Core Breast Biopsy

Why Nonsurgical Biopsy?

The majority of suspicious nonpalpable breast abnormalities found on mammograms are not malignant. Even when based on recommendations from expert radiologists, only 25%-30% of biopsies will result in the discovery of breast cancer. Consequently, a great deal of attention has been directed to a nonsurgical evaluation of nonpalpable breast lesions. The ideal procedure would be safe and simple, would accurately identify both benign and malignant abnormalities, and thus would markedly decrease the number of surgical procedures.

In one nonsurgical technique, called breast aspiration biopsy, a 20-23 gauge thin needle is inserted (under local anethesia) to withdraw cellular material from the abnormality. The microscopic evaluation is similar to a pap smear. This is a simple procedure for both the physician and the patient, but the accuracy has not been high enough to warrant widespread use of the technique.

Over the past five years, interest has grown in a new nonsurgical technique called large core breast biopsy. A specially designed stereotactic mammographic unit provides image guidance and makes it possible to accurately place a large core (14 gauge) needle into the center of a nonpalpable breast abnormality. With the aid of an automatic biopsy device, a cylinder of tissue is removed for histologic evaluation. Because this as a tissue rather than a cellular sample, the pathologist is better able to make a specific diagnosis (ie, fibroadenoma). For mass lesions visible on ultrasound, this imaging modality may be used as a guide for core biopsy. Recently, a more sophisticated biopsy assembly called a directional vacuum-assisted device has been introduced. This has resulted in successful sampling of smaller lesions (2-3 mm) and is particularly useful in biopsy of clusters of calcification. Several centers in the United States have compared the results of the large core breast biopsy with surgical excision and found the results to be nearly identical.

What Can I Expect from the Procedure?

The large core procedure takes 15-20 minutes, requires no surgical incision, and involves only local anesthesia. On average, 5-10 core tissue samples are removed and the final pathology results are available in two days. After biopsy the patient can either go home or back to work. A bandage covers the biopsy site for three days and a small bruise is common. Patient acceptance has been excellent and women who have had prior surgical biopsy are especially enthusiastic.

The stereotactic apparatus used in large core breast biopsy is designed to allow the patient to rest on a table while the breast is imaged digitally and the needle is placed in the center of the abnormality. When images confirm that the needle is placed properly, the tissue sample is extracted. The actual extraction may be vacuum-assisted or purely mechanical, depending on the type of sample needed.
Large core needles loaded in tissue retrieval devices. The larger apparatus is designed for vacuum-assisted biopsy (used primarily in cases of calcifications); the smaller apparatus is used for biopsy of soft-tissue masses.

How Can I Get More Information?

To schedule a core breast biopsy at Brigham and Women's Hospital or to discuss the procedure with one of our professionals, call 617-732-4708.

References

  1. Parker SH, Lovin JD, Jobe WE, et al. Nonpalpable breast lesions: Stereotactic automated large core biopsies. Radiology 1991; 180:403-07.

  2. Elvercrog EL, Lechner MC, Nelson MT. Nonpalpable breast lesions: Correlation of stereotaxic large core needle biopsy and surgical biopsy results. Radiology 1993; 188:453-55.

  3. Meyer JE, Christina RL, Lester SC, et al. Evaluation of nonpalpable solid breast masses with stereotaxic large needle core biopsy using a dedicated unit. AJR 1996; 167:179-82.

  4. Meyer JE, Smith DN, DiPiro PJ, et al. Stereotactic breast biopsy of clustered microcalcification with a directional vacuum-assisted device. Radiology 1997; 204:575-6.

Breast Imaging and Diagnostic Service
Department of Radiology
Brigham and Women's Hospital

See About BrighamRAD for information about this website.

Is this a mirrored page?
The official URL is http://brighamrad.harvard.edu/patients/education/Mammo/bc_biopsy.html

Contact the BrighamRAD design team at radweb@dsg.harvard.edu
Updated May 28, 1998