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Percutaneous Imaging-Guided Core Breast Biopsy

State of the Art at the Millennium

Laura Liberman1

1 Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.



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  		Fig. 1A. —40-year-old asymptomatic woman with nonpalpable mass in right breast. Photograph obtained during sonographically guided core biopsy shows 14-gauge automated needle in breast.

 


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  		Fig. 1B. —40-year-old asymptomatic woman with nonpalpable mass in right breast. Sonogram obtained during imaging-guided 14-gauge automated core biopsy shows that needle has traversed mass.

 


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  		Fig. 1C. —40-year-old asymptomatic woman with nonpalpable mass in right breast. Photograph shows specimen obtained from needle pass being placed in formalin.

 


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  		Fig. 1D. —40-year-old asymptomatic woman with nonpalpable mass in right breast. Photograph of breast immediately after core biopsy shows tiny skin incision (open arrow) that usually disappears within few weeks after biopsy. Note that skin nick from core biopsy is much smaller than periareolar scar from prior surgical biopsy (solid arrows). Histologic analysis (not shown) revealed benign fibroadenoma, and patient was spared surgery.

 


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  		George C. Johnson 10th President of ARRS 1909-1910

 


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  		George E. Pfahler 11th President of ARRS 1910-1911

 


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  		Fig. 2A. —54-year-old asymptomatic woman with abnormal results on screening mammography. Collimated craniocaudal mammogram of left breast at patient's first screening shows irregular, spiculated mass (arrow) measuring approximately 1.0 cm at longest dimension.

 


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  		Fig. 2B. —54-year-old asymptomatic woman with abnormal results on screening mammography. Sonogram shows left breast mass to be solid and markedly hypoechoic, with posterior acoustic shadowing.

 


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  		Fig. 2C. —54-year-old asymptomatic woman with abnormal results on screening mammography. Sonogram obtained during imaging-guided 14-gauge automated core biopsy shows that needle has traversed mass.

 


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  		Fig. 2D. —54-year-old asymptomatic woman with abnormal results on screening mammography. Photomicrograph of core biopsy specimens. Histologic analysis showed infiltrating ductal carcinoma (open arrows) and ductal carcinoma in situ (DCIS) (solid arrows). Patient underwent one-stage lumpectomy and sentinel lymph node biopsy, yielding DCIS and 0.8-cm infiltrating ductal carcinoma with clear margins and negative sentinel nodes. (H and E, x200)

 


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  		Fig. 3A. —59-year-old asymptomatic woman with cluster of pleomorphic calcifications in left breast. Close-up of 11-gauge directional vacuum-assisted biopsy probe shows holes in collecting area (bowl) of probe. Vacuum, applied via these holes, helps to pull tissue into probe and facilitates retrieval of large tissue samples.

 


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  		Fig. 3B. —59-year-old asymptomatic woman with cluster of pleomorphic calcifications in left breast. Photograph obtained during stereotactic biopsy with patient prone on dedicated table shows 11-gauge directional vacuum-assisted biopsy probe in breast.

 


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  		Fig. 3C. —59-year-old asymptomatic woman with cluster of pleomorphic calcifications in left breast. Specimen radiographs show calcifications (arrows) in multiple samples. All calcifications were removed.

 


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  		Fig. 3D. —59-year-old asymptomatic woman with cluster of pleomorphic calcifications in left breast. Craniocaudal mammogram after biopsy shows localizing clip placed at biopsy site. Clip can serve as marker for subsequent localization, if necessary. Histologic analysis showed benign fibroadenoma with calcification. Diagnosis was concordant with mammographic features, and no surgery was performed.

 

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