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Ultrasound image-guided core biopsy of the breast

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KLIMBERG, V., RIVERE, A.. Ultrasound image-guided core biopsy of the breast. Chinese Clinical Oncology, North America, 5, apr. 2016. Available at: <http://cco.amegroups.com/article/view/10277>. Date accessed: 18 Dec. 2018.

Results of partial mastectomy or lumpectomy including margin negativity are improved when preoperative diagnosis is obtained. This article describes the various techniques, instruments, utility and complications of the techniques. Emphasis is given to ultrasound (US) usefulness and effectiveness.

Recent trends in breast cancer treatment have favored breast conservation surgery with an emphasis on improved cosmesis. In the last twenty years of breast surgery, one of the most important advances has been the ability to diagnose breast cancer outside of the operating room utilizing the techniques of percutaneous core needle biopsy (CNB), stereotactic biopsy, and vacuum-assisted biopsy techniques. As nearly 80 percent of mammographic abnormalities are benign, the need for open biopsy has dramatically decreased, in turn supporting the use of minimally invasive percutaneous techniques. Utilizing excisional biopsy for diagnostic purposes often requires repeat surgery to establish clear margins in cases of a cancer diagnosis, propelling a shift towards percutaneous biopsy (1-5). The ability to obtain a diagnosis of cancer prior to surgery can allow for proper pre-operative planning, decrease the subsequent positive margin rate, and thus decrease the re-excision rate.

Percutaneous CNB is the preferred minimally invasive technique for diagnosing both palpable and non-palpable lesions. An international interdisciplinary consensus conference held in 2001, 2005, and again in 2009 agreed that percutaneous biopsy of breast lesions should be the gold standard biopsy method with use of US guidance if the lesion is amenable and stereotactic biopsy for calcifications not visualized on US (6). The Agency for Healthcare Research and Quality published an evidence report in 2014, that included 160 studies, and concluded that women were 15 times more likely to have their cancer treated with a single surgical procedure if they underwent image guided biopsy rather than open excisional biopsy (7). Breast surgeons are increasingly gaining expertise in breast US and US-guided core needle biopsies (CNB) (2,4). Surgeon-performed breast biopsies have shown to be cost-effective and associated with high patient satisfaction rates (3). Surgical societies are increasingly providing training programs and are certifying surgeon competency in these areas (2,4). In the United States, percutaneous CNB has nearly replaced fine needle aspiration (FNA) as the pre-operative diagnostic method of choice for breast lesions, as it provides a more definitive histological diagnosis and adequate tissue for prognostic markers (5-9). Performance of percutaneous biopsies for tissue diagnosis allows for optimization of surgical planning with concomitant staging of the axilla, therefore, decreasing the need for re-operation.

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