Advertisement
Review Article| Volume 25, ISSUE 4, P655-678, December 2005

Download started.

Ok

Image-Directed Fine Needle Aspiration Biopsy in Nonpalpable Breast Lesions

      The last few decades have seen the development of technology that allows detection of nonpalpable breast cancer. Screening mammography, ultrasound (US), and MRI are sensitive in varying degrees, but nonspecific in this task. Only 10% to 35% of nonpalpable lesions that are suspicious on mammography prove to be cancer at biopsy [
      • Shaw de Paredes E.
      Atlas of film-screen mammography.
      ,
      • Schwartz G.
      • Feig S.
      • Patchefsky A.
      Significance and staging of nonpalpable carcinomas of the breast.
      ]. Thus percutaneous methods to biopsy nonpalpable breast lesions are required, both for surgical and nonsurgical treatment planning for cancers, as well as to diagnose benign lesions so that surgical excision may be avoided. Percutaneous sampling of nonpalpable breast lesions permits relatively inexpensive tissue diagnosis while minimizing scarring, and allows optimal cosmesis after breast conservation surgery. It can be done with the guidance of US, stereotaxis, or MRI. This article discusses the use of fine needle aspiration biopsy (FNAB), and describe its strengths and limitations compared with other currently used biopsy needles.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Clinics in Laboratory Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Shaw de Paredes E.
        Atlas of film-screen mammography.
        2nd edition. Williams and Wilkins, Philadelphia1992
        • Schwartz G.
        • Feig S.
        • Patchefsky A.
        Significance and staging of nonpalpable carcinomas of the breast.
        Surg Gynecol Obstet. 1988; 166: 6-10
        • Masood S.
        Sampling of nonpalpable breast lesions: a plea for a multidisciplinary approach.
        Breast J. 1999; 5: 79-80
        • Hopper K.D.
        • Abendroth C.S.
        • Sturtz K.W.
        • et al.
        Fine-needle aspiration biopsy for cytologic analysis: utility of syringe handles, automated guns, and the nonsuction method.
        Radiology. 1992; 185: 819-824
        • Savage C.A.
        • Hopper K.D.
        • Abendroth C.S.
        • et al.
        Fine-needle aspiration biopsy versus fine-needle capillary (nonaspiration) biopsy: in vivo comparison.
        Radiology. 1995; 195: 815-819
        • Zajdela A.
        • Zillhardt P.
        • Voillemot N.
        Cytologic diagnosis by fine needle sampling without aspiration.
        Cancer. 1987; 59: 1201-1205
        • Fornage B.D.
        • Sneige N.
        • Singletary S.E.
        Masses in breasts with implants: diagnosis with US-guided fine-needle aspiration biopsy.
        Radiology. 1994; 191: 339-342
        • Fornage B.D.
        Fine-needle aspiration biopsy with a vacuum test tube.
        Radiology. 1988; 169: 553-554
        • Mair S.
        • Dunbar F.
        • Becker P.J.
        • et al.
        Fine needle cytology: is aspiration suction necessary? A study of 100 masses in various sites.
        Acta Cytol. 1989; 33: 809-813
        • Fagelman D.
        • Chess Q.
        Non-aspiration fine needle cytology of the liver: a new technique for obtaining diagnostic samples.
        AJR Am J Roentgenol. 1990; 155: 1217-1219
        • Zajdela A.
        • de Maublano M.A.
        • Schlienger P.
        • et al.
        Cytologic diagnosis of orbital and periorbital palpable tumors using fine needle sampling without aspiration.
        Diagn Cytopathol. 1986; 2: 17-20
        • Santos J.E.
        • Leiman G.
        Non-aspiration fine needle cytology: application of a new technique to nodular thyroid disease.
        Acta Cytol. 1988; 32: 353-356
        • Akhtar M.
        • Ali M.A.
        • Huq M.
        • et al.
        Fine needle biopsy: comparison of cellular yield with and without aspiration.
        Diagn Cytopathol. 1989; 5: 162-165
        • Briffod M.
        • Gentile A.
        • Hebert H.
        Cytopuncture in the follow-up of breast carcinoma.
        Acta Cytol. 1982; 26: 195-200
        • Gordon P.B.
        • Goldenberg S.L.
        Ultrasound-guided fine needle aspiration biopsy. Update 1998.
        Breast J. 1998; 4: 292-301
        • Gordon P.B.
        • Gagnon F.A.
        • Lanzkowsky L.
        Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up.
        Radiology. 2003; 229: 233-238
        • Gordon P.B.
        • Goldenberg S.L.
        • Chan N.
        Solid breast lesions: diagnosis with US-guided fine-needle aspiration biopsy.
        Radiology. 1993; 189: 573-580
        • Fajardo L.L.
        • Jackson V.P.
        • Hunter T.B.
        Interventional procedures in diseases of the breast: needle biopsy, pneumocystography and galactography.
        AJR Am J Roentgenol. 1992; 158: 1231-1238
      1. Jackson V. The status of mammographically guided fine-needle aspiration biopsy of nonpalpable breast lesions. In: Breast imaging: current status and future directions. Radiol Clin North Am 1992;30:155–66.

