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At least 19 recordsLinked to original sources
PubMed1995

Selective use of image-guided large-core needle biopsy of the breast: accuracy and cost-effectiveness.

OBJECTIVE: We examined the accuracy and cost-effectiveness of large-core needle breast biopsy in a selected group of patients with mammographically detected lesions. MATERIALS AND METHODS: We selectively used large-core needle biopsy to sample breast lesions that were intermediate (neither clearly benign nor clearly malignant) and wire localization biopsy to sample breast lesions that were strongly suggestive of cancer. We compared 2 years' experience using this protocol with the preceding 2 years at the University of Utah Health Sciences Center during which we did only a few large-core needle biopsies on a nonselective basis. RESULTS: Our biopsy rate increased from one biopsy per 36 mammographic screening examinations to one per 26 (p = .001) when the protocol was used. The cost of biopsy per cancer detected decreased from $11,555 to $8356. The specificity of large-core needle biopsy was 98%; the sensitivity based on limited follow-up was 100%. CONCLUSION: Large-core needle biopsy is an accurate and cost-effective method for sampling breast lesions when used in a selective fashion.

Analysis of Variance↗
PubMed1994

Myoepithelial lesions of the breast: imaging characteristics and diagnosis with large-core needle biopsy in two cases.

Two mammographically detected myoepithelial lesions (one each in women aged 77 and 73 years) were diagnosed at large-core needle biopsy, with the results confirmed by means of surgical excision. The imaging features were nonspecific. A key clue to the diagnosis at histologic examination was the presence of a well-defined capsule around the lesion; hence, sampling of the margins of the lesion is essential. Radiologists should be familiar with myoepithelial lesions in the differential diagnosis of fairly smoothly marginated solid masses.

Aged↗
PubMed1994

Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia.

PURPOSE: To determine whether histologic findings of cancer or atypical hyperplasia at large-core needle biopsy (LCNB) of nonpalpable breast lesions match histologic findings at excision. MATERIALS AND METHODS: Stereotaxic LCNB was performed with an automated prone unit, biopsy gun, and 14-gauge cutting needles in 450 nonpalpable breast lesions. Lesions classified as carcinoma or atypical ductal hyperplasia (ADH) at histologic examination after LCNB were excised. A pathologist retrospectively compared core and excisional histologic findings. RESULTS: Histologic comparison was performed in 116 of 135 carcinomas after LCNB. Histologic findings were concordant in 99 carcinomas. Partial discordance in 17 carcinomas led to an additional surgical procedure in one case. Histologic comparison was performed in 16 of 19 ADHs diagnosed with LCNB. Histologic findings were concordant in five and discordant in 11 ADHs. CONCLUSION: LCNB findings of carcinoma are accurate and allow definitive therapeutic surgery, including mastectomy. LCNB findings of ADH are inaccurate, and excisional biopsy is necessary.

Biopsy, Needle↗
PubMed1993

Nonpalpable breast lesions: correlation of stereotaxic large-core needle biopsy and surgical biopsy results.

One hundred women, each with a single nonpalpable breast lesion evident at mammography, underwent computer-guided sterotaxic 14-gauge needle biopsy followed by hook-wire localization and open surgical biopsy. Lesions were not less than 5 mm in diameter. Core biopsy yielded essentially correct findings in 96 cases and in 35 of 36 cancers. Open surgery yielded the correct findings in 97 cases and also in 35 of 36 cancers. Two fibroadenomas were missed at core biopsy and one was missed at surgical biopsy. There was complete or partial histologic agreement in 94 cases. This is further evidence that in selected cases, stereotaxic core biopsy can be as accurate as open surgical biopsy.

Biopsy, Needle↗
PubMed1995

Automated large-core needle biopsy of surgically removed breast lesions: comparison of samples obtained with 14-, 16-, and 18-gauge needles.

PURPOSE: To determine the needle size that would consistently enable the pathologist to correctly diagnose tissue core biopsy specimens. MATERIALS AND METHODS: Fifty-seven surgically removed mass lesions of the breast were sampled with a short-throw automated biopsy gun and an 18-gauge needle first, followed by a 16- and a 14-gauge needle. Samples were evaluated independently by three pathologists, and findings were compared with the final diagnosis made at surgical excision biopsy. RESULTS: The sensitivity for the diagnosis of all 26 malignant lesions was 100%, 92%, and 65% for biopsy samples obtained with 14-, 16-, and 18-gauge needles, respectively. Specificity for malignancy was 100% for all three needle sizes. All of the benign diseases were correctly diagnosed in samples obtained with all three size needles except for two samples that did not survive processing. CONCLUSION: Biopsy samples obtained with a 14-gauge needle provide the most accurate diagnosis, which correlates with the diagnosis made with the surgical excision biopsy technique.

