Imaging Guided Biopsy: An Alternative to Surgical Biopsy

Imaging guided percutaneous core needle biopsy of the breast is an accurate and cost-effective method for the diagnosis of indeterminate breast lesions. It is also useful for the preoperative confirmation of suspected carcinoma. Depending on the location of the lesion in the breast, its imaging characteristics, and the configuration of the breast, biopsy using sonographic or stereotactic guidance may be preferable. However, for many lesions either technique can be used. A variety of biopsy probes are available. For many lesions the ability to make a diagnosis does not appear to depend on the probe size or configuration. However, when calcifications undergo biopsy, the retrieval of larger volumes of tissue may improve the accuracy of the diagnosis of atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS), and other rare lesions. Major complications are rare with these techniques. With benign histologies, most patients can avoid surgery and return to 6-month follow-up or routine screening mammography. When benign histologies are not concordant with the imaging pattern, when certain high-risk lesions are found at core biopsy, and when the pathologist is unable to make a definitive diagnosis based on the small volume of tissue removed, surgical biopsy is necessary. However, the vast majority of patients with benign diagnoses can avoid surgery with these biopsy techniques. It should be remembered that these techniques are not appropriate for the treatment of breast carcinoma at the present time.