Sonographically guided directional vacuum-assisted breast biopsy using a handheld device

OBJECTIVE. The goal of this study was to show that one can safely remove al l sonographic evidence of masses in the breast less than or equal to 1.5 cm in greatest dimension using the 11-gauge handheld Mammotome, thereby reduc ing the possibility of a false-negative diagnosis and other shortcomings of the automated core biopsy device. SUBJECTS AND METHODS. Over a 12-week period (May 3-July 31, 2000), 124 sono graphically guided breast biopsies were performed in 113 patients, using a new handheld directional vacuum-assisted biopsy device. All lesions that: w ere less than or equal to 1.5 cm were biopsied using a handheld Mammotome; an attempt was made to continue the biopsy until no sonographic evidence of the lesion remained. RESULTS. Of these 124 lesions, 14 had infiltrating ductal carcinomas, four had infiltrating ductal carcinomas with associated ductal carcinoma in situ , one had infiltrating lobular carcinoma, one had ductal carcinoma in situ, three had atypical ductal hyperplasias, one had atypical lobular hyperplas ia, and one had phyllodes tumor. Only one infiltrating ductal carcinoma was entirely removed histologically at Mammotome biopsy. There were no underes timates of disease. No cases of epithelial displacement were observed in an y of the surgical excisions of malignancies. The remaining 99 lesions were benign. CONCLUSION. The handheld Mammotome diminishes the shortcomings of the autom ated core biopsy device. It reduces the possibility of false-negatives and underestimation of disease. It eliminates the need for multiple insertions and reduces the likelihood of epithelial displacement. As a result, we now use this device for all sonographically guided biopsies of breast masses sm aller than 1.5 cm and recommend that others consider it for such use.