Image Enhancement

Newer image-guided breast biopsies are preferred over traditional breast biopsies.

by Alicia Di Rado

A panel of breast cancer experts led by top breast cancer surgeon Melvin J. Silverstein, M.D., director of the Harold E. and Henrietta C. Lee Breast Center at the USC/Norris Comprehensive Cancer Center and Hospital, recently urged doctors to perform minimally invasive breast biopsies to check for breast cancer, rather than traditional open surgical biopsies, whenever possible. Minimally invasive breast biopsies can be performed in a doctor’s office.

Their recommendation expanded on a previous paper published in the Journal of the American College of Surgeons that urged greater use of image-guided detection and treatment techniques.

“More and more surgeons are moving toward the use of minimally invasive breast biopsies in their daily practices, and this is translating into better care and higher patient satisfaction. This is an important trend that should continue,” says Silverstein, professor of surgery at the Keck School of Medicine of USC.

“Image-guided breast biopsies allow surgeons to get a definitive diagnosis without open surgery. The implications are significant. We can now spare women who need a biopsy, but don’t have breast cancer, from a trip to the operating room. And for those women who do have breast cancer, it means one less operation and better preoperative planning if breast surgery is necessary,” Silverstein adds.

More than 1.6 million breast biopsies are performed each year in the United States. According to the American Cancer Society, about 80 percent of biopsies are benign, or non-cancerous.

The panel discussed several types of minimally invasive breast biopsies, but preferred minimally invasive vacuum-assisted breast biopsy. In this procedure, a needle or probe guided by ultrasound or X-ray is inserted once into a tiny incision in the breast, and suspicious tissue is cut, vacuumed and removed for analysis. Scarring is minimal and no stitches are required. The procedure typically takes less than an hour and can be performed in a doctor’s office. Traditional breast biopsies are performed in the operating room, require a 1-to-2-inch incision and stitches in the breast and can result in internal and external scarring.

In addition to Silverstein, panel members included these medical leaders: Michael J. Edwards, M.D., breast surgeon and chair, Department of Surgery at the University of Arkansas for Medical Sciences College of Medicine; Richard E. Fine, M.D., breast surgeon and co-director, The Breast Center, Marietta, Ga.; and Kenneth J. Bloom, M.D., pathologist and medical director, US Labs, Irvine, Calif.

Edwards recommended the continued adoption of sentinel lymph node biopsy and the avoidance of axillary lymph node dissection, whenever possible. He said sentinel lymph node biopsy can help women avoid major surgery and its complications, including lymphedema, a painful swelling, numbness or loss of motion in the arms. In sentinel lymph node biopsy, only one or two nodes are removed to determine if cancer has spread. In axillary lymph node dissection, surgeons remove nearly all the area’s lymph nodes.

The panel also discussed the pathology issues associated with minimally invasive breast biopsies and sentinel lymph node biopsies and the need for surgeons to closely coordinate with pathologists. Bloom said the imaging findings should be available to the pathologist and a pathology report ideally should correlate image-detected abnormalities with the microscopic findings.

Breast cancer is a leading cause of death in women. According to the American Cancer Society, more than 211,000 women will be diagnosed with breast cancer in 2003 and nearly 40,000 will die from the disease.