        • Lindfors K.
        • Rosenquist C.
        Needle core biopsy guided with mammography: a study of cost-effectiveness.
        Radiology. 1994; 190: 217-222
        • Pisano E.D.
        • Fajardo L.L.
        • Tsimikas J.
        • et al.
        Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial. The Radiologic Diagnostic Oncology Group 5 Study.
        Cancer. 1998; 82: 679-688
        • Parker S.H.
        • Jobe W.E.
        Percutaneous breast biopsy.
        Raven Press, New York1993
        • Liberman L.
        • Dershaw D.D.
        • Rosen P.P.
        • et al.
        Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed?.
        Radiology. 1994; 192: 793-795
        • Fishman J.E.
        • Milikowski C.
        • Ramsinghani R.
        • et al.
        US-guided core-needle biopsy of the breast: how many specimens are necessary?.
        Radiology. 2003; 226: 779-782
        • Berg W.A.
        • Thorsten T.L.
        • Campassi C.
        • et al.
        Evaluation of 14- and 11-gauge directional vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model.
        Radiology. 1997; 205: 203-208
        • Gordon P.B.
        Technical innovation: an alternative clip-marking method for use after 14-gauge large core needle biopsy of the breast; an opportunity for huge cost savings.
        Can Assoc Radiol J. 2004; 55: 75-78
        • Jackman R.J.
        • Nowels K.W.
        • Shepard M.J.
        • et al.
        Stereotactic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia.
        Radiology. 1994; 193: 91-95
        • Liberman L.
        • Cohen M.A.
        • Dershaw D.D.
        • et al.
        Atypical hyperplasia diagnosed at stereotactic core biopsy of breast lesions: an indication for surgical biopsy.
        AJR Am J Roentgenol. 1995; 164: 1111-1113
        • Jackman R.J.
        • Nowels K.W.
        • Radriguez-Soto J.
        • et al.
        Stereotactic, automated large-core needle biopsy of nonpalpable breast lesions: false negative and histologic underestimation rates after long-term followup.
        Radiology. 1999; 210: 799-805
        • Dronkers D.J.
        Stereotaxic core biopsy of breast lesions.
        Radiology. 1992; 183: 631-634
        • Parker S.H.
        • Burbank F.
        • Jackman R.J.
        • et al.
        Percutaneous large-core breast biopsy: a multi-institutional study.
        Radiology. 1994; 193: 359-364
        • Hoda S.A.
        • Rosen P.P.
        Observations of the pathological diagnosis of selected unusual lesions in needle core biopsies of the breast.
        Breast J. 2004; 10: 522-527
        • Esserman L.E.
        • Cura M.A.
        • DaCosta D.
        Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy.
        Radiographics. 2004; 24: 147-156
        • Tabara S.O.
        • Frierson H.F.
        • Fechner R.E.
        Diagnostic problems in tissues previously sampled by fine-needle aspiration.
        Am J Clin Pathol. 1991; 96: 76-80
        • Youngson B.J.
        • Cranor M.
        • Rosen P.P.
        Epithelial displacement in surgical breast specimens following needling procedures.
        Am J Surg Pathol. 1994; 18: 896-903
        • Boppana S.
        • May M.
        • Hoda S.
        Does prior fine-needle-aspiration cause difficulties in histologic assessment of breast carcinomas?.
        Lab Invest. 1994; 70: 13A
        • Diaz L.K.
        • Wiley E.L.
        • Venta L.A.
        Are malignant cells displaced by large-gauge needle core biopsy of the breast?.
        AJR Am J Roentgenol. 1999; 173: 1303-1313
        • Harter L.P.
        • Curtis J.S.
        • Ponto G.
        • et al.
        Malignant seeding of the needle track during stereotactic core biopsy.
        Radiology. 1992; 185: 713-714
        • Grabau D.A.
        • Anderson J.A.
        • Gaverson H.P.
        • et al.
        Needle biopsy of breast cancer. Appearance of tumor cells along the needle track.
        Eur J Surg Oncol. 1993; 19: 826-827
        • Baker J.A.
        • Scott Soo M.
        • Mengoni P.
        Sonographically guided percutaneous interventions of the breast using a steerable ultrasound beam.
        AJR Am J Roentgenol. 1999; 172: 157-159
        • Hann L.
        • Ducatman B.S.
        • Wang H.H.
        • et al.
        Nonpalpable breast lesions: evaluation by means of fine-needle aspiration cytology.
        Radiology. 1989; 171: 373-376
        • Dowlatshahi K.
        • Yaremko M.L.
        • Kluskens L.F.
        • et al.
        Nonpalpable breast lesions: findings of stereotaxic needle-core biopsy and fine-needle aspiration cytology.
        Radiology. 1991; 181: 745-750
        • Georgian-Smith D.
        • Shiels W.E.
        Freehand interventional sonography in the breast: basic principles and clinical applications.
        Radiographics. 1996; 16: 149-161
        • Mendelson E.B.
        • Tobin C.E.
        Critical pathways in using breast US.
        Radiographics. 1995; 15: 935-945
      2. Sickles EA. Management of probably benign lesions. RSNA Categorical Course in Breast Imaging 1995; p. 133–8.

