Download PDF
CC BY-NC-ND 4.0 · Indographics 2022; 01(01): 091-100
DOI: 10.1055/s-0042-1742573
Review Article

Managing the Lesion and Counseling Patient Post–Breast Biopsy

Bagyam Raghavan
1   Department of Radiodiagnosis, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
,
M. V. Gautham
1   Department of Radiodiagnosis, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
,
R. Monushree
1   Department of Radiodiagnosis, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
,
Ann Kurian
1   Department of Radiodiagnosis, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
,
Sivaramalingam Geethapriya
1   Department of Radiodiagnosis, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
,
V. Sathyashree
1   Department of Radiodiagnosis, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Breast cancer is the leading cause of cancer deaths worldwide among women. Early diagnosis and prompt treatment offers a chance for cure and long-term survival among afflicted women. Triple assessment which includes clinical examination, radiological imaging and histopathological evaluation has become a standard of care in the evaluation of breast cancer. Radiological imaging involves mammography, ultrasound, and magnetic resonance imaging while pathological evaluation can be done on fine needle, core-needle, and surgical excision biopsy specimens with core needle biopsy being the workhorse for diagnosis. While triple assessment has increased the diagnostic yield and helps in the identification of early lesions, an increasing subset of patients present with a situation where the imaging and pathological characteristics of a lesion do not correlate with each other thereby causing diagnostic and therapeutic dilemma. Imaging and pathology concordance and discordance present distinctly under differing circumstances in the care of the patient. While those with concordant findings proceed to treatment or follow up directly and hence benefit from the early treatment, those with discordant findings are beset with a delay in the diagnosis and should be subjected to further evaluations for confirming or refuting a diagnosis. This article reviews the salient features of image-guided breast biopsy and the outcomes and management options in imaging and pathology concordance and discordance. We also discuss the role of a radiologist in the counselling of the patient before and after receiving the pathological report after biopsy.

