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AJR 2001; 177:405-408
© American Roentgen Ray Society

Sonographically Guided Directional Vacuum-Assisted Breast Biopsy Using a Handheld Device

Steve H. Parker1, Anita J. Klaus2, Patrick J. Mc Wey3, Kathy J. Schilling4, Tommy E. Cupples5, Nathalie Duchesne6, Mark A. Guenin7 and Jay K. Harness8

1 The Sally Jobe Breast Centre, 8200 E. Belleview Ave., Ste. 102, Greenwood Village, CO 80111.
2 Wellspring Breast Center, Community General Hospital, POB South, 4900 Broad Rd., Syracuse, NY 13215.
3 Van Dyke Haebler Center for Women's Imaging, 2025 E. Newport Ave., Milwaukee, WI 53211.
4 Women's Center Boca Raton at Community Hospital, 690 Meadows Rd., Boca Raton, FL 33486.
5 South Carolina Comprehensive Breast Center, One Richland Medical Park Dr. # 120, Columbia, SC 29203.
6 Hopital St. Sacrement, Clinique Radiologique Audet, 1000 Chemin Ste-Foy, Ste. 208, Quebec, P. Q. G1S 2L6 Canada.
7 Tristan Associates, 4518 Union Deposit Rd., Harrisburg, PA 17111.
8 University of California-Davis, and Highland Hospital, Surgery Department, 1411 E. 31st St., Oakland, CA 94602.

OBJECTIVE. The goal of this study was to show that one can safely remove all sonographic evidence of masses in the breast less than or equal to 1.5 cm in greatest dimension using the 11-gauge handheld Mammotome, thereby reducing the possibility of a false-negative diagnosis and other shortcomings of the automated core biopsy device.

SUBJECTS AND METHODS. Over a 12-week period (May 3-July 31, 2000), 124 sonographically guided breast biopsies were performed in 113 patients, using a new handheld directional vacuum-assisted biopsy device. All lesions that were less than or equal to 1.5 cm were biopsied using a handheld Mammotome; an attempt was made to continue the biopsy until no sonographic evidence of the lesion remained.

RESULTS. Of these 124 lesions, 14 had infiltrating ductal carcinomas, four had infiltrating ductal carcinomas with associated ductal carcinoma in situ, one had infiltrating lobular carcinoma, one had ductal carcinoma in situ, three had atypical ductal hyperplasias, one had atypical lobular hyperplasia, and one had phyllodes tumor. Only one infiltrating ductal carcinoma was entirely removed histologically at Mammotome biopsy. There were no underestimates of disease. No cases of epithelial displacement were observed in any of the surgical excisions of malignancies. The remaining 99 lesions were benign.

CONCLUSION. The handheld Mammotome diminishes the shortcomings of the automated core biopsy device. It reduces the possibility of false-negatives and underestimation of disease. It eliminates the need for multiple insertions and reduces the likelihood of epithelial displacement. As a result, we now use this device for all sonographically guided biopsies of breast masses smaller than 1.5 cm and recommend that others consider it for such use.


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