الفهرس 
Anatomy of the BreastOnly 14 pages are availabe for public view
 |  | from | 331 |  |  |
| | | from | 331 | | |
Abstract
Generally any lesion, palpable or non-palpable which is not definitively benign or suspicious of being malignant (BI-RADS 4 and 5) should be biopsied.
It is found currently, that the biopsy is almost the only way to achieve an accurate breast cancer diagnosis with the choices ranging from an open surgical biopsy to minimally invasive techniques.
And the good news is that, approximately 80% of breast biopsies are benign with more than 1.6 million breast biopsies being performed annually in the United States, where the highest annual incidence rate of breast cancer in the world, with breast cancer causing 7% of cancer deaths and almost 2% of all deaths.
Recently, interventional radiology of the breast has proved to be beneficial both as diagnostic and therapeutic tool in the management of different breast lesions. Interventional procedures comprise imaging modalities guidance of various techniques of tissue sampling. This in turn aims at obtaining a representative sample of cells or tissue through accurate pinpointing and mapping the area to be biopsied .The tissue histopathological examination indicates the nature of the lesion which is suspected of being malignant giving its final diagnosis, and so this should replace a substantial number of open surgical biopsies.
Different image-guided modalities includes; high frequency ultrasound or stereotactic breast biopsies which are commonly performed, nevertheless, when the lesion is not visible on mammogram or ultrasound, recent alternative biopsy techniques are necessary as guided by MRI.
Stereotactic-guided biopsy is convenient for fatty breasts, mobile lesions and calcification associated lesions, while US guidance can be used to guide needles into lesions that lie close to the chest wall or into the lesions that are lying at the periphery of the breast and that cannot be projected on mammograms.
US has the unique capability of guiding the needle biopsy of lymph nodes in the axilla and infraclavicular or supraclavicular areas. Its advantages also include: reduced vasovagal reactions, real time monitoring, excellent tolerance by the patients with back pain or disc disorders as no need for prone position.US is a safe method especially in pregnant women as no radiation exposure.
Recently MR imaging guidance is necessary for histological verification of the lesions which are visible only at breast MR Imaging, with the advantages of its high sensitivity.
Many methods of percutaneous breast biopsy are used as fine needle aspiration and core needle biopsy. Fine needle aspiration provides information about cellular material. whereas the core needle biopsy procedures allow tissue within abnormality to be compared to surrounding tissue for a more accurate diagnosis.
FNAB is quick, less invasive, relatively easy, cost effective and available as office procedure. However, high rate of insufficient samples has been reported particularly for calcification, so that the role of core needle biopsy as diagnostic method for breast lesions is increasing, as it has lower frequency of inadequate specimen.
The devices of percutaneous core biopsy include, automated needles, directional vacuum-assisted biopsy devices and advanced breast biopsy instrumentation. The needle core biopsy is cost effective and even cheaper, quicker, and of less morbidity and easier than open surgical biopsy. It is an accepted tool for the definitive diagnosis of suspicious breast lesion.
Recently, vacuum assisted biopsy is used as a diagnostic tool under stereotactic guidance in case of a non-palpable calcification or with ultrasound guidance, and recently with MRI in case of suspicious breast mass which is not visualized by X-ray or ultrasound.
With the vacuum assisted system, breast biopsy can be performed in an outpatient setting with one small 1/4 –inch incision, and doctor can make a precise analysis with minimal pain, scarring and recovery time. The entire procedure generally takes less than an hour. This biopsy technique enables several samples to be acquired, resulting in a highly accurate breast cancer diagnosis. Also its capacity of suction allows for better tissue and microcalcification acquisition than with core biopsies, as well as these devices obtain multiple tissue cores in a circumferential manner around the biopsy probe, there is more complete sampling of the lesion, reducing the number of unsatisfactory biopsies.
Since multiple tissue samples are obtained without removing and reinserting the probe, so it is less traumatic than other core biopsy techniques with less internal scarring, which minimizes interference with future monitoring and diagnosis of breast abnormalities.
It is now considered the first choice for obtaining a definitive pathological diagnosis in suspicious breast lesions.
Advanced breast biopsy instrumentation (ABBI) removes a cylinder of tissue from just beneath the skin to the depth of the lesion. The tissue of interest can be accurately localized, and less amount of normal tissue is removed compared with surgical biopsy. On the other hand ABBI is considered costly technique which is more than the cost of the traditional surgical excision breast biopsies and also needs for stitches after the procedure.
The aim in the future is to develop combined procedures where imaging, biopsy, and interventional therapies are combined in a single outpatient procedure. As a step toward this goal, different interventional procedures are useful that include interstitial laser therapy (ILT), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), microwave ablation therapy and cryotherapy.
Thermal procedures are playing a key role in minimally invasive ablation of tumors as they destruct the tumor tissue by deposing thermal energy within tumorous cells. In contrast, cryotherapy ablates tumor tissue by cooling with a cryoprobe to temperatures as low as –180°C. Until now cryotherapy has been used mainly in the ablation of liver tumors and prostate cancer, but recently, a few reports about cryotherapy of breast cancer and of fibroadenomas were published.