No abstract

We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.

The purpose of this study is to evaluate the accuracy of gray scale and Doppler US findings in the detection of axillary metastases in breast cancer patients with no palpable lymph nodes. One-hundred and ninety-eight lymph nodes detected in 83 women were evaluated. The size and longitudinal/transverse axis ratios of each node were documented. Absence of echogenic hilum, asymmetrical cortical thickening, and presence of peripheral flow were prospectively considered signs of malignancy. Histopathologically, there were 93 malignant and 105 benign nodes. The above criteria and a low longitudinal-transverse axis ratio were statistically significant for malignancy. In lymph nodes smaller than 1 cm, only asymmetric cortical thickening and presence of peripheral flow were significant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 86.49, 93.62, 91.43, 89.8 and 90.48%, respectively. In conclusion, US is successful and reliable in the determination of axillary metastatic involvement in nonpalpable and small lymph nodes. Inclusion of axillary US in the preoperative diagnostic evaluation would be complimentary to sentinel node biopsy, and also could eliminate the need for it in patients with positive US results, after confirmation with biopsy.