Stereotactic 11-gauge directional vacuum-assisted breast biopsy: experience with 249 patients

Purpose: To assess the value of percutaneous vacuum-assisted core biopsy to improve the diagnosis of non palpable mammographic abnormalities. Materials and methods: A total of 252 core biopsies using an 11G Mammotome(R) were performed in 249 patients. Stereotactic localization was performed in the prone position on a dedicated digital Fischer table. Results: Fifty-one, or 25%, of 200 clusters of microcalcifications corresponded to carcinomas: 126 benign lesions, 23 atypical hyperplasia and LCIS, 31 DCIS, 15 invasive ductal carcinomas, and 4 false negative biopsies. In these 4 last cases, surgery was performed because radiographs of the core biopsy showed no microcalcifications; carcinoma was confirmed at histology of the surgical specimen. Using the BI-RADS system, 7 lesions were category 3, 175 lesions were category 4, and 18 lesions were category 5. From a total of 52 masses, 31 were benign lesions, 2 were borderline lesions, and 19 were invasive carcinomas. From these, 5 lesions were category 3, 31 were category 4, and 16 were category 5. Diagnostic surgical biopsy was avoided in 161 cases (63%), in 152 cases for benign lesions including 151 lesions classified as category 4 lesions and in 9 cases for multifocal or recurrent malignant lesions. Conclusion: When technical pitfalls are avoided and when presence of microcalcifications in the core biopsy sample is verified, vacuum assisted core biopsy with Mammotome(R) 11G provides accurate diagnosis of non-palpable mammographic abnormalities.