Lesions in 17% of patients with LCIS or ALH at CNB were upgraded to invasive cancer or DCIS; this rate was similar to the upgrade rate in patients with ADH. Excisional biopsy is supported when LCIS, ALH, or ADH is diagnosed at CNB.
The commitment to the goal of diagnosing and treating breast cancer at its earliest point of development remains strong. As a result, biopsy techniques continue to evolve. Freehand needle localizations were supplanted by fenestrated grids and hook wires. In the 1990s, stereotactic and ultrasound guided large core needle biopsy techniques were introduced, and now ultrasound and stereotactic guided vacuum-assisted procedures with 11-gauge needles are commonplace. Most recently, very large core needle biopsy devices were developed with a purpose of percutaneously diagnosing and treating nonpalpable breast lesions. However, bigger may not necessarily be better. This paper reviews the very large core needle biopsy technique and compares it to traditional large core needle biopsy. Factors such as technical success, histologic concordance, surgical margin positivity and cost are discussed.
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