What is the efficacy of breast stereotactic needle 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

Answer

Comparable health economic data on the comparative efficacy of image guidance modalities or needle-biopsy options may not be readily available. The costs of the consumables are not insubstantial compared with those of fine-needle aspiration (FNA).

Undoubtedly, percutaneous needle-biopsy techniques are advantageous in increasing the preoperative diagnostic accuracy of impalpable breast lesions and even in reducing the overall costs of diagnosis compared with surgical excision. [4, 5, 6, 10, 43, 44]  Even so, each new and incremental development has increased the cost of the procedure. It is therefore prudent to use a biopsy technique with full knowledge and awareness of the individual strengths and weaknesses of not only the individual modality, but also the expertise available in one's institution. According to available expertise, masses may be successfully sampled with FNA or core biopsy under ultrasonographic guidance, whereas stereotactic vacuum biopsy of small clusters of indeterminate microcalcifications may be more appropriate as a modality of choice compared with FNA or core biopsy. [14, 15]

An evidence-based approach to the image-guided modality and appropriate sampling modality for particular lesion types, combined with health economic measures is required. Due considerations must also be given to patient acceptance and outcome measures. A United Kingdom multicenter study evaluating the health economics and cost-effectiveness of 14-gauge core biopsies and biopsies using the Mammotome with conventional or digital upright stereotactic units and a prone table is underway.

The pathologic results should always be carefully evaluated in accordance to the level of clinical and radiologic suspicion in a multidisciplinary setting to ensure that the appropriate management decision is reached. Used in this manner, image-guided percutaneous needle biopsy can be used effectively to ensure that most palpable and impalpable breast lesions are diagnosed with accuracy and certainty.

The technique is safe and performed with the patient under local anesthesia. The complication rate is low, this method reduces intangible costs due to physical and psychologic morbidity.


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