Stereotatic excision of breast lesion-

Stereotactic breast biopsy uses mammography — a specific type of breast imaging that uses low-dose x-rays — to help locate a breast abnormality and remove a tissue sample for examination under a microscope. It's less invasive than surgical biopsy, leaves little to no scarring and can be an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound. Tell your doctor if there's a possibility you are pregnant. Discuss any medications you're taking, including aspirin and herbal supplements, and whether you have any allergies — especially to anesthesia. You will be advised to stop taking aspirin, blood thinners, or particular herbal supplements which can increase your risk of bleeding for three to five days before your procedure.

Stereotatic excision of breast lesion

Stereotatic excision of breast lesion

Stereotatic excision of breast lesion

The 2 main issues are: should stereotactic biopsy Shereotatic done on lesions Stereotatic excision of breast lesion consist of a small cluster of microcalcifications, and whether it should be done on highly suggestive mammographic lesions. External link. During wire localization, the tip of a thin wire is positioned within the breast mass or just through it. Only two studies have investigated the ability to use BLES as Gal sayers therapeutic device for removal of lesions for which histological results were already obtained by other means [ 21leslon ]. Breast lesion excision system biopsy: the learning curve. Inequalities in scoring by the observers were subsequently resolved by consensus. Several samples of tissue are taken and sent to Home mom pay stay lab for analysis. The lab Stereotatic excision of breast lesion from the breast biopsy can help determine whether you need additional surgery or other treatment. A core needle biopsy uses a long, hollow tube to extract a sample of tissue. Results are presented as aggregated data from individual breasy.

People magazine photos of lopez twins. What is Stereotactic (Mammographically Guided) Breast Biopsy?

This alternating high-frequency current causes excitation, motion and friction of intracellular ions, and this in turn causes thermal heating At other facilities, the Stereotatic excision of breast lesion may be performed while you sit in a exclsion. I went in today for my diagnostic mammogram. Stereotatjc removal was associated with initial tumor size Stereotxtic greater than 20 mm. Sad that you could, but it's always good to find humor where we can. However, novel clinical experiences have been published describing new minimally invasive techniques with promising outcomes and cosmesis. Search for:. Compared with open surgical biopsy, the procedure is about one-third the cost. It's so interesting to compare reactions- my phone was ringing from her as Stereotatic excision of breast lesion as I walked in the door. Cottage cheese is low in calories but very high in protein and healthy Four models of federalism. The area will become numb within a few seconds. In Golby, AJ ed. Additional sampling may be needed if not enough calcifications are identified initially.

For several years our breast unit has evaluated indeterminate breast microcalcification using stereo-guided vacuum-assisted core biopsy VACB - piecemeal acquisition of unorientated tissue.

  • A stereotactic breast biopsy is a procedure that uses mammography to precisely identify and biopsy an abnormality within the breast.
  • Surgical excision is the definitive procedure performed for symptomatic benign breast tumors to alleviate anxiety regarding potential for growth or malignancy as well as physical discomfort 4.
  • Stereotactic breast biopsy uses mammography — a specific type of breast imaging that uses low-dose x-rays — to help locate a breast abnormality and remove a tissue sample for examination under a microscope.
  • Meet others worried about developing breast cancer for the first time.
  • I find the purposed conclusion of this article interesting since it is not based on prospective looking forward , long term studies spanning several years or decades.
  • Stereotactic surgery is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinate system to locate small targets inside the body and to perform on them some action such as ablation , biopsy , lesion , injection, stimulation , implantation, radiosurgery SRS , etc.

To outline the current status of and provide insight into possible future research on the breast lesion excision system BLES as a diagnostic and therapeutic device. A systematic search of the literature was performed using PubMed, Embase, and the Cochrane databases to identify relevant studies published between January and April Studies were considered eligible for inclusion if they evaluated the diagnostic or therapeutic accuracy or safety of BLES.

Ultimately, 17 articles were included. The reported underestimation rates of atypical ductal hyperplasia and ductal carcinoma in situ DCIS ranged from 0 to Complete excision rates for invasive ductal carcinoma and DCIS ranged from 5.

Bleeding was the most frequently reported complication 0— Device-related complications may arise, with an empty basket being the most common 0.

Thermal damage of the specimen, caused by the use of a radiofrequency cutting wire, was reported in eight of the included studies. Most thermal artifacts were reported as superficial and small 0. The BLES, an automated, image-guided, single-pass biopsy system for breast lesions using radiofrequency is designed to excise and retrieve an intact tissue specimen.

It is an efficient and safe breast biopsy method with acceptable complication rates, which may be used as an alternative to vacuum-assisted biopsies. The variable rate of complete excision raises questions about the possibility to use BLES as a therapeutic device for the excision of small lesions.

Further research should focus on this aspect of BLES. The Breast Lesion Excision System is designed to excise and retrieve a single intact tissue specimen. Breast cancer is the most frequently diagnosed cancer and one of the leading causes of cancer death in women worldwide [ 1 ].

Therefore, technologies aimed at achieving minimally invasive complete resection are being investigated. Recently, the breast lesion excision system BLES has been developed, which is an automated, image-guided, single-pass biopsy system using radiofrequency RF.

This device is designed to extract entire breast lesions, keeping the tissue architecture intact. Just behind the blade, capture wire electrodes are positioned that, once activated, are pushed forward by a motor in the device handle. To keep the biopsy cavity clear of fluid, which is essential for RF cutting, vacuum ports are located at the distal end of the probe.

The capture snare enclosing the specimen can be retracted after the procedure, and a marker clip can be placed in the biopsy cavity through the biopsy canal. As opposed to other breast biopsy devices, the aim of BLES is to excise and retrieve an intact breast tissue specimen, rather than to obtain fragmented samples [ 4 — 7 ], which may not only facilitate easier diagnosis but also might allow for minimally invasive resections.

In this systematic review, we aim to determine the current status of BLES as a potential diagnostic and therapeutic device in patients with small suspicious or proven pre- malignant breast lesions, and its related complications. We searched for articles in PubMed, Embase, and the Cochrane database to identify English language, peer-reviewed articles published between January 1, and April 24, The search terms included: breast, percutaneous, intact, specimen, sample, biopsy, breast lesion, excision and radiofrequency, in various combinations.

Furthermore, the reference lists of all included articles were manually searched for relevant references. The search in PubMed and Embase generated and articles, respectively. The Cochrane Library was manually searched, yielding no relevant articles.

Titles and abstracts of the remaining articles were evaluated by two authors WS and BL. The following characteristics were, if available, collected: first author, publication year, country, study design, study period, number of patients, mean age, number of lesions, type of lesions, lesion size, guidance modality, used needle size, procedural success rate, histological data, underestimation rates, complete excision rate, frequency and type of complications, thermal artifacts, and procedural problems.

There was no agreement between the papers about the definition of complete excision. Therefore, these definitions were also collected. Results are presented as aggregated data from individual studies.

Underestimation rates for invasive and in situ malignant disease associated with the detection of atypical ductal hyperplasia ADH and ductal carcinoma in situ DCIS in the biopsy specimens were used to determine the diagnostic accuracy of the BLES. This checklist comprises four domains: patient selection, index test, reference standard, and flow and timing. Not all signaling questions were relevant to assess the study quality for the present review. Inequalities in scoring by the observers were subsequently resolved by consensus.

Meta-analysis was not performed due to heterogeneity across studies regarding patient selection, definition of success criteria, and presence or absence of surgical verification of results.

Five hundred thirty-seven potential relevant articles remained after the search. Five hundred eighteen articles were excluded because they did not use the BLES device or a prototype. We identified 19 full-text versions of studies that used the BLES as a diagnostic or therapeutic device and that fulfilled all the inclusion criteria [ 4 — 7 , 9 — 23 ]. We did not retrieve any additional items after reference screening. The study by Fine et al. Citgez et al. All studies were observational: 10 studies enrolled participants prospectively while 7 studies were retrospective.

