Stereotactic Percutaneous Breast Biopsy: A Comparative Analysis Between Surgeon and Radiologist

Trucut biopsy of breast lesions: the first step toward international standards in developing countries

The new concept in breast cancer diagnosis and treatment is based on a less invasive, more accurate and effective strategy, with a multidisciplinary approach in a specialised breast unit. When indicated, conservative surgery has replaced mastectomy with sentinel-node biopsy substituting routine axillary dissection. But the key factor in respect of these new standards is to confirm the cancer before going to the operating room. Trucut biopsy is performed instead of incisional or excisional biopsy and frozen section. The technique is reliable, simple, and reproducible, and not at all expensive; it can be adapted even for low-income developing countries.

MATERIALS AND METHODS

Between March 2006 and June 2010, 764 patients under clinical suspicion of cancer and/or with BIRADS (Breast Imaging Reporting and Data System) III-V in imaging in one university and one private hospital in Tehran, Iran underwent trucut biopsy (60% palpable and 40% non-palpable lesions). Cancer was found in 30.8% of the cases. In benign pathology, in concordance with clinical and imaging suspicion, surgery was omitted with short-term follow-up. For palpable symptomatic benign lesions surgery was performed to relieve the patient's symptoms. When the pathology report was not in concordance with clinical/imaging suspicion (1.8%), and in the presence of moderate and severe hyperplasia with or without atypia, in lobular and papillary lesions (4.9%) open biopsy was done to rule out cancer (10 added cancers, 1.3%; total cancers 32.1%). Cancer surgery was done as a single procedure in 89.8% of cases.

CONCLUSION

Trucut biopsy for breast lesion assessment is the first step toward a new concept in breast cancer care. It is simple, reduces the number of surgeries (no surgery for non-symptomatic benign lesions and one surgery for cancer), and avoids diagnostic errors with full respect for the patient's rights. We insist on its routine use to extend international guidelines while decreasing the total cost of this common disease in all low-resource countries.

Core needle biopsy versus fine needle aspiration biopsy: are there similar sampling and diagnostic issues?

Evidence suggests that in experienced hands fine needle aspiration biopsy (FNAB) is highly safe and effective for the evaluation of patients who have palpable breast lesions. In most cases, FNAB leads to an appropriate clinical or surgical management. FNAB can also be effectively used in evaluation of cystic lesions under ultrasound guidance. Other nonpalpable lesions can benefit from image-directed core needle biopsy (CNB). Overall, cost should influence the decision to use FNAB or CNB. FNAB may be the only affordable procedure in developing countries. Breast cancer affects significant numbers of women worldwide. Attempts should be made to take all the measures necessary to consider optimal approaches to breast health care for everyone regardless of age, race, ethnicity, or social status.

New diagnostic techniques and treatments for early breast cancer

OBJECTIVES

To review diagnostic techniques and treatments for early breast cancer, including radiologic techniques, biomarkers, surgical techniques, radiation therapy, adjuvant chemotherapy regimens, and hormonal therapy.

DATA SOURCES

Scientific and review articles, book chapters, and clinical practice.

CONCLUSIONS

Breast cancer is a major health problem. The advances in diagnosis and treatment of early breast cancer and the amount of information available make it difficult for patients to make diagnostic and treatment decisions.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses need to be knowledgeable in the many advances in diagnostic and treatment techniques for early breast cancer to assist patients with difficult decisions.