What is the role of stereotactic wide-bore needle biopsy in the workup of breast lesions?

Answer

A Tru-Cut needle, ideally 14-gauge, is used for core biopsy. Because of the fibrous nature of much breast tissue, adequate samples are best obtained using a spring-loaded firing device, such as the Biopty-Cut system. The procedure is often less painful than FNA despite the wider-bore needle.

After subcutaneous injection of local anesthetic, cores of tissue can be taken and should be fixed immediately in formalin. If the lesion contains calcification based on the mammogram findings, radiographs of the cores are taken to confirm the presence of calcification and that the cores are representative. The risk of bruising with wide-bore needle biopsies is higher than with FNA. For this reason, anticoagulants should be stopped, when possible, before biopsy and a pressure dressing is applied, usually for at least 24 hours.

Often, the samples are large enough to allow detailed histologic assessment, including tumor type and grade and hormone receptor status, but sampling error may occur if the cores are not representative of the entire lesion.

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Media Gallery

Stereotactic images obtained during a prone-table biopsy procedure.
Comparison of the size of specimens obtained during core biopsy with a 14-gauge needle (left) and those obtained during vacuum biopsy with a 16-gauge needle (right).

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Author

Hemant Singhal, MD, MBBS, MBA, FRCS, FRCS(Edin), FRCSC Consultant Breast Surgeon, Clementine Churchill Hospital; Consultant Breast Surgeon, Harley Street Breast Clinic, UK

Hemant Singhal, MD, MBBS, MBA, FRCS, FRCS(Edin), FRCSC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Coauthor(s)

William Teh, MBChB, FRCR Lead Cancer Clinician, Department of Radiology, Northwick Park Hospital; Director of Screening, North London Breast Screening Service, UK

William Teh, MBChB, FRCR is a member of the following medical societies: British Institute of Radiology, British Medical Association, Royal College of Radiologists

Disclosure: Received honoraria from Hologic for speaking and teaching.

Avi Agrawal, MBBS, MSc, FRCS(Ed), FRCS(GenSurg) Consultant Oncoplastic Breast Surgeon, Portsmouth Hospitals, NHS Trust, UK

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Edward Azavedo, MD, PhD Director of Clinical Breast Imaging Services, Associate Professor, Department of Radiology, Karolinska University Hospital, Sweden

Edward Azavedo, MD, PhD is a member of the following medical societies: Radiological Society of North America, Swedish Medical Association, Swedish Society of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Meda Raghavendra (Raghu), MD Associate Professor, Interventional Pain Management, Department of Anesthesiology, Chicago Stritch School of Medicine, Loyola University Medical Center

Meda Raghavendra (Raghu), MD is a member of the following medical societies: American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Additional Contributors

John M Lewin, MD Section Chief, Breast Imaging, Diversified Radiology of Colorado, PC; Associate Clinical Professor, Department of Preventative Medicine and Biometrics, University of Colorado School of Medicine

John M Lewin, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, Society of Breast Imaging

Disclosure: Received consulting fee from Hologic, Inc. for consulting; Received grant/research funds from Hologic, Inc. for research.

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