Skip to main content

Image-Guided Biopsies of the Breast: Technical Considerations, Diagnostic Challenges, and Postbiopsy Clinical Management

  • Chapter
Breast Cancer 2nd edition

Part of the book series: M.D. Anderson Cancer Care Series ((MDCCS))

Currently, nonpalpable breast lesions are sampled using image-guided biopsy—either needle localization excisional biopsy or image-guided fineneedle aspiration or core needle biopsy—to obtain a tissue diagnosis. Ten percent to 30% of nonpalpable lesions are found to be malignant. Accurate diagnosis is essential for the appropriate management of these early-stage lesions. The diagnostic accuracy of image-guided biopsy is dependent on standardization of biopsy procedures, familiarity with common diagnostic challenges, and correlation of the histopathologic findings with the prebiopsy imaging and clinical findings.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Acs G, Lawton TJ, Rebbeck TR, et al. Differential expression of E-cadherin in lobular and ductal neoplasms of the breast and its biologic and diagnostic implications. Am J Clin Pathol 2001;115:85–98.

    Article  PubMed  CAS  Google Scholar 

  • Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia. Can we accurately predict benign behavior from core needle biopsy? Am J Clin Pathol 2004;122:440–443.

    Article  PubMed  Google Scholar 

  • Arpino G, Allred DC, Mohsin SK, et al. Lobular neoplasia on core-needle biopsy: clinical significance. Cancer 2004;101:242–250.

    Article  PubMed  Google Scholar 

  • Baker LH. Breast Cancer Detection Demonstration Project: five-year summary report. Cancer 1982;32:194–225.

    CAS  Google Scholar 

  • Ballo SM, Sneige N. Can core needle biopsy replace fine-needle aspiration cytology in the diagnosis of palpable breast carcinoma? A comparative study of 124 women. Cancer 1996;78:773–777.

    Article  PubMed  CAS  Google Scholar 

  • Bijker N, Peterse JL, Duchateau L, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer trial 10853. J Clin Oncol 2001;19:2263–2271.

    PubMed  CAS  Google Scholar 

  • Boerner S, Fornage B, Singletary E, et al. Ultrasound-guided fine needle aspiration of non-palpable breast lesions: a review of 1,885 FNA cases using the NCI-supported recommendations on the uniform approach to breast FNA. Cancer Cytopathol 1999;87:19–24.

    CAS  Google Scholar 

  • Boerner S, Sneige N. Specimen adequacy and false-negative diagnosis rate in fine-needle aspirates of palpable breast masses. Radiology 1998;84:344–348.

    CAS  Google Scholar 

  • Brenner RJ, Fajardo L, Fisher PR, et al. Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy. AJR Am J Roentgenol 1996;166:341–346.

    PubMed  CAS  Google Scholar 

  • Brenner RJ, Jackman RJ, Parker SH, et al. Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol 2002;179:1179–1184.

    PubMed  Google Scholar 

  • Burbank F. Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy. Radiology 1997;202:843–847.

    PubMed  CAS  Google Scholar 

  • Carder PJ, Garvican J, Haigh I, et al. Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology 2005;46:320–327.

    Article  PubMed  CAS  Google Scholar 

  • Chinyama CN, Davies JD. Mammary mucinous lesions: congeners, prevalence and important pathological associations. Histopathology 1996;29:1–7.

    Article  Google Scholar 

  • Crisi GM, Mandavilli S, Cronin E, et al. Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy. Am J Surg Pathol 2003;27:325–333.

    Article  PubMed  Google Scholar 

  • Dershaw DD. Does LCIS or ALH without other high-risk lesions diagnosed on core biopsy require surgical excision? Breast J 2003;9:1–3.

    Article  PubMed  Google Scholar 

  • Dershaw DD, Morris EA, Liberman L, et al. Nondiagnostic stereotaxic core breast biopsy: results of rebiopsy. Radiology 1996;198:323–325.

    PubMed  CAS  Google Scholar 

  • Diaz LK, Sneige N. Estrogen receptor analysis for breast cancer: current issues and keys to increasing testing accuracy. Adv Anat Pathol 2001;12:10–19.

    Article  Google Scholar 

  • Dowlatshahi K, Yaremko ML, Kluskens LK, et al. Nonpalpable breast lesions: findings of stereotaxic needle-core biopsy and fine-needle aspiration cytology. Radiology 1991;181:745–750.

    PubMed  CAS  Google Scholar 

  • Ely K, Carter B, Page D, et al. Core biopsy of the breast with atypical ductal hyperplasia: probabilistic approach to reporting. Am J Surg Pathol 2001;25:1017–1021.

    Article  PubMed  CAS  Google Scholar 

  • Eusebi V, Feudale E, Foschini MP, et al. Long-term follow-up of in situ carcinoma of the breast. Semin Diagn Pathol 1994;11:223–235.

