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Biopsy Techniques in Nonpalpable or Palpable Breast Lesions

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Breast Disease

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Abstract

Diagnostic breast biopsy is one of the most common medical procedures, and a variety of methods have been developed in the last 30 years to augment classic surgical incisional and excisional biopsies. Fine-needle aspiration (FNA) has an important historical role and remains among the most cost-effective methods but is limited by the weakness of current breast cytology to adequately reproduce all information provided by traditional histopathology. FNA continues to play an important role in assessing risk. Core biopsies ranging from the use of simple needle cores to larger coring devices to remove spaghetti- to macaroni-sized pieces have become the mainstay of current biopsy techniques for most palpable and nonpalpable lesions. Surgical incisional and excisional biopsies, which are the classic standards, are reserved for a few exceptional circumstances, including the removal of symptomatic benign lesions or when coring biopsy tools fail to provide adequate diagnostic information and material. Ductoscopy, which was initially developed as a tool to investigate pathological nipple discharge, is an evolving technology that may have an increasing role in research and prevention, as tools and techniques become more refined. Failure of biopsy to accurately diagnose breast problem remains a small but persistent problem requiring the diligent methodical use of biopsy methods and the careful consideration of issues such as sample bias when the entire lesion is not removed, and there is discordance between clinical expectations and biopsy pathology.

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References

  1. Nagar S, Iacco A, Riggs T, Kestenberg W, Keidan R. An analysis of fine needle aspiration versus core needle biopsy in clinically palpable breast lesions: a report on the predictive values and a cost comparison. Am J Surg. 2012;204(2):193–8.

    Article  Google Scholar 

  2. Weigner J, Zardawi I, Braye S. The true nature of atypical breast cytology. Acta Cytol. 2013;57(5):464–72.

    Article  CAS  Google Scholar 

  3. Fung AD, Collins JA, Campassi C, Ioffe OB, Staats PN. Performance characteristics of ultrasound-guided fine-needle aspiration of axillary lymph nodes for metastatic breast cancer employing rapid on-site evaluation of adequacy: analysis of 136 cases and review of the literature. Cancer Cytopathol. 2014;122(4):282–91.

    Article  Google Scholar 

  4. Laucirica R, Bentz JS, Khalbuss WE, Clayton AC, Souers RJ, Moriarty AT. Performance characteristics of mucinous (colloid) carcinoma of the breast in fine-needle aspirates: observations from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. Arch Pathol Lab Med. 2011;135(12):1533–8.

    Article  Google Scholar 

  5. Konofaos P, Kontzoglou K, Parakeva P, Kittas C, Margari N, Giaxnaki E, Pouliakis M, Kouraklis G, Karakitsos P. The role of ThinPrep cytology in the investigation of ki-67 index, p53 and HER-2 detection in fine-needle aspirates of breast tumors. J BUON. 2013;18(2):352.

    CAS  PubMed  Google Scholar 

  6. Georgieva RD, Obdeijn IM, Jager A, Hooning MJ, Tilanus-Linthorst MM, van Deurzen CH. Breast fine-needle aspiration cytology performance in the high-risk screening population: a study of BRCA1/BRCA2 mutation carriers. Cancer Cytopathol. 2013;121(10):561–7.

    Article  CAS  Google Scholar 

  7. Lai HW, Wu HK, Kuo SJ, Chen ST, Tseng HS, Tseng LM, et al. Differences in accuracy and underestimation rates for 14- versus 16-gauge core needle biopsies in ultrasound-detectable breast lesions. Asian J Surg. 2013;36(2):83–8.

    Article  Google Scholar 

  8. Gadgil PV, Korourian S, Malak S, Ochoa D, Lipschitz R, Henry-Tillman R, et al. Surgeon-performed touch preparation of breast core needle biopsies may provide accurate same-day diagnosis and expedite treatment planning. Ann Surg Oncol. 2014;21(4):1215–21.

    Article  Google Scholar 

  9. Koca B, Kuru B, Yuruker S, Gokgul B, Ozen N. Factors affecting surgical margin positivity in invasive ductal breast cancer patients who underwent breast-conserving surgery after preoperative core biopsy diagnosis. J Kor Surg Soc. 2013;84(3):154–9.

    Article  Google Scholar 

  10. Polat AV, Soran A, Andacoglu O, Kamali Polat A, McGuire K, Diego E, et al. The importance of pre-operative needle core breast biopsy results on resected tissue volume, margin status, and cosmesis. J BUON. 2013;18(3):601–7.

    CAS  PubMed  Google Scholar 

  11. D’Alfonso TM, Wang K, Chiu YL, Shin SJ. Pathologic upgrade rates on subsequent excision when lobular carcinoma in situ is the primary diagnosis in the needle core biopsy with special attention to the radiographic target. Arch Pathol Lab Med. 2013;137(7):927–35.

    Article  Google Scholar 

  12. Polom K, Murawa D, Kurzawa P, Michalak M, Murawa P. Underestimation of cancer in case of diagnosis of atypical ductal hyperplasia (ADH) by vacuum assisted core needle biopsy. Rep Pract Oncol Radiother. 2012;17(3):129–33.

