Stereotactic biopsy assessment of microcalcification clusters with direct and frontal macrobiopsies was performed in a population of 46 women screened for breast cancer. In these women the only clinical finding was microcalcification. Sensitivity of the procedure was 98% and calcifications were detected in 107 out of 148 tissue specimen (73%). This is the highest reported ratio so far. Interestingly the total number of cores inversely correlated with the success rate suggesting that the accuracy of the direct and frontal approach is high. 4 out of 46 women underwent surgery for malignancy indicating that 41 women escaped intervention with a mean follow-up of at least one year. Patient satisfaction is high, in particular regarding reported pain, fear and overall appreciation. No complications were seen.The data suggests that a lower number of macrobiopsies for microcalcifications could be acceptable with direct and frontal biopsy methods without reducing sensitivity. Lowering the number of biopsies can optimize surgical margin interpretation and reduce the number of biopsy related mastectomies.
The recent introduction of ultrasound-guided vacuum assisted biopsy (VAB) has led to an increase in the non-operative diagnosis of indeterminate breast lesions. Local working practices have evolved in line with current evidence-based research for ultrasound-guided vacuum assisted excision biopsy of a selected group of these indeterminate lesions. Due to service demands and role extension within the professions allied to health, opportunities have arisen to train radiographers with proven expert practice in breast ultrasound in interventional procedures. Departmental policy has been established to support such suitably experienced radiographers to train and undertake this procedure. Aims have been to provide an effective, acceptable, cost-efficient service which can be accessed as an alternative to surgery. This paper demonstrates how with audited training, competence can be established. Discussion of initial experience suggests that once long-term effective follow up is reported, excision VAB could become established as an appropriate treatment for some patients with initial B3 core biopsy histology.
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