Three years of experience with advanced breast biopsy instrumentation (ABBI)

This article reports our experience using the advanced breast biopsy instrument (ABBI) system for excisional biopsy of mammographically visible nonpalpable breast lesions. Patients with nonpalpable mammographically detected breast lesions were evaluated as potential ABBI candidates. Selection criteria included noncystic lesions for which complete removal or large sampling was indicated, compressed thickness of the breast of more than 25 mm, and the patient's ability to lie prone for at least 1 hour. During the period August 1997-April 2000 (33 months), 284 patients were found to be potential ABBI candidates. Sixteen patients were subsequently excluded. Biopsies using the ABBI system were performed in 268 cases, yielding an overall technical success rate of 94.4%. The mammographic abnormalities included mass in 125 cases (46.6%), mass with calcifications in 63 cases (23.5%), and microcalcifications without a mass in 80 cases (29.8%). Histologically 56 specimens (20.9%) were malignant (mass in 30 cases, mass with calcifications in 12, and microcalcifications in 14) and 212 (79.1%) were benign. Carcinoma in situ was found in 17 cases (30.4%), invasive carcinoma in 35 cases (62.5%), tubular carcinoma in 2 cases (3.6%), metastatic intramammary lymph node of previously unknown malignant melanoma in 1 case, and malignant lymphoma in 1 case. Open reexcision was performed in 54 cases with primary breast cancer. The histologic investigation revealed that in 26 (48.15%) cases the mammographic lesion was completely excised and in 28 (51.85%) cases the margins involved malignant residue and/or other foci of carcinoma. There were complications in 17 cases: wound infection in 2, ecchymosis in 9, seroma in 5, and a large immediate hematoma in 1 patient. Only the latter patient required immediate revision and drainage; the remainder underwent successful conservative treatment. Most nonpalpable breast lesions, if selected properly, are accessible for ABBI procedure. The biopsy causes minimal complications and minimal distortion of the breast architecture. Should relumpectomy be needed after the ABBI procedure, the tunnel of the cannula path is easily recognized, leaving no need for needle localization.