The evolving practice pattern of the breast surgeon with disappearance of open biopsy for nonpalpable lesions

BACKGROUND: Recent advances in technology have prompted growth in the surge on's armamentarium for breast biopsy. For nonpalpable, mammographically det ected lesions, the options include stereotactic needle/wire localization an d open biopsy (SNL/OBx), stereotactic needle core biopsy (SNCB), and direct ional, vacuum-assisted biopsy (VAB; Mammotome). METHODS: A review of 372 patients with 424 breast lesions biopsied by the s ame surgeon between January 1993 and August 1997 was performed. RESULTS: SNCB and VAB procedures were less invasive and less morbid than SN L/OBx. Vacuum-assisted biopsy was superior to SNCB for sampling efficiency, with 74% of microcalcifications removed compared with 20% (P < 0.0001), Ad ditionally, underestimation of disease was seen with the SNCB technique, bu t not with VAB. Follow-up mammography found no false negative biopsies in a ny group. Over the 56 consecutive months, VAB progressively replaced SNL/OB x and SNCB as the procedure of choice. CONCLUSION: A breast surgeon can use VAB to replace open biopsy and core ne edle procedures for the initial biopsy of nonpalpable breast lesions. Am J Sorg. 1998;176:525-528. (C) 1998 by Excerpta Medica, Inc.