    PubMed  CAS  Google Scholar 

  • Flotte TJ, Bell DA, Greco MA. Tubular carcinoma and sclerosing adenosis: the use of basal lamina as a differential feature. Am J Surg Pathol 1980;4:75–77.

    Article  PubMed  CAS  Google Scholar 

  • Fornage BD, Sneige N, Edeiken B. Interventional breast sonography. Eur J Radiol 2002;42:17–31.

    Article  PubMed  Google Scholar 

  • Gala I, Fisher P, Hermann GA. Usefulness of TELFA pads in the histologic assessment of stereotactic-guided breast biopsy specimens. Mod Pathol 1999;12:553–557.

    PubMed  CAS  Google Scholar 

  • Gobbi H, Simpson JF, Borowsky A, et al. Metaplastic breast tumors with a dominant fibromatosis-like phenotype have a high-risk of local recurrence. Cancer 1999;85:2170–2182.

    Article  PubMed  CAS  Google Scholar 

  • Hamele-Bena D, Cranor ML, Rosen PP. Mammary mucocele-like lesions: benign and malignant. Am J Surg Pathol 1996;20:1081–1085.

    Article  PubMed  CAS  Google Scholar 

  • Hoang MP, Sahin AA, Ordonez NG, et al. HER-2/neu gene amplification compared with HER-2/neu protein overexpression and interobserver reproducibility in invasive breast carcinoma. Am J Clin Pathol 2000;113:852–859.

    Article  PubMed  CAS  Google Scholar 

  • Ioffe OB, Berg WA, Silverberg SG, et al. Mammographic-histopathologic correlation of large-core needle biopsy of the breast. Mod Pathol 1998;11:721–727.

    PubMed  CAS  Google Scholar 

  • Ivan D, Selinko V, Sahin AA, et al. Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol 2004;17:165–171.

    Article  PubMed  Google Scholar 

  • Jackman RJ, Nowles KW, Shepard MJ, et al. Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology 1994;193:91–95.

    PubMed  CAS  Google Scholar 

  • Jacobs TW, Chen YY, Guinee DG Jr, et al. Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision? Am J Clin Pathol 2005;124:342–354.

    Article  PubMed  Google Scholar 

  • Jacobs TW, Siziopikou KP, Prioleau JE, et al. Do prognostic marker studies on core needle biopsy specimens of breast carcinoma accurately reflect the marker status of the tumor? Mod Pathol 1998;11:259–264.

    PubMed  CAS  Google Scholar 

  • Kraus FT, Neubecker RD. The differential diagnosis of papillary tumors of the breast. Cancer 1962;15:444–455.

    Article  PubMed  CAS  Google Scholar 

  • Landercasper J, Gundersen SB Jr, Gundersen AL, et al. Needle localization and biopsy of nonpalpable lesions of the breast. Surg Gynecol Obstet 1987;164:399–403.

    PubMed  CAS  Google Scholar 

  • Liberman L, Bracero N, Vuolo MA, et al. Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol 1999a;172:331–337.

    PubMed  CAS  Google Scholar 

  • Liberman L, Cohen MA, Dershaw DD, et al. Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy. AJR Am J Roentgenol 1995a;164:1111–1113.

    PubMed  CAS  Google Scholar 

  • Liberman L, Dershaw D, Glassman JR, et al. Analysis of cancers not diagnosed at stereotactic core breast biopsy. Radiology 1997;203:151–157.

    PubMed  CAS  Google Scholar 

  • Liberman L, Dershaw D, Rosen PP, et al. Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed? Radiology 1994a;192:793–795.

    PubMed  CAS  Google Scholar 

  • Liberman L, Dershaw DD, Rosen PP, et al. Stereotaxic core biopsy of breast carcinoma: accuracy at predicting invasion. Radiology 1995b;194:379–381.

    PubMed  CAS  Google Scholar 

  • Liberman L, Evans WP, Dershaw DD, et al. Radiography of microcalcifications in stereotaxic mammary core biopsy specimens. Radiology 1994b;190:223–225.

    PubMed  CAS  Google Scholar 

  • Liberman L, Sama M, Susnik B, et al. Lobular carcinoma in situ at percutaneous breast biopsy: surgical biopsy findings. AJR Am J Roentgenol 1999b;173:291–299.

    PubMed  CAS  Google Scholar 

  • Mainiero MB, Philpotts LE, Lee CH, et al. Stereotactic core needle of breast microcalcifications: correlation of target accuracy and diagnosis with lesion size. Radiology 1996;198:665–669.

    PubMed  CAS  Google Scholar 

  • McDivitt RW, Boyce W, Gersell D. Tubular carcinoma of the breast. Clinical and pathological observations concerning 135 cases. Am J Surg Pathol 1982;6:401–411.

    PubMed  CAS  Google Scholar 

  • Middleton LP, Grant S, Stephens T, et al. Lobular carcinoma in situ diagnosed by core needle biopsy: when should it be excised? Mod Pathol 2003;16:120–129.

