Stereotaxic needle-core biopsy and fine-needle aspiration cytologic evaluation of nonpalpable breast lesions

Article Abstract:

Mammographic screening to detect breast abnormalities, including cancer, in their early stages is increasingly being performed in the United States. Early detection of an abnormality poses the problem of how the abnormality should be further evaluated. Traditional biopsy, surgical removal of suspicious tissue, is invasive, painful, and costly, and is preferably avoided unless absolutely necessary. Fine-needle aspiration biopsy (FNAB), in which a fine needle is inserted into the suspicious area to obtain a sample by aspirating tissue into the needle, avoids many of the problems associated with surgery. Unfortunately, the samples obtained are often inadequate. An alternative to FNAB is needle-core biopsy, in which the needle removes a core of tissue rather than just an aspirated sample. Two earlier studies comparing FNAB and core biopsy indicated that FNAB was superior. Two recent studies have indicated that stereotaxic needle-core biopsy might be effective. In the December 1991 issue of Radiology, Dowlatshahi and colleagues present their study, which compared stereotaxic needle-core biopsy with FNAB and surgical biopsy. Their results indicate that core biopsy does not necessarily eliminate the problems that occur with FNAB. Both techniques require a number of passes, an experienced technician, can result in specimen damage, and can be complicated by sampling error. In addition, the core biopsy technique is still dogged by technical problems. An advantage of core biopsy over needle biopsy is its ability to differentiate ductal carcinoma in situ from invasive cancer. FNAB and core biopsy for evaluation of breast abnormalities are still promising techniques, but further improvements are needed before either can supplant surgical biopsy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial

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Image-directed percutaneous biopsies with a biopsy gun

Article Abstract:

Biopsy is the removal of small tissue samples from living persons. Several biopsy techniques may be chosen, including the creation of a small incision or puncture through the skin to remove a tissue sample for laboratory analysis. Image-directed percutaneous (through the skin) biopsies performed by radiologists are the method of choice since they are safer and more cost-effective than the surgical alternative, but difficulties associated with this type of technique have prompted research into an alternative method. Research was conducted to assess a biopsy 'gun' as a tool for replacing needle aspiration as a means of acquiring tissue samples. More than 180 biopsies were performed with the device at multiple sites. High quality specimens were obtained in 177 biopsies, diagnostic target tissue was obtained in 167, and only three complications occurred in over 180 procedures. The biopsy gun eliminated difficulties often encountered with the use of conventional techniques that use flexible, narrow, needles. Ultrasound (US) imaging was used in 77 of the cases to guide the biopsy gun to the target, while computed tomography (CT) was used in the remainder. A significant advantage was gained in terms of patient comfort: image-directed percutaneous biopsies cause some discomfort to the patient, while the biopsy gun method appears to be both faster and less painful than conventional methods. The biopsy gun method is more cost- and time-efficient than percutaneous techniques: fewer attempts are needed, on average, to obtain a useful tissue sample. This technique requires further evaluation and some of the design deficiencies require improvement before the device can be made available for widespread use.

Research, Usage, Medical imaging equipment, Biopsy

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Nonpalpable breast lesions: stereotactic automated large-core biopsies

Article Abstract:

Mammography is the X-raying of the breasts and is mainly used in screening for breast cancer. When breast abnormalities that could be cancerous are discovered on mammograms, a sample of the abnormal tissue must be obtained for examination (biopsy). Surgical excision of breast tissue is the usual biopsy procedure performed. A simpler and less invasive procedure for obtaining tissue samples is desirable. Tissue samples can be obtained using a needle and a biopsy gun. The gun helps to guide the needle and to make the puncture quickly so that the breast and lesion do not move during the procedure. To examine if breast tissue samples obtained with the biopsy gun were comparable in quality to those obtained surgically, both procedures were performed on 102 women with suspicious breast masses found by mammography. Results from examination of the tissue obtained by each method were in agreement in 98 cases. In two cases, the gun biopsy procedure missed the mass in the breast and in two cases the surgical biopsy missed the mass. Twenty-three patients had a final diagnosis of cancer. In 22 of these cases, findings from both biopsy procedures were in agreement. In 57 cases, the final diagnosis was a noncancerous, fibrocystic change in tissue. Findings from both procedures were fully in agreement in 43 cases and partially so in 14 cases. Breast biopsy with a biopsy gun and needle was comparable to surgical biopsy in diagnostic value. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast diseases

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