Comparison of mammographically guided breast biopsy techniques

Objective To determine which mammographically guided breast biopsy techniqu e is the most efficient in making a diagnosis in women with suspicious mamm ograms. Summary Background Data Mammographically guided biopsy techniques include s tereotactic 14-gauge core-needle biopsy (SC bx), stereotactic Ii-gauge suct ion-assisted core biopsy (Mammotome [Mbx]), stereotactic coring excisional biopsy (Advanced Breast Biopsy Instrument [ABBI]), and wire-localized biops y (WL bx). Controversy exists over which technique is best. Methods All patients undergoing any one of these biopsy methods over a 15-m onth period were reviewed, totaling 245 SC bx, 107 Mbx, 104 ABBI, and 520 W L bx. Information obtained included technical success, pathology, discordan t pathology, and need for open biopsy. Results Technical success was achieved in 94.3% of SC bx, 96.4% of Mbx, 92. 5% of ABBI, and 98.7% of WL bx. The sensitivity and specificity were 87.5% and 98.6% for SC bx, 87.5% and 100% for Mbx, and 100% and 100% for ABBI. Di scordant results or need for a repeat biopsy occurred in 25.7% of SC bx, 23 .2% of Mbx, and 7.5% of ABBI biopsies. In 63.6% of ABBI and 50.9% of WL bx, positive margins required reexcision; of the cases with positive margins, 71.4% of ABBI and 70.4% of WL bx had residual tumor in the definitive treat ment specimen. Conclusion Although sensitivities and specificities of SC bx and Mbx are go od, 20% to 25% of patients will require an open biopsy because a definitive diagnosis could not be reached. This does not occur with the ABBI excision al biopsy specimen. The positive margin rates and residual tumor rates are comparable between the ABBl and WL bx. The ABBI avoids operating room and r eexcision costs; therefore, in appropriately selected patients, this appear s to be the most efficient method of biopsy.