        • Sickles E.A.
        Periodic mammographic follow-up of probably benign lesions: results in 3184 consecutive cases.
        Radiology. 1991; 179: 463-468
      3. American College of Radiology breast imaging reporting and data system (BI-RADS).
        4th edition. American College of Radiology, Reston (VA)2003
        • Krishnamurthy S.
        • Sneige N.
        • Bedi D.G.
        • et al.
        Role of ultrasound-guided fine-needle aspiration biopsy of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma.
        Cancer. 2002; 95: 982-988
        • Sapino A.
        • Cassoni P.
        • Zanan E.
        • et al.
        Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management.
        Br J Cancer. 2003; 88: 702-706
        • Nees A.V.
        • Helvie M.A.
        • Patterson S.K.
        • et al.
        Pre-operative staging of the axilla in women recently diagnosed with breast cancer: accuracy of axillary ultrasound and ultrasound-guided fine needle aspiration biopsy.
        ([abstract])in: Radiological Society of North America Scientific Assembly and Annual Meeting Program 2004. Radiological Society of North America, Oak Brook (IL)2004: 380
        • Koelliker S.L.
        • Chung M.
        • Steinhohh M.
        • et al.
        Ultrasound and fine needle aspiration of axillary lymph nodes in initial staging of breast cancer.
        ([abstract])in: Radiological Society of North America Scientific Assembly and Annual Meeting Program 2004. Radiological Society of North America, Oak Brook (IL)2004: 380
        • Oruwari J.U.
        • Chung M.A.
        • Koelliker S.
        • et al.
        Axillary staging using ultrasound-guided fine needle aspiration biopsy in locally advanced breast cancer.
        Am J Surg. 2002; 184: 307-309
        • International Consensus Conference
        Breast Cancer Diagnosis and Treatment.
        J Am Coll Surg. 2001; 193: 19-24