Comparison of large-core vacuum-assisted breast biopsy and excision systems.

The past 30 years have seen dramatic changes in the diagnosis and management of breast problems. Much of this change has been driven by the quest for early diagnosis and by the widespread use of imaging in the diagnosis of symptomatic breast disease and for breast cancer screening. The traditional approach of surgical biopsy for diagnosis has now been replaced by needle biopsy techniques that provide both accurate and reliable diagnosis. The aims are to prevent unnecessary surgery for benign processes and to provide detailed information on borderline and malignant processes that allow for prospective fully informed treatment planning (Teh et al. 1998). To achieve these aims, specialized techniques for needle biopsy of the breast have been developed that facilitate the removal of sufficient amounts of tissue required to ensure accurate diagnoses. In the 1980s, the predominant technique for needle sampling of the breast was fine-needle aspiration for cytology (FNAC). The results achieved with FNAC were encouraging but the required reliability and acceptable sensitivity and specificity proved to be only achievable in expert centers. Even then, false-negative results for sampling in situ disease represented by microcalcifications and for certain types of invasive breast cancer were disappointing. For this reason, in the 1990s there was a trend away from the use of FNAC to needle core biopsy techniques. Core biopsy provides histological material for morphological as well as cellular assessment and the skills required for interpretation are much more widely available. The sensitivity for the more elusive disease, such as lobular invasive carcinoma, is also significantly better. In addition, when sampling microcalcifications, core samples can be imaged to prove retrieval of representative tissue. Overall, compared to cytology, core biopsy histology provides significantly better sensitivity and positive predictive values for both benign and malignant disease and has a reduced rate of false-negative results. Automated core biopsy is now accepted as the preferred technique for breast tissue sampling (Bassett et al. 1997; Teh et al. 1998; Litherland 2001; Parker et al. 1996; Schueller et al. 2008). Using core biopsy, the vast majority of breast abnormalities can be accurately diagnosed and most breast lesions are amenable to ultrasoundguided biopsy (Philpotts et al. 2003). However, particularly for screen-detected impalpable lesions, there remain around 5–10% of abnormalities where core biopsy either does not provide sufficient material for accurate diagnosis or does not target the lesion accurately (Parker and Burbank 1996). For these abnormalities, either more tissue or more accurate targeting is Comparison of Large-Core Vacuum-Assisted Breast Biopsy and Excision Systems