The use of stereotactic excisional biopsy in the management of invasive breast cancer.

Stereotactic breast biopsy techniques minimize the surgical trauma associated with conventional wire-guided open breast biopsy for non-palpable breast lesions (NPBLs). Advanced breast biopsy instrumentation (ABBI) allows for a 2-cm core of breast tissue to be excised under stereotactic guidance in an outpatient setting. We report our initial experience with ABBI. Hospital charts from 89 ABBI procedures between 10/1996 and 07/2002 were retrospectively reviewed for patient characteristics, ABBI parameters, radiographic appearance, pathology, complications, and clinical follow-up. