The evolution of minimally invasive breast biopsy: from FNA to percutaneous incisional and excisional biopsy

Surgical biopsy of the breast has long been the most commonly accepted method of determining the na- ture of a clinical or mammographic abnormality. Because this method carries with it certain cost and morbidity drawbacks, physicians have investigated less invasive alternatives. Until recently, however, there has not been sufficient confidence in the minimally invasive techniques to supplant surgical breast biopsy. Fine needle aspiration (FNA) of the breast has been available for decades and, in some hands, per- formed reliably enough to avoid surgical biopsy in certain instances. For the most part, however, surgeons and other physicians have been reluctant to base definitive decision making upon the results of FNA.This is un- derstandable in that FNA carries significant insufficient tissue and false negative rates."l As a result, FNA frequently represented an additional test and attendant cost without obviating the need for surgical biopsy.