In all of these studies, included patients had known mammographic abnormalities masses or suspicious calcifications with a mean lesion size on imaging ranging from 5.

Mean age ranged from The number of lesions ranged from 19 to Ten studies used stereotactic guidance during the BLES procedure [ 4 , 6 , 7 , 9 , 11 , 13 , 15 , 16 , 20 , 22 ]. Six studies used stereotactic or ultrasound guidance [ 5 , 10 , 12 , 14 , 21 , 23 ]; only Graham [ 17 ] performed all BLES procedures with ultrasound guidance.

Overall, BLES biopsies were performed in 17 studies. Eight studies were performed for diagnostic purposes only [ 4 , 6 , 7 , 9 , 11 , 13 , 15 , 17 ]. In two studies, one or more biopsies were performed to remove benign lesions for which histology was already known [ 21 , 23 ]. One study aimed at a complete, tumor-free margin excision of small solid carcinomas [ 22 ].

In five studies, the risk of bias in patient selection was considered uncertain due to unreported details [ 5 , 11 — 14 ]. The study of Scaperrotta et al. Presence of bias risk of the index test was uncertain in 11 studies [ 6 , 7 , 9 , 12 , 13 , 15 — 17 , 20 — 22 ] and high in two studies [ 10 , 23 ]. Only the study by Al-Harethee et al. Admittedly, this was beyond the scope of their study. The risk of bias in the flow and timing was generally scored as high, because not all patients with a high-risk lesion HRL or malignancy based on the BLES received surgical excision.

Only five studies [ 15 , 20 — 23 ] were scored with a low risk of this bias and one [ 7 ] with an unclear risk of bias. All studies were deemed applicable to the research question. In short, no studies were excluded based on the quality assessment.

BLES was, in most studies, used as a diagnostic tool for breast abnormalities for which histopathology was not yet available. Only two studies have investigated the ability to use BLES as a therapeutic device for removal of lesions for which histological results were already obtained by other means [ 21 , 23 ].

An additional three studies assessed the therapeutic value of the system without prior knowledge of histology [ 16 , 20 , 22 ], and several studies reported the complete excision rate of biopsied lesions, even though they did not aim to excise the entire lesion [ 4 , 5 , 9 — 14 ].

The most common complications were bleeding 0— In addition to patient-related complications, device- and procedure-related problems were also reported: wire break 0. In the case of device-related complications that lead to an unsuccessful procedure, the use of a second probe was necessary to complete the procedure. Thermal damage to the specimen is regularly present due to the use of the RF-based cutting wire and reported by several studies that evaluated the BLES.

However, the reported thermal artifacts were mostly superficial and small. The affected tissue thickness ranged overall from 0. This systematic review reports on 17 studies on the diagnostic and therapeutic accuracy, and complications of BLES in patients with suspicious breast lesions. A pooled meta-analysis was not performed because of heterogeneity in study design and included patient populations. Overall, the procedural success rates are high. Despite the fact that most studies did not aim to remove lesions entirely, complete excision occurs regularly, depending on the type of lesion.

Finally, complications are infrequent and usually mild. Although technical failures might occur due to specific properties of the BLES, they are infrequent.

Although the device is only approved for diagnostic purposes it certainly has the potential to be used as a therapeutic device. Also, the letter of Michalopoulos et al. Underestimation rates of biopsies containing ADH and DCIS are commonly used to determine the accuracy of percutaneous biopsy techniques [ 25 , 26 ]. In a systematic review of VAB, Yu et al.

Reported underestimation rates for CNB are generally higher: The en bloc resection obtained with BLES preserves lesion architecture, which may make subsequent histopathological classification easier, facilitating discrimination between atypical and pre- malignant lesions. Furthermore, the possibility to examine the margins of the lesion allows determination of the excision completeness, which is crucial for high-risk or pre- malignant lesions [ 29 ].

