[Screening and imaging guided biopsies of the breast]

In cases of subclinical mammographic abnormalities, being able to determine after screening, the indications regarding the type of imaging guidance and the type of biopsy equipment. In presence of microcalcifications, stereotactic mammography, either screen-film or digital, is the modality of choice. As fine needle aspiration cytology is insufficient, it is necessary to obtain tissue specimens with at least 14 Gauge Tru-cut needle, triggered by automatic guns, or coaxial needles of 11 G or 8 G, adaptable on a vacuum aspiration system. In case of mammographic opacities or masses, the same type of sampling can be used under US guidance as long as there is a good sonographic contrast of the lesion. Fine needle puncture, well accepted, keeps all its interest for cystic lesions and for solid ones, because of the value of its multidirectionnal sampling that well trained cytopathologists can make very informative. However, in case of insufficient or discordant results, US guided microbiopsies or macrobiopsies, using newer guns, allow to obtain a histologic diagnosis equivalent to surgical biopsy. If fine needle US guided puncture can be performed in first intention, straight after ultrasonographic examination, percutaneous micro- or macrobiopsies (using US or stereotactic guidance) must be undertaken in second intention after having explained to the patient this ambulatory procedure, the eventual risks, and by insisting on the results that can be expected for a precise diagnosis.