Breast Biopsy

Excerpt

Breast cancer carries a high cost to society; the loss of life and the economic impact is almost unimaginable. In 2018 alone, there were 2.2 million cases of breast cancer diagnosed worldwide, and most were discovered by imaging. However, there are limitations to breast imaging evaluation.

The majority of suspicious breast lesions require further diagnostic workup with a biopsy and pathology diagnosis to determine management. Historically, a surgical excisional biopsy was the only option and was only feasible for masses large enough to be localized by palpation intraoperatively.

In the mid to late 1980s, a series of practical breakthroughs occurred to propel minimally invasive procedures into a new age. Initially, when the minimally invasive ultrasound-guided biopsy was developed, it required three hands - one hand to operate the ultrasound probe and two hands to operate the biopsy needle. Lindgreen, a radiologist, frustrated with the clumsy nature of this method, developed a biopsy device that could be used with one hand by a system of springs and buttons. This allowed an individual provider to control the ultrasound transducer with one hand and the biopsy device with the other.

The second breakthrough was the modification of the mammographic controlled stereotactic system primarily used for fine needle aspirations to accept the modified biopsy device. The third breakthrough occurred with the integration of magnetic resonance (MR) guidance and the modification in the previously developed biopsy devices to be MR compatible. Today, millions of breast biopsies are performed annually using these minimally invasive techniques as a cost-effective alternative to surgical excisional biopsies with high accuracy and low complication rates.