THE IMPACT OF IMAGE-DIRECTED CORE BIOPSY ON THE PRACTICE OF BREAST SURGERY - A NEW ALGORITHM FOR A CHANGING TECHNOLOGY

Open surgical biopsy has long been the standard of care for the diagno sis of breast pathology. As more lesions are diagnosed by mammography, image-directed core biopsy has taken on increasing importance. This s tudy consisted of a consecutive group of 540 patients who underwent br east biopsy for mammographically or sonographically detected lesions. The percentage of those undergoing image-directed biopsy and open biop sy were determined as well as the rate of positive biopsy for each met hod. Results showed that for patients with nonpalpable lesions, the pr oportion of image-directed core biopsies rose steadily during the stud y period, from 0 per cent in early 1993 to 70.1 per cent by early 1996 . During this same period, positive biopsy rate rose from 23.9 to 31.0 per cent in the first 18 months of the study to a range of 45.2 to 48 .3 per cent in the last 18 months. It was concluded that image-directe d core biopsies have begun to impact the practice of breast surgery by replacing, to a great extent, the open surgical biopsy. This study al so demonstrates an increased proportion of positive biopsies done by o pen surgical technique. It was suggested that many of the mammographic ally benign lesions are diagnosed by image-directed core biopsy, obvia ting the need for an open technique. An algorithm for managing nonpalp able breast lesions is presented.