    Article  PubMed  Google Scholar 

  • Mitnick JS, Vazquez MF, Pressman PI, et al. Stereotactic fine-needle aspiration biopsy for the evaluation of nonpalpable breast lesions: report of an experience based on 2,988 cases. Ann Surg Oncol 1996;3:185–191.

    Article  PubMed  CAS  Google Scholar 

  • Nath ME, Robinson TM, Tobon H, et al. Automated large-core needle biopsy of surgically removed breast lesions: comparison of samples obtained with 14-, 16-, and 18-gauge needles. Radiology 1995;197:739–742.

    PubMed  CAS  Google Scholar 

  • Page DL, Salhany KE, Jensen RA, et al. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer 1996;78:258–266.

    Article  PubMed  CAS  Google Scholar 

  • Parker SH. Percutaneous large core breast biopsy. Cancer 1994;74:256–262.

    Article  PubMed  CAS  Google Scholar 

  • Parker SH, Burbank F, Jackman RJ, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 1994;193:359–364.

    PubMed  CAS  Google Scholar 

  • Peters GN, Wolff M, Haagensen CD. Tubular carcinoma of the breast. Clinical pathologic correlations based on 100 cases. Ann Surg 1981;193:138–149.

    Article  PubMed  CAS  Google Scholar 

  • Pisano ED, Fajardo LL, Tsimikas J, et al. Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in multicenter clinical trial. Cancer 1998;82:679–688.

    Article  PubMed  CAS  Google Scholar 

  • Raju UB, Lee MW, Zarbo RJ, et al. Papillary neoplasia of the breast: immunohistochemically defined myoepithelial cells in the diagnosis of benign and malignant papillary breast neoplasms. Mod Pathol 1989;2:569–576.

    PubMed  CAS  Google Scholar 

  • Renshaw AA, Derhagopian RP, Tizol-Blanco DM, et al. Papillomas and atypical papillomas in breast core needle biopsy specimens: risk of carcinoma in subsequent excision. Am J Clin Pathol 2004;122:217–221.

    Article  PubMed  Google Scholar 

  • Reynolds HE, Jackson VP, Gin FM, et al. Large-gauge core needle biopsy of the breast. Breast J 1996;1:370–373.

    Article  Google Scholar 

  • Ro JY, Sneige N, Sahin AA, et al. Mucocele-like tumor of the breast associated with atypical duct hyperplasia or mucinous carcinoma. A clinicopathologic study of seven cases. Arch Pathol Lab Med 1991;115:137–140.

    PubMed  CAS  Google Scholar 

  • Schnitt SJ, Vincent-Salomon A. Columnar cell lesions of the breast. Adv Anat Pathol 2003;10:113–124.

    Article  PubMed  Google Scholar 

  • Sharifi S, Peterson MK, Baum J, et al. Assessment of standard prognostic factors in breast core needle biopsies (CNB). Mod Pathol 1999;12:941–945.

    PubMed  CAS  Google Scholar 

  • Skinner MA, Swain M, Simmons R, et al. Nonpalpable breast lesions at biopsy: a detailed analysis of radiographic features. Ann Surg 1988;208:203–208.

    Article  PubMed  CAS  Google Scholar 

  • Sneige N, Yaziji H, Mandavilli SR, et al. Low grade (fibromatosis-like) spindle cell carcinoma of the breast. Am J Surg Pathol 2001;25:1009–1016.

    Article  PubMed  CAS  Google Scholar 

  • Sneige N, Lim SC, Whitman GJ, et al. Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcifications. Considerations for surgical excision. Am J Clin Pathol 2003;119:248–253.

    Article  PubMed  Google Scholar 

  • Sneige N, Tulbah A. Accuracy of cytologic diagnoses made from touch imprints of image-guided needle biopsy specimens of nonpalpable breast abnormalities. Diagn Cytopathol 2000;23:29–34.

    Article  PubMed  CAS  Google Scholar 

  • Wargotz ES, Deos PH, Norris HJ. Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. Hum Pathol 1989;20:732–740.

    Article  PubMed  CAS  Google Scholar 

  • Wong AY, Salisbury E, Bilous M. Recent developments in stereotactic breast biopsy methodologies: an update for the surgical pathologist. Adv Anat Pathol 2000;7:26–35.

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization. Histological Typing of Breast Tumors. 2nd edition. International Histological Classification of Tumors. No. 2. Geneva: World Health Organization; 1981:19.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Science + Business Media, LLC

About this chapter

Cite this chapter

Sneige, N. (2008). Image-Guided Biopsies of the Breast: Technical Considerations, Diagnostic Challenges, and Postbiopsy Clinical Management. In: Hunt, K.K., Robb, G.L., Strom, E.A., Ueno, N.T. (eds) Breast Cancer 2nd edition. M.D. Anderson Cancer Care Series. Springer, New York, NY. https://doi.org/10.1007/978-0-387-34952-7_6

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-34952-7_6

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-34950-3

  • Online ISBN: 978-0-387-34952-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics