Year: 2025
Type: article
Abstract: In recent years, minimally invasive diagnostic options for breast lesions have expanded, but consensus on optimal biopsy techniques and imaging combinations remains lacking. This study, driven by an adapted RAND-UCLA Appropriateness Method and insights from eight experts in breast biopsy from across the world, aims to create consensus for selecting biopsy techniques. Highlighted findings suggest Vacuum-Assisted Biopsy (VAB) for lesions visible exclusively at mammography/tomosynthesis (with or without contrast enhancement) or MRI. Core-needle biopsy (CNB) takes precedence for masses over 5 mm visible under US. The selection of other biopsy techniques during US-guided procedures depends on lesion type, size, and sampling indication. VAB is preferred for smaller masses (< 5 mm), complex cystic and solid lesions with small solid parts, small intraductal masses, architectural distortions, and calcifications visible on US. In re-biopsy scenarios for inconclusive findings or high-risk lesions, the panel suggests two VAB extensions: Extended Vacuum-Assisted Biopsy (EVAB) for unambiguous lesion classification and Vacuum-Assisted Excision (VAE) for complete lesion removal. Furthermore, the panel provides detailed input on how to handle specific cases, such as re-biopsy for lobular neoplasia, flat epithelial atypia and atypical ductal hyperplasia. Surgical excision is advised for DCIS and benign or borderline phyllodes tumors found through initial CNB or VAB. In conclusion, an international expert group formulated recommendations on diagnostic breast biopsies under image guidance, aiming to ensure accurate diagnosis worldwide by providing practical advice on needle selection and biopsy approach. KEY POINTS: Evidence-based literature on the preferred biopsy technique and imaging combination for the diagnosis of breast lesions is sparse, and a general consensus is not available. The selection of biopsy technique for different image-guided procedures depends on lesion type, size, and sampling indication. This international expert panel consensus statement addresses standard approaches for varying biopsy indications.
Source: Insights into Imaging
Authors: Wendelien B. G. Sanderink, Julia Camps-Herrero, Alexandra Athanasiou, Henrique L. Couto, Kirti Mehta, Popat Palak Bhavesh Thakkar, Pooja Jagmohan, Sara E. Vázquez-Manjarrez, Seigo Nakamura, Jelle Wesseling, Ritse M. Mann
Institutions: Radboud University Nijmegen, Radboud University Medical Center, Hospital de La Ribera, Mitera Hospital, Eastern Health, Homi Bhabha National Institute, Tata Memorial Hospital, National University of Singapore, National University Hospital, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SHOWA Medical University, Leiden University Medical Center, The Netherlands Cancer Institute
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,290
Funder: BD
OpenAlex ID: W4414510222