Direct frontal core biopsy in breast cancer detection

Abstract

Introduction: Recent innovations in tissue acquisition led to the development of unique direct frontal and 360 degree vacuum aspiration systems. Preclinical and single center clinical trials proved the usefulness of these methods. Now multicenter clinical experience in early detection of new and recurrent breast cancer is described. Methods: 120 women with a suspect lesion were eligible for biopsy. Anticoagulant medication was allowed. No prior sedation was given. The lesion was detected by clinical examination, mammography, ultrasound, and/or MRI. Emphasis was made on those conditions where the classical vacuum assisted large core biopsy was difficult or impossible: small breasts, subcutaneous tumours, fibrotic tissues, breast implants, tumours near to ribs etc. The performance data, patient comfort and sample quality was examined. The accuracy of diagnosis was evaluated by comparing the pathology results of the samples and definitive pathology at subsequent surgery or follow-up of the patient in benign lesions. Both manual (Spirotome) and computerized systems (Coramate) were used throughout the study in various clinical conditions. Results: An average of 1,74 biopsies per procedure was obtained; the average diameter 4,0 mm with a length of 1,27 cm. All patients had sufficient sample size to make a complete pathological diagnosis. None of the patients suffered from a serious complication and the procedure was in general extremely well tolerated. Hematoma was seen in only 4 patients that could be treated with conservative measures. Postprocedure esthetic results were excellent. Correct diagnosis was made in 118 patients. One patient had a minimal invasive cancer on definite pathology after resection while the sample contained only DCIS. Conclusions: The direct frontal approach with 360 degree vacuum aspiration is a new technology that gives excellent diagnostic results without major patient discomfort and with high quality tissue samples. The systems are particularly useful in traditional difficult clinical situations at low costs.