Keywords

breast biopsy - core-needle biopsy - postbiopsy management


Publication History

Article published online:
19 September 2023

© 2022. Indographics. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Silverstein MJ, Recht A, Lagios MD. et al. Special report: consensus conference III. Image-detected breast cancer: state-of-the-art diagnosis and treatment. J Am Coll Surg 2009; 209 (04) 504-520
    CrossrefPubMedGoogle Scholar
  • 2 Bae S, Yoon JH, Moon HJ, Kim MJ, Kim EK. Breast microcalcifications: diagnostic outcomes according to image-guided biopsy method. Korean J Radiol 2015; 16 (05) 996-1005
    CrossrefPubMedGoogle Scholar
  • 3 Uematsu T. How to choose needles and probes for ultrasonographically guided percutaneous breast biopsy: a systematic approach. Breast Cancer 2012; 19 (03) 238-241
    CrossrefPubMedGoogle Scholar
  • 4 Keranen AK, Haapea M, Rissanen T. Ultrasonography as a guiding method in breast micro-calcification vacuum-assisted biopsies. Ultraschall Med 2016; 37: 497-502
    CrossrefPubMedGoogle Scholar
  • 5 Park VY, Kim EK, Moon HJ, Yoon JH, Kim MJ. Evaluating imaging-pathology concordance and discordance after ultrasound-guided breast biopsy. Ultrasonography 2018; 37 (02) 107-120
    CrossrefPubMedGoogle Scholar
  • 6 Youk JH, Kim EK, Kim MJ. et al. Concordant or discordant? Imaging-pathology correlation in a sonography-guided core needle biopsy of a breast lesion. Korean J Radiol 2011; 12 (02) 232-240
    PubMedGoogle Scholar
  • 7 Johnson NB, Collins LC. Update on percutaneous needle biopsy of nonmalignant breast lesions. Adv Anat Pathol 2009; 16 (04) 183-195
    CrossrefPubMedGoogle Scholar
  • 8 The American Society of Breast Surgeons. Performance and practice guidelines for stereotactic breast procedures. Accessed November 5, 2010 at: https://www.breastsurgeons.org/docs/statements/Performance-and-Practice-Guidelines-for-Stereotactic-Breast-Procedures.pdf
    Google Scholar
  • 9 American College of Radiology. ACR practice parameter for the performance of stereotactic/tomosynthesis-guided breast interventional procedures. Accessed June 25, 2011 at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/stereo-breast.pdf
    Google Scholar
  • 10 Landercasper J, Linebarger JH. Contemporary breast imaging and concordance assessment: a surgical perspective. Surg Clin North Am 2011; 91 (01) 33-58
    CrossrefPubMedGoogle Scholar
  • 11 Neal L, Tortorelli CL, Nassar A. Clinician's guide to imaging and pathologic findings in benign breast disease. Mayo Clin Proc 2010; 85 (03) 274-279
    CrossrefPubMedGoogle Scholar
  • 12 Masood S, Rosa M. Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol 2011; 18 (03) 190-198
    CrossrefPubMedGoogle Scholar
  • 13 Corben AD, Edelweiss M, Brogi E. Challenges in the interpretation of breast core biopsies. Breast J 2010; 16 (Suppl. 01) S5-S9
    CrossrefPubMedGoogle Scholar
  • 14 Youk JH, Kim EK, Kim MJ, Lee JY, Oh KK. Missed breast cancers at US-guided core needle biopsy: how to reduce them. Radiographics 2007; 27 (01) 79-94
    CrossrefPubMedGoogle Scholar
  • 15 Liberman L, Drotman M, Morris EA. et al. Imaging-histologic discordance at percutaneous breast biopsy. Cancer 2000; 89 (12) 2538-2546
    CrossrefPubMedGoogle Scholar
  • 16 Parikh J, Tickman R. Image-guided tissue sampling: where radiology meets pathology. Breast J 2005; 11 (06) 403-409
    CrossrefPubMedGoogle Scholar
  • 17 Liberman L. Percutaneous image-guided core breast biopsy. Radiol Clin North Am 2002; 40 (03) 483-500
    CrossrefPubMedGoogle Scholar
  • 18 Comstock CE. US-guided interventional procedures. In: Feig SA. ed. 2005 Syllabus: A Categorical Course in Diagnostic Radiology Breast Imaging. Oak Brook, IL: Radiological Society of North America; 2005: 155-168
    Google Scholar
  • 19 Bassett LW, Mahoney MC, Apple SK. Interventional breast imaging: current procedures and assessing for concordance with pathology. Radiol Clin North Am 2007; 45 (05) 881-894
    CrossrefPubMedGoogle Scholar
  • 20 Whitman GJ, Erguvan-Dogan B, Yang WT, Wilson J, Patel P, Krishnamurthy S. Ultrasound-guided breast biopsies. Ultrasound Clin 2006; 1: 603-615
    CrossrefGoogle Scholar
  • 21 Fishman JE, Milikowski C, Ramsinghani R, Velasquez MV, Aviram G. US-guided core-needle biopsy of the breast: how many specimens are necessary?. Radiology 2003; 226 (03) 779-782
    CrossrefPubMedGoogle Scholar
  • 22 Dillon MF, Hill AD, Quinn CM, O'Doherty A, McDermott EW, O'Higgins N. The accuracy of ultrasound, stereotactic, and clinical core biopsies in the diagnosis of breast cancer, with an analysis of false-negative cases. Ann Surg 2005; 242 (05) 701-707
    CrossrefPubMedGoogle Scholar
  • 23 Schueller G, Jaromi S, Ponhold L. et al. US-guided 14-gauge core-needle breast biopsy: results of a validation study in 1352 cases. Radiology 2008; 248 (02) 406-413
    CrossrefPubMedGoogle Scholar
  • 24 Philpotts LE, Hooley RJ, Lee CH. Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR Am J Roentgenol 2003; 180 (02) 347-351
    CrossrefPubMedGoogle Scholar
  • 25 Wu YC, Chen DR, Kuo SJ. Personal experience of ultrasound-guided 14-gauge core biopsy of breast tumor. Eur J Surg Oncol 2006; 32 (07) 715-718
    CrossrefPubMedGoogle Scholar
  • 26 Yoo JL, Woo OH, Kim YK. et al. Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas?. Radiographics 2010; 30 (06) 1689-1702
    CrossrefPubMedGoogle Scholar
  • 27 Song SE, Cho N, Chu A. et al. Undiagnosed breast cancer: features at supplemental screening US. Radiology 2015; 277 (02) 372-380
    CrossrefPubMedGoogle Scholar
  • 28 Youk JH, Kim EK, Kim MJ. et al. Concordant or discordant? Imaging-pathology correlation in a sonography-guided core needle biopsy of a breast lesion. Korean J Radiol 2011; 12 (02) 232-240
    CrossrefPubMedGoogle Scholar
  • 29 Moon HJ, Jung I, Youk JH, Kim MJ, Kim EK. Short-term follow-up in 6 months is unnecessary for asymptomatic breast lesions with benign concordant results obtained at ultrasonography-guided 14-gauge core needle biopsy. Am J Surg 2016; 211 (01) 152-158
    CrossrefPubMedGoogle Scholar
  • 30 Sickles EA, Ominsky SH, Sollitto RA, Galvin HB, Monticciolo DL. Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations. Radiology 1990; 175 (02) 323-327
    CrossrefPubMedGoogle Scholar
  • 31 Cho SH, Park SH. Mimickers of breast malignancy on breast sonography. J Ultrasound Med 2013; 32 (11) 2029-2036
    CrossrefPubMedGoogle Scholar
  • 32 Kim MJ, Kim D, Jung W, Koo JS. Histological analysis of benign breast imaging reporting and data system categories 4c and 5 breast lesions in imaging study. Yonsei Med J 2012; 53 (06) 1203-1210
    CrossrefPubMedGoogle Scholar
  • 33 Kim MJ, Kim EK, Lee JY. et al. Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings. Eur Radiol 2007; 17 (09) 2376-2383
    CrossrefPubMedGoogle Scholar
  • 34 Krishnamurthy S, Bevers T, Kuerer H, Yang WT. Multidisciplinary considerations in the management of high-risk breast lesions. AJR Am J Roentgenol 2012; 198 (02) W132-40
    CrossrefPubMedGoogle Scholar
  • 35 Middleton LP, Sneige N, Coyne R. et al. Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting. Cancer Med 2014; 3 (03) 492-499
    CrossrefPubMedGoogle Scholar
  • 36 Hutcherson KC, Ferrara M, Gillis J, Roberson S, Robinson C. Closing the loop with a post-biopsy breast clinic. Accessed January 11, 2022 at: https://www.accc-cancer.org/docs/documents/oncology-issues/articles/nd15/nd15-closing-the-loop-with-a-post-biopsy-breast-clinic.pdf?sfvrsn=d4b9974b_7
    Google Scholar
  • 37 Soo MC. Optimizing the patient experience in breast imaging: improving radiologist – patient communication. Accessed January 11, 2022 at: https://www.sbi-online.org/Portals/0/Breast%20Imaging%20Symposium%202016/Final%20Presentations/325C%20Soo%20-%20How%20to%20Talk%20to%20Patients.pdf
    Google Scholar