Imaging-guided breast biopsy performed with large-core needles can acc
urately diagnose most breast pathologies, often allowing a diagnosis t
o be made more quickly and less expensively than with surgical biopsy.
Major complications, such as hemorrhage and infection, are extremely
rare, although post-biopsy ecchymosis and tenderness are not unusual.
Because less tissue is removed, post-biopsy cosmetic deformity does no
t occur. Stereotactic biopsy is performed by triangulating the positio
n of a breast lesion and by obtaining views angled equally off a centr
al axis. This can be done using dedicated tables or add-on equipment.
Stereotactic core biopsy has a reported accuracy of at least 90%. All
lesions for which biopsy would ordinarily be recommended are amenable
to stereotactic techniques, but those near the chest wall or in the ax
illa may be more difficult to biopsy with some equipment Lesions chara
cterized by calcifications are sometimes more difficult to sample. A b
iopsy diagnosis of ductal atypia, because of its histologic heterogene
ity, requires surgical excision to exclude coexistent carcinoma, which
has been found in half of women at subsequent surgical excision. A co
re biopsy diagnosis of ductal carcinoma in situ does not preclude the
discovery of invasive carcinoma at surgery. In rare instances, the sma
ll tissue volume removed at stereotactic biopsy does not permit a fina
l diagnosis to be made; this occurs most commonly when differentiating
phyllodes tumor from fibroadenoma.