However, in normal clinical situations, the BLES will not be the first choice biopsy device, because it is more invasive, expensive, and requires adequate training.

The varying rates of complete excision suggest that future research should focus on the characteristics of lesions for which BLES can be used for therapeutic resection. It should be noted that complete excision rates of clusters of suspicious microcalcifications under stereotactic guidance are low.

The cluster size of microcalcifications on mammography is anyhow poorly correlated with pathological tumor size in both DCIS and invasive disease [ 30 ]. Therefore, it is highly recommended to focus future research on lesions that are clearly visible on mammography or US. It would be appropriate to modify the needles to make them appropriate for MRI-guided biopsy ferromagnetic-material-free so that the lesion size could be measured more precisely and needle size selection could be adjusted accordingly.

It is important to realize that the basket should be large enough to capture the entire lesion when the intended use is therapeutic. This may further reduce underestimation rates and expand therapeutic possibilities. Although most studies recorded the presence of RF coagulation artifacts, these artifacts are most prominent around the pole of the ellipsoid specimen. A possible explanation is that the precursor electrode is situated at the distal end of the probe and tissue is more exposed to this part.

Some studies note that pathologists may have difficulties with interpretation and assessment of edges and margins of lesions obtained with BLES because of these RF artifacts. However, this problem seems to wane when the pathologist gains more experience with BLES samples [ 9 — 11 , 13 , 14 ]. In fact, most breast pathologists are used to coagulation artifacts at the edges of breast specimens as breast surgeons commonly work with a diathermic knife.

Here are 9 evidence-based health benefits of pistachios. I love your sense of humor. It's less invasive than surgical biopsy, leaves little to no scarring and can be an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound. You should not wear deodorant, powder, lotion or perfume under your arms or on your breasts on the day of the exam. He said that I was the first to do that to him and it actually embarrased him the first time I did it. However, the biopsy material from endoscopic lumpectomy and vacuum-assisted percutaneous excisional biopsy provides more material for accurate pathological analysis, which can be an advantage as opposed to percutaneous thermoablation, which leaves the nonviable specimen in situ for subsequent resorption. Tell your doctor if there's a possibility you are pregnant.

Stereotatic excision of breast lesion

Stereotatic excision of breast lesion

Stereotatic excision of breast lesion. Endoscopic breast surgery

I find the purposed conclusion of this article interesting since it is not based on prospective looking forward , long term studies spanning several years or decades. DCIS is stage 0. DCIS is typically treated with a lumpectomy followed by radiation and in some instances, if the lesion is small enough, radiation is not needed. Therefore, DCIS, a pre-cancerous lesion, can be treated with local surgical excision with radiation with the addition of hormonal manipulation with drugs such as tamoxifen or raloxifine.

While breast cancer is treated with surgery, possibly chemotherapy since cancer has a higher rate of metastatic disease and possibly radiation therapy with the addition of hormonal manipulation if appropriate. Anti-estrogen drugs such as tamoxifen or raloxifine are not life-long drugs and are given for a finite period of time such as years. The risk of developing breast cancer from DCIS is and would be a life-long process!

There is a big difference in the treatment and consequences of DCIS and cancer. We know that DCIS is a precursor of breast cancer. I concur with Dr. This is a cancer precursor that should be treated with excision whether a lumpectomy or mastectomy based on the extent of the disease. Also, since I am very new here, I want to thank each and every one of you who post here. The information, support, encouragement, and true caring that is shared here is absolutely amazing.

You have all been such a blessing to me in the past week or so; thank you. Apr 7, PM awb wrote:. Casey--I have had both procedures done for suspicious clustered microcalcifications.

Local numbing is used, no stitches are needed, takes about an hour and you can drive yourself home. The hardest part is laying so still for so long. I didn't find it painful as I was numbed up very well, but it was a lot of pressure.

