Image-guided procedures for breast masses

Breast cancer is a disease affecting millions of women worldwide. In the United States, the institution of screening mammography protocols has increased the number of suspicious breast abnormalities requiring diagnostic intervention. Up to 80% of these lesions are benign, forcing the medical community to devise minimally invasive techniques for tissue sampling. A reduction in the number of needle-localized open breast biopsies reduces the morbidity and cost associated with image-detected breast masses. Ultrasound, stereotaxis, and MRI are excellent modalities for detection of breast cancers. Image-guided, large-core biopsy systems have been developed for each of these imaging modalities, enabling successful and accurate tissue sampling and, ultimately, diagnosis of a suspicious lesion. Care must be taken to ensure correlation between imaging findings and pathologic diagnosis; if the two are discordant, further investigation is mandatory. There remains a role for needle-localized open breast biopsy, although is has been reduced significantly. Some patients prefer this method of diagnosis, and in others further investigation in required because of discordant findings. When the documented pathology of the breast abnormality is ADH, ALH, or LCIS, the patient should undergo surgical excision because of the possibility of DCIS or invasive disease in the same area. Some lesions are inaccessible with the current imaging modalities and biopsy systems available. Minimally invasive, image-guided biopsy for breast masses promises to continue to evolve, enabling physicians to diagnose breast cancer with a high degree of accuracy without significant morbidity.