Automation↗
PubMed1994

Mammographic findings after stereotaxic biopsy of the breast performed with large-core needles.

PURPOSE: To evaluate changes seen on mammograms obtained after large-core stereotaxic biopsy of the breast. MATERIALS AND METHODS: Twenty-seven patients underwent stereotaxic breast biopsy performed with large-core, 14-gauge needles. At least five core samples were obtained from each lesion. The mammograms obtained before biopsy were compared with those obtained 6 months later in the 24 patients in whom follow-up was performed. RESULTS: The only changes seen on the postbiopsy mammograms were due to tissue sampling (ie, fewer microcalcifications or defects were seen in areas of lesions from which tissue had been extracted). CONCLUSION: Large-core needle biopsy of the breast does not produce change or deformity that can be recognized on mammograms. Parenchymal scarring, architectural distortion, fat necrosis, or other identifiable changes seen after surgical biopsy of the breast are not seen after large-core, stereotaxic breast biopsy.

Biopsy, Needle↗
PubMedDate not supplied

Image-directed percutaneous biopsy with large-core needles. Comparison of cytologic and histologic findings.

Large biopsy needles (18 and 19 gauge) have been reported to yield high-quality tissue cores for reliable histologic diagnosis. In our institution, image-directed percutaneous biopsy specimens obtained with these needles are processed routinely for simultaneous cytologic and histologic analysis. For the present study, we reviewed our experience with 82 such biopsies of the thoracoabdominal region. We examined the value of cytologic analysis as a supplement to histologic analysis of such biopsies in terms of diagnostic yield and sensitivity for detecting malignancy. Among the 82 specimens, material was adequate for histologic diagnoses in 70 (85%) and for cytologic diagnosis in 63 (77%). Combining the histologic and cytologic results increased the diagnostic yield to 93% (76 of 82 specimens). Forty-eight lesions were diagnosed as malignant by either one or both means of analysis. While histologic analysis produced 44 of the 48 positive results (92%), cytologic analysis produced 33 (66%) (P < .05, McNemar's test). Because tissue fragments were selected preferentially for histologic processing, histologic evaluation was more valuable than cytologic evaluation in achieving definitive diagnoses of malignancy. In spite of this bias in preparation technique, malignancy was diagnosed by cytologic analysis alone in 4 of the 48 positive cases (8%). We conclude that the combined approach of histologic and cytologic examination of large-gauge core needle biopsy specimens maximizes the diagnostic yield and sensitivity for detecting malignancy.

Abdominal Neoplasms↗
PubMed1992

Fine-needle aspiration cytology and core biopsy of nonpalpable breast lesions.

Interest in fine-needle aspiration cytology (FNA) and core biopsy of nonpalpable breast lesions as an alternative to surgical biopsy has increased during the past year. The most accurate results have been reported with large-core needle biopsy using a dedicated prone stereotactic unit and stereotactic FNA biopsy obtained with an onsite cytopathologist determining sample adequacy. Ultrasound-guided needle biopsy using either FNA or core is another important technique. Questions remain concerning 1) the accuracy of FNA and core compared to surgical biopsy; 2) the efficacy of needle guidance by a mammographic add-on upright unit, dedicated prone table, or ultrasound; and 3) the lesions best suited for various biopsy techniques. Currently these nonsurgical biopsy methods are most appropriately used in conjunction with mammographic-histologic or cytologic correlation and a careful clinical management plan.

Biopsy, Needle↗
PubMed1994

Benign circumscribed breast masses. Mammographic and sonographic appearance.

Mammography is an excellent screening tool for the detection of breast masses. One of the goals of the radiologist is to separate benign breast masses warranting no intervention from the indeterminate and malignant masses that require histologic evaluation. Thorough mammographic and sonographic work-up of lesions detected at screening will reduce the number of biopsies performed and increase the true positive biopsy rate. By systematically evaluating a breast mass as to its density location, size, margins, and interval change, one can separate benign lesions from those requiring additional work-up and those that will require a biopsy diagnosis. Any features suggesting malignancy should prompt histologic assessment. For many women, FNAB or large-core needle biopsy, guided either stereotactically or sonographically, will not only reduce the morbidity associated with excisional biopsy but also decrease the cost of evaluating questionable lesions found at screening. Ultrasound examination will further reduce the number of biopsies by separating cysts from solid and indeterminate lesions that require further evaluation. What rate of carcinoma in biopsy specimens should be the mammographer's guideline? Ciatto et al found in his series a 30% positive predictive value for mammography in detecting carcinoma. In the author's opinion, a goal to strive for should be in the range of 40%. The mammographer's experience and confidence as well as patient's compliance with follow-up recommendations will help the mammographer reach this goal.

