Three-dimensional ultrasound-guided biopsy of breast lesion: a new diagnostic support in the preoperative diagnosis

A safe and precise preoperative histologic diagnosis is the goal in the modern treatment of breast cancer, to optimize the surgical radicality and to reduce unnecessary mutilation without increasing the risk of residual cancer and later recidives and to optimize the degree of surgical radicality. Ultrasound-guided procedures are useful in biopsying US-detectable breast lesions. In recent years many bioptic procedures have been developed; each shows advantages and disadvantages, but until now none has been defined as the optimal one.

The aim of our study was to improve and to optimize the reliability of the high-speed breast core biopsy, using three-dimensional ultrasound guidance.

From September 2000 to March 2001, we performed 57 high-speed breast core biopsies (Bard Instrument) under 3D US guidance (three dimensional representation of the needle in the lesion): 13 lesions had a diameter >2 cm and 44 had a diameter ≤ 2 cm; in 13 of the latter the diameter was ≤ 1 cm. From each tumor we obtained only 2 to 3 bioptic cores (in at least one core we demonstrated the presence of the needle central or marginally in the lesion). All of the patients underwent breast operation after the bioptic histologic diagnosis (at biopsy approximately 90% had breast cancer, and approximately 10% did not have malignant lesions). The diagnosis of malignancy or benignancy was confirmed in 97% of cases (55/57); two false-negative bioptic results indicated hyperplasy and suspected adenosis, but the successive postoperative diagnosis showed clear malignancy.

With 3D US support we were able to reduce the number of biopsies for each lesion (two to three) without reduction of the histologic results, also reducing the costs and the possible complications (haematomas, infections and malignant cell spreading).