.

Galactography was performed in women who had problematic nipple discharge. In five women who had a focal intraductal filling defect, immediate stereotactic vacuum-assisted directional biopsy of the filling defect was performed; results were a benign intraductal papilloma in each, with atypia in one. In the four women who did not have atypia, the procedure was diagnostic and appears to have been therapeutic as well, since nipple discharge ceased after the procedure.

Core needle breast biopsy in patients undergoing anticoagulation therapy: preliminary results.

We compared complication rates of core needle breast biopsy in patients with and without concurrent anticoagulation therapy. Experience with 501 14-gauge and 179 11-gauge core needle breast biopsies was recorded prospectively. We performed 18 (3%) of 680 procedures on patients undergoing anticoagulation therapy. Eleven biopsies were performed in eight women treated with warfarin, one in a patient treated with heparin, and six in six women treated with aspirin. Ten biopsies were performed with sonographic guidance and a 14-gauge automated biopsy gun. Eight biopsies were performed with an 11-gauge vacuum-assisted probe and stereotactic guidance. Hematomas occurred in three (38%) of eight anticoagulated patients undergoing 11-gauge vacuum-assisted stereotactic biopsy, measuring 13 mm, 17 mm, and 40 mm. In patients not known to be anticoagulated, small hematomas were mammographically evident in 77 (45%) of 171 biopsies performed with an 11-gauge probe, averaging 8 mm (range, 2-17 mm); only 13 (8%) of 171 had hematomas larger than 10 mm. Small hematomas, averaging 6 mm (range, 2-12 mm) were evident mammographically in 45 (45%) of 100 stereotactic biopsies using a 14-gauge automated biopsy gun; three (3%) experienced hematomas larger than 10 mm. A 10-mm hematoma was evident during one (10%) of the 10 biopsies performed in patients undergoing anticoagulation therapy under sonographic guidance using a 14-gauge automated biopsy gun; small hematomas (mean, 10 mm) were noted during seven (2%) of 391 corresponding sonographically guided biopsies in patients not undergoing anticoagulation therapy. No patients undergoing anticoagulation therapy experienced clinically important complications; preliminary results suggest rates of hematoma formation similar to those in the control group. As such, discontinuing anticoagulation medication before core needle breast biopsy may be unnecessary when the need for biopsy is urgent.

Percutaneous removal of malignant mammographic lesions at stereotactic vacuum-assisted biopsy.

To determine whether complete percutaneous removal of a malignant lesion detected at mammography ensures complete excision of the carcinoma histopathologically. A retrospective review was performed of 135 lesions in which stereotactic biopsy was performed with a directional, vacuum biopsy instrument and an 11-gauge probe followed by mammography. Carcinoma was diagnosed at stereotactic biopsy in 51 (38%) lesions. In 15 (29%) carcinomas, the lesion seen at mammography was removed at stereotactic biopsy. Surgical findings were available for correlation with biopsy and imaging findings in all 15 cases. Mammographic and histopathologic findings were reviewed. Mammographic findings were calcifications in 11 lesions and a mass in four lesions. The median lesion size was 0.7 cm (range, 0.2-1.4 cm), and the median number of biopsy specimens was 15 (range, 10-22 specimens). Histopathologic findings at stereotactic biopsy were ductal carcinoma in situ in 12 lesions and infiltrating ductal carcinoma in three. Surgery revealed residual carcinoma in 11 (73%) of 15 lesions, including all three infiltrating ductal carcinomas and eight of 12 ductal carcinoma in situ lesions. Complete removal of the mammographic lesion does not ensure complete excision of the carcinoma.

Clip placement after stereotactic vacuum-assisted breast biopsy.

To assess accuracy and usefulness of placement of a localizing clip after stereotactic, vacuum-assisted breast biopsy. Retrospective review was performed of 57 lesions that underwent placement of a localizing clip after stereotactic vacuum-assisted biopsy with an 11-gauge (n = 42) or 14-gauge (n = 15) probe. The clip was placed when images obtained after stereotactic biopsy suggested that the lesion seen at mammography was removed. Coordinates of the clip on stereotactic images obtained after placement were compared with lesion coordinates determined before biopsy. Surgery was performed in 25 cases. Mammographic and histopathologic findings were reviewed. The distance from clip to lesion site was less than 1 cm in 40 (95%) of 42 lesions that underwent clip placement with the 11-gauge probe versus 11 (73%) of 15 lesions that underwent clip placement after 14-gauge biopsy (P < .04). The biopsy site was identified in the surgical specimen in 19 (100%) lesions with clips after 11-gauge biopsy and five (83%) of six lesions with clips after 14-gauge biopsy. No complications occurred. A localizing clip can be placed in proximity to the stereotactic biopsy site through an 11-gauge probe. Clip placement can enable accurate localization for surgical excision.