Consensus document on preoperative diagnostic procedures in breast lesions

Currently, percutaneous sampling via core needle or vacuum-assisted biopsy is the primary choice to guide the management of patients with clinical or screen-detected breast lesions. Preoperative biopsies allow physicians to get pathological diagnoses as well as key prognostic and predictive data about the nature of the investigated process. Namely, adequate biopsy sampling is crucial for assigning lesions to one diagnostic category (B1-B5). Similarly, evaluating morphological (histotype, vascular invasion, necrosis, etc.) and immunohistochemical/molecular features (ER, PR, Ki-67, and HER2) is the key to address the most effective therapies, especially in the neoadjuvant setting. The multidisciplinary team should always discuss the results of percutaneous biopsies, whose global integration with clinical and radiological findings will drive the adoption of specific treatment options, particularly for uncertain (B3) and suspicious/malignant (B4-B5) lesions.

In the present work, we report a comprehensive overview of breast percutaneous biopsy techniques, diagnostic categories, and multidisciplinary management based on widely acknowledged evidence of good clinical practice.