What equipment in needed to perform breast stereotactic core biopsy?

Updated: Aug 09, 2018
  • Author: Hemant Singhal, MD, MBBS, MBA, FRCS, FRCS(Edin), FRCSC; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Although core biopsy under ultrasonographic guidance has traditionally been the first choice for diagnosis of most breast lesions, [14]  and it has improved the accuracy of image-guided needle biopsy in the diagnosis of impalpable lesions, the problems with underestimation and the potential for sampling error has led to more invasive and larger-volume percutaneous biopsy devices. The two main types are (1) vacuum-assisted biopsy devices, such as the Mammotome device and the Hologic ATEC device, and (2) image-guided single-cylinder excision alternatives, such as the INTACT device. The common denominator of these devices is their ability to sample larger tissue volumes.

The Mammotome probe, for example, consists of an outer shell with an aperture at its end for collecting tissue. It is a single-insertion device that uses vacuum suction to pull the target tissue into the collecting aperture. The tissue is then excised by a rotating cutter. Multiple harvests can be performed 360º around the lesion while the probe remains in the lesion during the whole procedure.

The vacuum device can be used under ultrasonographic guidance or stereotactic guidance, particularly for microcalcifications [14, 15] ; the patient is prone or upright with the use of certain units, with adequate room to accommodate the device. The vacuum devices are available in different sizes (eg, the Mammotome is available in 11g and 8g, the ATEC in 12g and 9g, and the Encor in 10g and 7g).

The vacuum device has been demonstrated to be superior in the diagnosis of DCIS compared with a 14-gauge core biopsy, with 6% of vacuum-biopsy ductal carcinoma in situ (DCIS) found to be invasive carcinoma at surgery compared with 21% with 14-gauge core biopsy. [16, 17]  Repeat biopsy rates for inadequate sampling of microcalcifications is also significantly lower when using vacuum biopsy (11.6%) compared with core biopsy (23.7%), although an equal proportion of malignancy is diagnosed following rebiopsy. [18]  Although vacuum biopsy appears to be nearly three times more accurate than core biopsy in the diagnosis of atypical ductal hyperplasia (ADH), underestimation still occurs in 18%-25% of cases. [19, 20]

Because vacuum biopsy removes more tissue during sampling than core biopsy, complete removal of the mammographic abnormality has been reported [17, 21] ; however, this is not always correlated with removal of the pathologic lesion at surgery. [16]  A localizing clip can be inserted if the mammographic lesion is small; this clip can potentially be removed during vacuum biopsy. Thus far, no cases or tumor track seeding has been described, although benign epithelial displacement has been described. [22]  The likelihood of this occurrence is probably minimized if the operator chooses to insert the probe into position rather than fire it into place.


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