Role of stereotactic breast biopsy

Screening mammography can detect early, nonpalpable breast cancer, resulting in improved long-term survival and cure rates. However, greater compliance with screening guidelines has increased the number of mammographic abnormalities found. Since 75% of the surgical biopsies performed for nonpalpable lesions are benign, less expensive and invasive methods of diagnosis are evolving to reduce the cost of screening mammography programs and the number of women undergoing surgery for benign mammographic findings. Stereotactic needle core biopsy allows minimally invasive sampling of most breast lesions and generates tissue cores for histologic evaluation. A specific pathologic diagnosis, as well as determination of invasiveness, can be achieved for mass lesions. Microcalcification can also be sampled to diagnose in situ cancer, although the use of core biopsy for noncomedo intraductal cancer is still evolving. The procedure demands meticulous technique to assure accurate needle placement, and careful correlation of biopsy results and patient follow-up is mandatory. Accuracy relative to surgical biopsy of nonpalpable lesions has been excellent in published series. The role of this procedure in patients with low, intermediate, and high suspicion mammographic lesions is discussed.