Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging

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.

Keywords: Breast; Breast lesion localisation; Core needle biopsy; Fine-needle sampling; Vacuum-assisted biopsy.

Fig. 1

Ultrasound-guided core needle biopsy. The patient is in supine position. After local anaesthesia, the ultrasound probe (on the left) guides the needle to the lesion

Fig. 2

Mammography-guided (stereotactic) vacuum-assisted biopsy. The patient is in prone position lying on the table over the field of view of the image, with the breast pendent by gravity (she does not see the procedure). After local anaesthesia, the needle is guided to the lesion by the computer on the basis of specifically acquired mammographic images

Fig. 3

Mammography-guided (stereotactic) vacuum-assisted biopsy. The patient is sitting on a dedicated chair. After local anaesthesia, the needle is guided to the lesion by the computer on the basis of specifically acquired mammographic images

Fig. 4

Magnetic resonance imaging-guided vacuum-assisted biopsy. The patient is prone, positioned on a dedicated coil that allows to insert the needle through a greed (light blue arrow), shown in the figure outside the magnet. After local anaesthesia, the needle is guided to the lesion on the basis of specifically acquired magnetic resonance images. To conclude the procedure, the patient has to enter and exit the magnet at least three times (see text)