Adult↗
PubMed1994

Intramuscular myxoma: sonographic appearance and sonographically guided needle biopsy.

The sonographic appearances of four intramuscular myxomas were reviewed. These tumors appeared as well-defined, ovoid masses surrounded by normal muscle. The echogenicity was decreased in all cases, and the presence of small fluid-filled clefts and cystic areas was noted in three of the four lesions. Color Doppler examination was performed in two cases and was negative. Sonographically guided fine-needle aspiration biopsy yielded a thick myxoid substance. Large-core cutting needle biopsy allowed establishment of the diagnosis in one of the two cases in which it was performed. The differential diagnosis of a well-demarcated intramuscular mass with multiple fluid-filled clefts or cystic areas should include intramuscular myxoma.

Biopsy, Needle↗
PubMed1992

Malignant seeding of the needle track during stereotaxic core needle breast biopsy.

Early reports demonstrated the diagnostic advantage of large-core (14-gauge) biopsy over fine-needle aspiration biopsy of nonpalpable lesions of the breast without apparent significant increase in morbidity. A case of malignant seeding of the needle track after a large-core biopsy of a mucinous carcinoma of the breast is documented. The potential for increased risk of tract seeding of malignancy must be considered.

Adenocarcinoma, Mucinous↗
PubMed1986

Sampling error in diagnosing hyperparathyroid changes in bone in small needle biopsies.

Sampling error in diagnosing the effects of hyperparathyroidism on bone was studied retrospectively by subdividing large-core bone biopsy samples and evaluating them histologically. We used intratrabecular osteoclastic tunneling resorption as the diagnostic feature of secondary hyperparathyroidism in 10 hemodialysis patients. All biopsies were taken with a large-core bone biopsy instrument, resulting in a mean biopsy width of 5 mm. The processed tissue slides were divided into halves (mean width 2.5 mm) and subsequently into thirds (mean width 1.6 mm), mimicking smaller bone biopsy instruments such as the Jamshidi needle. In 30% of the cases the diagnosis of secondary hyperparathyroidism would have been missed if taken by a Jamshidi-type needle, and 60% if taken by a needle with a core diameter of 1.6 mm. Our findings emphasize the necessity of utilizing large-core bone biopsies in diagnosing certain metabolic bone diseases.

Biopsy, Needle↗
PubMed1991

Nonpalpable breast lesions: stereotactic automated large-core biopsies.

One hundred two patients with mammographically suspicious, nonpalpable lesions underwent stereotactic breast biopsy with a biopsy gun and an automated 14-gauge cutting needle. After biopsy, a localization wire was placed and surgical biopsy performed. There was agreement of the histologic results from the gun biopsy and the surgical biopsy specimens in 98 cases (96%), including 22 of 23 carcinomas (96%) (kappa = 0.936). The gun biopsy yielded findings that led to the correct diagnosis in two cases involving lesions that were missed at surgical biopsy; two lesions found at surgery were missed at gun biopsy. The results of this study suggest that the use of 14-gauge needles improves agreement between surgical and needle core biopsy findings and that stereotactic biopsy with an automated needle and gun can be an acceptable alternative to surgical biopsy in women with mammographically suspicious breast lesions.

Adenofibroma↗
PubMed1994

Percutaneous large core breast biopsy.

BACKGROUND: Surgical excision biopsy is considered by many to be the "gold standard" for the diagnosis of breast lesions. Fine needle aspiration biopsy is used by some radiologists and other physicians in an attempt to diagnose breast lesions nonsurgically. To overcome the drawbacks associated with both of these methods, the author and his coworkers have developed the image-guided automated large-core breast biopsy method. METHODS: All biopsies are performed using either a dedicated, prone stereotactic device or high-resolution near-field ultrasound equipment for needle guidance. A "long-throw" (2.3 cm) automated core biopsy device fitted with a 14-gauge needle is used to acquire five or more core samples from each lesion for histologic evaluation. RESULTS: The ability of percutaneous, image-guided, large-core breast biopsy to provide the correct histologic diagnosis of a breast lesion is equivalent to open surgical biopsy. The cost of large-core breast biopsy is one half to one quarter that of surgical biopsy. No adverse cosmesis or mammographic pseudolesion results. CONCLUSION: In an era of increasing cost restraints in health care, it is important to identify means by which the level of patient care can be maintained or improved at lesser cost. Percutaneous large-core breast biopsy provides that opportunity in the diagnosis of breast disease and should prove to be a cost-effective, reliable, and expedient alternative to surgical biopsy.

Biopsy↗