Expert panel develops new breast biopsy guidelines
A group of breast imaging experts has developed a set of recommendations to help guide providers in navigating breast biopsy decisions.
Published this week in Insights Into Imaging, the recommendations are the result of a collaboration between eight breast health experts from around the world. The team developed the guidelines to help providers effectively choose between the numerous minimally invasive diagnostic options for breast biopsy in multiple clinical scenarios.
“Although every practitioner of breast biopsies should be aware of the advantages and limitations of biopsy and imaging techniques, evidence-based literature discussing which biopsy technique and imaging combination is to be preferred for the diagnosis of breast lesions is sparse, and a general consensus is not available,” Wendelien B. G. Sanderink, MD, with the department of medical imaging at Radboud University Medical Center in the Netherlands, and colleagues noted. “This article provides an expert consensus for biopsy of breast lesions and re-biopsy in case of radiological-pathological discordance or findings of uncertain malignant potential.”
The new recommendations were designed to improve accuracy and safety in diagnosing breast lesions using multiple imaging methods, including digital breast tomosynthesis (DBT), ultrasound and MRI.
Some of the highlights are listed below.
Vacuum-assisted biopsy (VAB) is recommended for:
Lesions visible exclusively on mammography (with or without contrast) or MRI.
Masses smaller than 5 millimeters.
Complex cystic and solid lesions with small solid parts.
Small intraductal masses.
Architectural distortions and calcifications visualized on ultrasound.
The group recommends using core-needle biopsy (CNB) for:
Larger masses that are bigger than 5 millimeters and can be seen with ultrasound.
When an additional biopsy is required due to inconclusive results or high-risk lesions, the group recommends:
Two types of VAB extensions—Extended vacuum-assisted biopsy (EVAB) for unambiguous lesion classification and vacuum-assisted excision (VAE) for the complete removal of the lesion.
For more unique situations, such as re-biopsy for lobular neoplasia, flat epithelial atypia and atypical ductal hyperplasia, the panel recommends:
Surgical removal for DCIS and benign or borderline phyllodes tumors found during initial CNB or VAB procedures.
More detailed information about the recommendations can be found here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.