Breast Biopsy: Core

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Chapter 231 Breast Biopsy: Core

DESCRIPTION

Core breast biopsy is a technique used to obtain small tissue samples for the histologic diagnosis of breast masses.

INDICATIONS

Breast mass or suspicious lesion (palpable; nonpalpable masses may be sampled if image guidance is available).

CONTRAINDICATIONS

Local skin infection, known or suspected allergy to agents used (e.g., latex, iodine). Core needle biopsy may not be suitable for patients who have very small or very hard breast lumps; masses close to the chest wall, the nipple, or the surface of the breast; calcifications that require magnification; or very small breasts. Patients who take blood thinners or aspirin should discontinue them in advance of the procedure. Women who cannot remain still or supine for 20 to 40 minutes because of physical illness or other problems are not good candidates for stereotactic core needle biopsy.

TECHNIQUE

After appropriate informed consent has been obtained from the patient, the skin is disinfected and a skin wheal of local anesthetic is injected at the site chosen for needle penetration. (The patient may be either supine or prone based on the location of the lesion to be biopsied, optimal access, and the availability or need for image guidance.) Using the fingers of the opposite hand to stabilize the area in question, the physician advances the needle into the area of concern by palpation or under image guidance using either stereotactic mammography or ultrasound. (Passage of the needle through the skin may be facilitated by a small incision if desired.) A change in tissue resistance or a “gritty” sensation may be noticed as the needle enters some mass lesions.

Core biopsy needles generally have a specialized tip with a covering sheath and cutting edge. The needles are of large caliber (14 g) and are mounted onto a spring-loaded device that allows small cylinders of tissue to be cut and collected within the notch of the needle. Techniques vary slightly based on the specific needle but commonly involve placing the tip just short of the tissue to be biopsied; then, the inner core is advanced into the tissue and the outer (cutting) sheath is advanced to free the tissue sample trapped in the inner portion of the needle. The needle is removed, the tissue sample is extracted, and additional samples (as needed) are obtained in the same manner. Typically, samples approximate 2.0 cm long by 0.16 cm in diameter.

Three to six separate core needle insertions are typically needed to obtain a sufficient sample of breast tissue. Patients may experience a slight pressure during core needle biopsy but should not experience any significant pain. At the close of the procedure, samples are sent to the pathology laboratory for diagnosis and light dressing is applied. (A self-adhesive bandage suffices.) Ice and gentle pressure may be applied for 15 to 30 minutes to minimize bruising.

Vacuum-assisted breast biopsy is able to remove approximately twice the amount of tissue compared with core needle biopsy while still offering a minimally invasive procedure. The technique is the same as with core biopsy, differing only in the nature of the sampling device.

COMPLICATIONS

Bleeding, hematoma, infection.

FOLLOW-UP

The reported false-negative rate for malignancy with core biopsy is in the range of 2% to 6.7% with a mean rate of 4.4%. Approximately 10% of biopsy attempts will be inconclusive. Certain histologic results should be interpreted with caution: more than one half of all cases of atypical ductal hyperplasia (ADH) diagnosed with core biopsy prove malignant at surgery, and invasive carcinoma is found in up to one third of core biopsy–confirmed ductal carcinoma in situ (DCIS).

CPT CODE(S)

19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)

19102 Biopsy of breast; percutaneous, needle core, using imaging guidance

19103 Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance

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