    Article  Google Scholar 

  13. Buckley ES, Webster F, Hiller JE, Roder DM, Farshid G. A systematic review of surgical biopsy for LCIS found at core needle biopsy – do we have the answer yet? Eur J Surg Oncol. 2014;122(4):282–91.

    Google Scholar 

  14. Lee SK, Yang JH, Woo SY, Lee JE, Nam SJ. Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. Br J Surg. 2013;100(13):1756–63.

    Article  CAS  Google Scholar 

  15. Soot L, Weerasinghe R, Wang L, Nelson HD. Rates and indications for surgical breast biopsies in a community-based health system. Am J Surg. 2014;207(4):499–503.

    Article  Google Scholar 

  16. Dooley WC. Breast ductoscopy and the evolution of the intra-ductal approach to breast cancer. Breast J. 2009;15(Suppl 1):S90–4.

    Article  Google Scholar 

  17. Kamali S, Bender O, Kamali GH, Aydin MT, Karatepe O, Yuney E. Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods. Breast Cancer. 2014;21(2):154–61.

    Article  Google Scholar 

  18. Fisher CS, Margenthaler JA. A look into the ductoscope: its role in pathologic nipple discharge. Ann Surg Oncol. 2011;18(11):3187–91.

    Article  CAS  Google Scholar 

  19. Dubowy A, Raubach M, Topalidis T, Lange T, Eulenstein S, Hünerbein M. Breast duct endoscopy: ductoscopy from a diagnostic to an interventional procedure and its future perspective. Acta Chir Belg. 2011;111(3):142–5.

    Article  CAS  Google Scholar 

  20. Cyr AE, Margenthaler JA, Conway J, Rastelli AL, Davila RM, Gao F, et al. Correlation of ductal lavage cytology with ductoscopy-directed duct excision histology in women at high risk for developing breast cancer: a prospective, single-institution trial. Ann Surg Oncol. 2011;18(11):3192–7.

    Article  Google Scholar 

  21. Tang SS, Twelves DJ, Isacke CM, Gui GP. Mammary ductoscopy in the current management of breast disease. Surg Endosc. 2011;25(6):1712–22.

    Article  Google Scholar 

  22. Rose C, Bojahr B, Grunwald S, Frese H, Jäger B, Ohlinger R. Ductoscopy-based descriptors of intraductal lesions and their histopathologic correlates. Onkologie. 2010;33(6):307–12.

    Article  Google Scholar 

  23. Zhu W, Qin W, Zhang K, Rottinghaus GE, Chen YC, Kliethermes B, et al. Trans-resveratrol alters mammary promoter hypermethylation in women at increased risk for breast cancer. Nutr Cancer. 2012;64(3):393–400.

    Article  CAS  Google Scholar 

  24. Yamamoto D, Tsubota Y, Yoshida H, Kanematsu S, Sueoka N, Uemura Y, Tanaka K, Kwon AH. Endoscopic appearance and clinicopathological character of breast cancer. Anticancer Res. 2011;31(10):3517–20.

    PubMed  Google Scholar 

  25. Feng XZ, Song YH, Zhang FX, Jiang CW, Mei H, Zhao B. Diagnostic accuracy of fiberoptic ductoscopy plus in vivo iodine staining for intraductal proliferative lesions. Chin Med J. 2013;126(16):3124–9.

    PubMed  Google Scholar 

  26. Sauter ER, Klein-Szanto A, Macgibbon B, Ehya H. Nipple aspirate fluid and ductoscopy to detect breast cancer. Diagn Cytopathol. 2010;38(4):244–51.

    PubMed  PubMed Central  Google Scholar 

  27. Vaughan A, Crowe JP, Brainard J, Dawson A, Kim J, Dietz JR. Mammary ductoscopy and ductal washings for the evaluation of patients with pathologic nipple discharge. Breast J. 2009;15(3):254–60.

    Article  Google Scholar 

  28. Hünerbein M, Raubach M, Dai K, Schlag PM. Ductoscopy of intraductal neoplasia of the breast. Recent Results Cancer Res. 2009;173:129–36.

    Article  Google Scholar 

  29. Montroni I, Santini D, Zucchini G, Fiacchi M, Zanotti S, Ugolini G, et al. Nipple discharge: is its significance as a risk factor for breast cancer fully understood? Observational study including 915 consecutive patients who underwent selective duct excision. Breast Cancer Res Treat. 2010;123(3):895–900.

    Article  Google Scholar 

  30. Kamali S, Bender O, Aydin MT, Yuney E, Kamali G. Ductoscopy in the evaluation and management of nipple discharge. Ann Surg Oncol. 2010;17(3):778–83.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and OU Breast Institute, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    William C. Dooley

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  1. William C. Dooley
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Correspondence to William C. Dooley .

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Editors and Affiliations

  1. Oncology Institute, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Adnan Aydiner

  2. Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Abdullah Igci

  3. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Women’s Hospital of UPMC, Pittsburgh, PA, USA

    Atilla Soran

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Dooley, W.C. (2019). Biopsy Techniques in Nonpalpable or Palpable Breast Lesions. In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-16792-9_1

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  • DOI: https://doi.org/10.1007/978-3-030-16792-9_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16791-2

  • Online ISBN: 978-3-030-16792-9

  • eBook Packages: MedicineMedicine (R0)

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