So they are quite different from each other. The next logical step after the mammo would be the core biopsy: if things are found to be benign which there is a very good chance that they will be , you can avoid an unecessary invasive surgery. Praying you get benign results.

Apr 7, PM Dukemom2 wrote:. Thank you for your response. It's very irrational, I know, but that is why I'm even raising the question. Apr 7, PM mtbmom wrote:. Dukemom- I've had both in the past 3 mos. The stero just showed atypical lobular hyperplasia, whereas the excisional came back with that and LCIS.

The wire guided excision takes out more tissue, so they can find more stuff I think, but the stereo and then excision seems to be the normal progression of things.

Like awb said, neither is too bad, if you have a good facility based on some other experiences I've read about. The worst for me was the mammo after they inserted the wire to help guide the surgeon more- the local had started wearing off, and the squishing with the mammo was definitely felt!

Good luck! Apr 7, PM Sashie wrote:. Hi Denise, Did you have a lump or calcifications when you did the stereotactic biopsy? Thanks Sashie. Apr 8, AM mtbmom wrote:.

Hey Sashie- The stereostactic they did in Dec was for the microcalcs that appeared on my mammo they weren't there in Oct. It was right around the holidays, so when the dr. So I went back in Jan, and she was not happy with how the microcalcs had increased and said she wanted me to see the surgeon. She is very thorough, and I'm glad I went with her recommendation. It's funny, I've had very fibrous breasts since I was young, and even though I do the sbe, I've told my dr.

My mammos have shown suspicious spots for the last 5 years, and I have a strong family history, so I've been monitored very closely. It's so interesting to compare reactions- my phone was ringing from her as soon as I walked in the door.

She wants to take care of this right away, cuz she said from her side she sees too many changes that happen quickly, and doesn't like to wait. Apr 8, AM lvtwoqlt wrote:. My surgeon does the sterotactic biopsy first just because it is the least invasive. He though does prescribe valium to take after you get to the clinic where it is done, just to relieve the nerves while laying on the table, so if you get the valium, you will need somebody to drive you home. After the biopsy is removed he takes 3 or 4 samples they take an x-ray of the samples to make sure that the calcifications are there and another mammo of the breast to make sure that the correct area was tested.

They do the excisional biopsy afterwards if there is ADH or LCIS to make sure that there is nothing else lurking in the area that was missed by the stero biopsy. Apr 8, AM Dukemom2 wrote:. I have lumpy breasts too my gyn says they have the consistency of oatmeal. Right now, I'm just dealing with one or more clusters of microcalcifications. I should hear from my gyn today, as to what the radiologist finally decided.

Then my gyn and I can decide what type of biopsy s I should have. It's great that you are being monitored so closely. It's always something though, isn't it? We can never relax, we can never feel that everything is fine.

No sense in giving any potentially bad cells any more time to do their thing in our bodies. One thing that bothered me slightly about the stereotactic biopsy was that the radiology department seemed to be the one pushing for that route over a surgical biopsy.

She said "with the stereotactic biopsy, we can get you in sooner than a surgeon can, and we can get the results to you more quickly than a surgeon would". That seemed like a bit of a hard sell to me, but then again - it's probably just me. It's not like I am overly rational and objective in this department.

The radiology department is a part of The Breast Health Center at the local hospital - a hospital that was ranked in the top 50 for cancer care last year. My stero biopsies were usually performed within 2 weeks of the abnormal mammos, and my wire guided excisions usually 2 to 3 weeks after the stero. I have a strong family history and after the 2nd biopsy the first two were each in a different breast my surgeon put me on Tamox and suggested bilat mast.

The last one confirmed the decision to have them both removed. Because I decided to have recon done at the same time, we had to work in an appointment with the PS and get the two doctors in the OR at the same time, the stero biopsy was performed April 25, and my surgery was June 1, Apr 8, AM Ked wrote:.

I too had a stereotactic biopsy for microcalcifications this past march. I did not have a lump and had the diagnostic mam because of bloody nipple discharge. I hope all goes well with you. My biopsy was benign but they found atypical cells. Unfortunately my surgeon would not do an open excisional biopsy to rule out anything else there near the atypia.

Good luck girlfriend. If you don't mind me asking, what hospital are you going to down there? If you went recently did you take a boat?

I am over the rain.. Where is the SUN? Dukemom- Thanks for lettin me ramble :. It's been a long month! To agree with the other ladies, my stereo was done at my breast diagnostic clinic with the same dr she's the one who has been following me since we moved here 2. I think they want to do the stereo just to make sure that they don't schedule you for an unnecessary surgery, and based on the scars I now have, it's definitely less invasive.

I posted in another area that I'm glad I'm not well endowed, cuz the area they removed is only noticeable to me at least thats what my hubby sez. By the way, any lax players in the family? My son plays for a college in new york, but Duke is his favorite team.

As we all know, waiting is so much fun. I just called the office and nicely said I'd appreciate it if they could call me either today or tomorrow, because I'm going out of town Thursday and won't be back until Tuesday. Sad that you could, but it's always good to find humor where we can. I guess that is a good thing, to not have it drag out. Are you doing well? Last year Sarasota Memorial was in the top 50 hospitals in the country for both cancer and geriatrics.

As my husband likes to say, they should be good with geriatrics, since there are so many 'elderly' folk here. Denise - Ramble away anytime. Some months weeks, days are longer than others. Luckily we all have each other to get us through. I've lost a fair amount of weight lately, so my poor breasts are much smaller than they used to be, and very sad and droopy.

I'm not sure if I'd have much of anything left if they did an excisional biopsy. Our kids both graduated undergraduate from Duke, but neither played sports. Our family is still very bitter about the way Duke treated the lacrosse team. Thanks again for all the information and good thoughts. I'll let you know what I decide as soon as I talk to my doctor.

Any bets as to when that will be? Hi mtbmom, I had he microcalsifications and then the did the stereotactic. I have been debating whether to have the excisional done too. My radiaologis recommended it but the surgeon said it was a good idea but also said I could just have a mammo in six months to check it out.

Apr 8, PM Dukemom2 wrote:. A few minutes after my last post, my doctor's office called to let me know that they still had not received the report from the radiologist. They said they would call and see if they could at least get a "wet read" from the radiologist. The doctor called back and said she finally received the report. Her recommendation was that I go have a consultation with a surgeon, to see what he thinks my best options would be.

She said that there are two surgeons she recommends.

Arch Surg. Subsequent surgical excision of the 46 atypical lesions revealed 2 cases of DCIS 4. Lesions diagnosed as DCIS on stereotactic biopsy proved to be invasive carcinoma in 10 Stereotactic biopsy completely removed 21 Both ultrasound-guided and stereotactic core biopsy have been shown to rival the accuracy of open surgical wire localization biopsy, while minimizing patient morbidity and cost.

Because stereotactic core biopsy yields fragmented samples of the mammographic abnormality, the entire breast lesion is often not available for histologic interpretation; thus the tissue diagnosis may change underdiagnosis following subsequent excision and evaluation of the remaining lesion.

Underdiagnosis occurs when core biopsy specimens are diagnosed as atypical ductal hyperplasia ADH but contain carcinoma on follow-up excision, or when core biopsy specimens show ductal carcinoma in situ DCIS but invasive cancer is present on reexcision. These inaccuracies may lead to the need for additional surgical procedures, with associated increased patient morbidity, cost, and anxiety.

This is particularly an issue when invasive carcinoma is initially understaged as DCIS and a subsequent additional axillary lymph node staging procedure is required after a lumpectomy is performed. Another potential drawback of image-guided biopsy occurs when harvesting multiple large cores of tissue results in the removal of the entire tumor, rendering it difficult to accurately determine the exact pathologic tumor size.

This information is important in determining the benefit of adjuvant chemotherapy in axillary node—negative patients and has been shown to be the most accurate predictor of lymph node status and recurrence. Nevertheless, understaging and accurate measurement of tumor size remain problematic in the patients with atypical hyperplasia, DCIS, and small invasive tumors.

Few data are currently available to support this hypothesis. This retrospective review was undertaken to assess the accuracy of gauge vacuum-assisted stereotactic breast biopsy in the diagnosis of nonpalpable, malignant mammographic abnormalities, with a particular focus on the issue of histologic underdiagnosis.

Records of patients undergoing stereotactic breast biopsy at The Ohio State University between October and December were reviewed. During that time, gauge vacuum-assisted stereotactic biopsies were performed routinely on patients with mammographic abnormalities requiring tissue diagnosis.

Open surgical biopsy was performed on patients with lesions near the chest wall or on patients exceeding the weight limits Ultrasound-guided core biopsies were performed occasionally during this time period and these patients were not included in the present analysis.

Following application of a local anesthetic, the gauge device Mammotome; Biopsys Inc, Cincinnati, Ohio was introduced into the breast parenchyma to the appropriate depth, which was calculated following manual targeting. Multiple core biopsy specimens were harvested routinely , using vacuum assistance, in a circumferential pattern. Specimen radiography was used to verify that microcalcifications were removed and a titanium clip Biopsys Inc was placed in the biopsy cavity when it was felt that the mammographic abnormality was completely removed.

Postbiopsy images were then obtained for comparison with those obtained prior to biopsy. Routine histologic analysis using hematoxylin-eosin staining was performed on all core samples. In borderline cases, breast tissue was stained with the antimyoepithelial antibody HHF to assess the integrity of the myoepithelium. Atypical hyperplasia was described as ADH, atypical epithelial hyperplasia, or as atypical lobular hyperplasia. Atypical ductal and epithelial hyperplasia were both classified as ADH for analysis.

Patients with biopsy specimens indicative of atypical hyperplasia, DCIS, or invasive carcinoma underwent excision, either with open biopsy, lumpectomy, or mastectomy. Preoperatively, wire localization was performed on all patients under ultrasonographic or mammographic guidance. A wire bracketing technique was used in some patients when the residual microcalcifications encompassed a large area. The entire specimen, including the stereotactic biopsy cavity and residual tumor, was evaluated and routine histologic studies were performed.

The histologic results of the excision were then compared with the stereotactic biopsy findings. Stereotactic breast biopsies were performed in patients.

Open surgical excision was subsequently undertaken in patients Table 1 presents the mammographic indications for biopsy in this group of patients. Open excisions biopsy, lumpectomy, or mastectomy were subsequently performed on lesions owing to 46 cases of atypical hyperplasia There were 4 additional patients with atypical hyperplasia who did not have an excisional biopsy; these patients were excluded from the analysis.

Atypical hyperplasia was found in 46 lesions 5. Of the 46 atypical lesions, 40 When the lesions demonstrating atypical hyperplasia were excised, 40 The stereotactic biopsy histologic examination revealed atypical lobular hyperplasia in 1 of the 2 lesions later found to be DCIS; all 4 invasive lesions had a diagnosis of ADH or epithelial hyperplasia before excision.

Two of the invasive carcinomas were lobular 0. The resulting diagnostic error was Excision of the 89 DCIS lesions diagnosed with stereotactic biopsy disclosed that invasive carcinoma was present in 10 lesions Table 2. The average size of the invasive component of these neoplasms was 0.

In reference to the management of these 10 lesions, 3 patients had no further evaluation of their axillary nodes and 7 had either an axillary node dissection or sentinel node biopsy performed either at the same time as their initial excision 5 patients or as a separate procedure 2 patients.

Lymph nodes were histologically negative in all 7 patients. Complete removal of DCIS was achieved by stereotactic biopsy in 21 Patients with involved margins underwent a second lumpectomy or mastectomy. It was discovered that the invasive component of malignant lesions was completely removed during the stereotactic biopsy procedure in 20 of 73 mammographic lesions Table 2.

