Current Image-Guided Interventional Procedures in The Breast
Özet
This text comprehensively reviews current image-guided interventional breast procedures, which serve as less invasive, lower-cost, and efficient alternatives to open surgical biopsies for managing non-palpable lesions classified under BI-RADS 4 or 5. The primary imaging modalities utilized for guidance are ultrasonography (US), mammography (MG), and magnetic resonance imaging (MRI). US remains the preferred first-line, radiation-free method widely used for cystic and solid lesions, core needle biopsies (CNB), and wire marking. Mammography is critical for stereotactic biopsies and preoperative wire marking of microcalcifications and structural distortions invisible via ultrasound. MRI offers the highest diagnostic sensitivity and is reserved for specific lesions uniquely visible on MR scans, frequently utilizing vacuum-assisted biopsy (VAB) to counteract underestimation limitations. Regarding biopsy techniques, fine needle aspiration (FNA) is suited for fluid collections and lymph nodes, CNB delivers definitive histological typing and tumor grading, and VAB stands as the most accurate percutaneous method by acquiring larger tissue volumes through negative pressure. Furthermore, preoperative localization approaches like hook-shaped wires and Radionuclide Occult Lesion Localisation (ROLL) ensure precise surgical removals, while advanced percutaneous excision devices and ablation therapies offer promising minimally invasive alternatives. Potential procedural complications like pain and hematomas are successfully mitigated via local anesthetics, sterility, and post-procedure compression.
Referanslar
Bevers TB, Anderson BO, Bonaccio E, et al. NCCN clinical practice guidelines in oncology: Breast cancer screening and diagnosis. Journal of the National Comprehensive Cancer Network. 2009;7: 1060–1096. doi: 10.6004/jnccn.2009.0070.
Bruening W, Fontanarosa J, Tipton K, et al. Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Annals of Internal Medicine. 2010;152(4): 238–246. doi: 10.7326/0003-4819-152-1-201001050-00190.
O'Flynn EA, Wilson AR, Michell MJ. Image-guided breast biopsy: state-of-the-art. Clinical Radiology. 2010;65(4): 259–270. doi: 10.1016/j.crad.2010.01.008.
Soo MS, Baker JA, Rosen EL, et al. Sonographically guided biopsy of suspicious microcalcifications of the breast: a pilot study. American Journal of Roentgenology. 2002; 178(4): 1007–1016. doi: 10.2214/ajr.178.4.1781007.
Wu J, Kong R, Tian S, et al. Advances in ultrasound-guided vacuum-assisted biopsy of breast microcalcifications. Ultrasound in Medicine and Biology. 2021;47(5): 1172–1181. doi: 10.1016/j.ultrasmedbio.2021.01.008.
Derici H, Tansug T, Nazlı O, et al. Stereotactic wire localization and surgical excision of non-palpabl breast lesions. The European Journal of Breast Health. 2007;3(1): 10–13.
Dershaw DD. Equipment, technique, quality assurance and accreditation for imaging guided breast biopsy procedures. Radiologic Clinics of North America. 2000;38(4): 773–789. doi: 10.1016/s0033-8389(05)70200-1
Heywang-Köbrunner SH, Heinig A, Schaumlöffel U, et al. MR-guided percutaneous excisional and incisional biopsy of breast lesions. European Radiology. 1999;9(8): 1656–1665. doi: 10.1007/s003300050905.
Peters NH, Borel Rinkes IH, Zuithoff NP, et al. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology. 2008; 246(1): 116–124. doi: 10.1148/radiol.2461061298.
Teifke A, Lehr HA, Vomweg TW, et al. Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. American Journal of Roentgenology. 2003; 181(3): 655–662. doi: 10.2214/ajr.181.3.1810655.
Kuhl CK, Morakkabati N, Leutner CC, et al. MR imaging-guided large-core (14-gauge) needle biopsy of small lesions visible at breast MR imaging alone. Radiology. 2001; 220(1): 31–39. doi: 10.1148/radiology.220.1.r01jl0731.
Vandromme MJ, Umphrey H, Krontiras H. Image-guided methods for biopsy of suspicious breast lesions. Journal of Surgical Oncology. 2011;103(4): 299–305. doi: 10.1002/jso.21795.
Kılıc F, Yılmaz MH. Breast biopsy: patient and method selection; What should we do in which lesion? Turkish Radiology Seminars. 2014; 2: 140–157
Wang M, He X, Chang Y, et al. A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: A systematic review and meta-analysis. The Breast. 2017;31: 157–166. doi: 10.1016/j.breast.2016.11.009.
Tse GM, Tan PH. Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better? Breast Cancer Research and Treatment. 2010;123(1): 1–8. doi: 10.1007/s10549-010-0962-4.
Parker SH, Jobe WE, Dennis MA, et al. US-guided automated large-core breast biopsy. Radiology. 1993;187(2): 507–511. doi: 10.1148/radiology.187.2.8475299.
Cubuk R, Tasalı N, Midi A, et al. The Value of Ultrasound Guided Tru-Cut Needle Biopsy in Histopathological Evaluation of Breast Lesions Which Were Assessed as BI-RADS Category 3-5 Radiologically: Our Experience of Three Years. Maltepe Medical Journal. 2009;1(2): 23–27
Liberman L, Cohen MA, Dershaw DD, et al. Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: An indication for surgical biopsy. American Journal of Roentgenology. 1995;164(5): 1111–1113. doi: 10.2214/ajr.164.5.7717215.
Bae S, Yoon JH, Moon HJ, et al. Breast Microcalcifications: Diagnostic Outcomes According to Image-Guided Biopsy Method. Korean Journal of Radiology. 2015;16(5): 996–1005. doi: 10.3348/kjr.2015.16.5.996.
Esen G, Tutar B, Uras C, et al. Vacuum-assisted stereotactic breast biopsy in the diagnosis and management of suspicious microcalcifications. Diagnostic and Interventional Radiology. 2016; 22(4): 326–333. doi: 10.5152/dir.2015.14522.
Perretta T, Lamacchia F, Ferrari D, et al. Evaluation of ultrasound-guided 8-Gauge vacuum-assisted excision system for the removal of us-detectable breast lesions. Anticancer Research. 2020;40(3): 1719–1729. doi: 10.21873/anticanres.14125.
Salazar JP, Miranda I, de Torres J, et al. Percutaneous ultrasound-guided vacuum-assisted excision of benign breast lesions: A learning curve to assess outcomes. British Journal of Radiology. 2019;92(1094): 20180626. doi: 10.1259/bjr.20180626.
Heywang-Köbrunner SH, Sinnatamby R, Lebeau A, et al. Interdisciplinary consensus on the uses and technique of MR-guided vacuum-assisted breast biopsy (VAB): results of a European consensus meeting. European Journal of Radiology. 2009; 72(2): 289–294. doi: 10.1016/j.ejrad.2008.07.010.
Rampaul RS, Bagnall M, Burrell H, et al. Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions. British Journal of Surgery. 2004;91(12): 1575–1577. doi: 10.1002/bjs.4801.
Ocal K, Dag A, Turkmenoglu O, et al. Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial. Clinics(Sao Paulo). 2011; 66(6): 1003–1007. doi: 10.1590/s1807-59322011000600014.
Sie A, Bryan DC, Gaines V, et al. Multicenter evaluation of the breast lesion excision system, a percutaneous, vacuum-assisted, intact-specimen breast biopsy device. Cancer. 2006;107(5): 945–949. doi: 10.1002/cncr.22090.
