The impact of image-directed core biopsy on the practice of breast surgery: a new algorithm for a changing technology

Open surgical biopsy has long been the standard of care for the diagnosis of breast pathology. As more lesions are diagnosed by mammography, image-directed core biopsy has taken on increasing importance. This study consisted of a consecutive group of 540 patients who underwent breast biopsy for mammographically or sonographically detected lesions. The percentage of those undergoing image-directed biopsy and open biopsy were determined as well as the rate of positive biopsy for each method. Results showed that for patients with nonpalpable lesions, the proportion of image-directed core biopsies rose steadily during the study period, from 0 per cent in early 1993 to 70.1 per cent by early 1996. During this same period, positive biopsy rate rose from 23.9 to 31.0 per cent in the first 18 months of the study to a range of 45.2 to 48.3 per cent in the last 18 months. It was concluded that image-directed core biopsies have begun to impact the practice of breast surgery by replacing, to a great extent, the open surgical biopsy. This study also demonstrates an increased proportion of positive biopsies done by open surgical technique. It was suggested that many of the mammographically benign lesions are diagnosed by image-directed core biopsy, obviating the need for an open technique. An algorithm for managing nonpalpable breast lesions is presented.