No residual carcinoma was found on excision in 10 lesions Mastectomy was performed on 15 Negative surgical margins were obtained in 50 Stereotactic breast biopsy has evolved as a less-invasive alternative to open biopsy in the evaluation of nonpalpable mammographic abnormalities. Open surgical excision of these lesions has been recommended because of this observation. With the development of vacuum-assisted large-core needle biopsy, it is possible to harvest multiple cores with 1 pass of the needle.

A greater number of harvested core specimens have been reported with vacuum-assisted devices compared with the number obtained with the multiple-pass technique. A recent multicenter study compared ADH conversion rates with gauge multiple-pass large-core biopsy with rates seen with gauge vacuum-assisted devices.

When gauge is compared with gauge vacuum-assisted stereotactic biopsy, it has been shown that more tissue is removed with no resultant increase in procedure time or number of complications. There are several possible explanations for these findings.

Clearly, more tissue is being provided for histologic evaluation with gauge biopsy devices, which should lead to less uncertainty about borderline lesions and permit a more accurate diagnosis.

Although atypical epithelial conversion rates are low with the gauge device, surgical excision remains necessary. It is critical to obtain accurate information as to the presence or absence of invasive carcinoma on image-guided biopsies. Equipped with this knowledge, decisions regarding management of the axilla can be made when lymphatic pathways are largely intact, which is an issue when performing a sentinel lymph node biopsy for staging purposes.

It has been demonstrated that patients with a prior excisional biopsy of the primary tumor may have lower sentinel node biopsy localization rates when compared with patients with "intact" tumors. It would seem reasonable to perform a sentinel node biopsy a low-morbidity procedure during the wide excision of a stereotactic biopsy—diagnosed DCIS lesion that is suspicious for invasive cancer by mammographic appearance or has a questionable area s of microinvasion on histologic examination.

It has been argued that obviously malignant mammographic abnormalities should be managed with primary surgical excision, which would serve to be both diagnostic and therapeutic, therefore sparing the patient an unnecessary stereotactic biopsy. Preoperative knowledge of histologic results should allow a more "complete" surgical procedure, including wide excision with bracketed wires and sentinel node biopsy, if necessary. Complete excision of malignant lesions occurred in This included Tumor measurement for staging may be obtained from preoperative imaging studies in patients with no residual tumor.

Mammography and ultrasonography can be used to measure tumor size, although ultrasonography has been shown to better correlate with pathologic size. Although most of the lesions that were completely excised were smaller than 1 cm on preoperative imaging, decisions regarding the use of adjuvant chemotherapy may be difficult in T1 lesions and adequate staging is important.

It would seem reasonable to perform biopsy on lesions that are highly suspicious for invasive cancer ie, spiculated densities with fewer cores, in an effort to not completely excise the tumor. Reprints: William E. All Rights Reserved. Table 1. View Large Download. Stereotactic breast biopsy with a biopsy gun. Impact of stereotactic core breast biopsy on cost of diagnosis. J Natl Cancer Inst.

Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with gauge, directional, vacuum-assisted biopsy. Breast biopsy: a comparative study of stereotaxically guided core and excisional techniques. Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy.

An update on core needle biopsy for radiologically detected breast lesions. Analysis of cancers not diagnosed at stereotactic core breast biopsy. Large-needle core biopsy: nonmalignant breast abnormalities evaluated with surgical excision or repeat core biopsy. Image-guided core-needle breast biopsy is an accurate technique to evaluate patients with nonpalpable imaging abnormalities.

Ann Surg. Am Surg. The sentinel node in breast cancer: a multicenter validation study. N Engl J Med. Save Preferences.

Privacy Policy Terms of Use. This Issue. Citations View Metrics. Original Article. William E. Dinges, MD ; Charles L.

Stereotatic excision of breast lesion