Stereotaxic core biopsy of impalpable spiculated breast masses

The role of stereotaxic core biopsy in evaluating mammographically detected lesions that have a high probability of being malignant is still debated. This study was undertaken to assess the use of stereotaxic core biopsy in evaluating spiculated masses, by determining the frequency with which core biopsy reduced the number of surgical procedures performed in the management of these highly suspicious lesions.

Forty-three impalpable spiculated breast masses in 43 patients were sampled with stereotaxic core biopsy. All patients underwent surgery. Patient charts were reviewed to determine the histopathologic findings at stereotaxic core biopsy and at surgery, and the number and type of surgeries performed.

Invasive carcinoma was identified at stereotaxic core biopsy in 40 (93%) of 43 patients. Therapeutic surgical procedures were lumpectomy in 28 patients (22 with axillary dissection) and mastectomy in 12. The presence of tumor at the lumpectomy margins led to subsequent mastectomy in one case. One lesion yielded atypical ductal hyperplasia at core biopsy; surgical biopsy revealed ductal carcinoma in situ. Surgical biopsy was recommended in two lesions yielding benign histologies at core biopsy and revealed invasive ductal carcinoma in one. Thirty-three (77%) of 43 patients had the number of surgical procedures reduced by stereotaxic core biopsy; these were patients with carcinoma diagnosed at core biopsy who underwent one-stage lumpectomy with axillary lymph node dissection or mastectomy.

Stereotaxic core biopsy reduced the number of surgical procedures in most women with impalpable spiculated breast masses. These data suggest that stereotaxic core biopsy is a valuable diagnostic technique for assessing these lesions, which are likely to represent carcinoma.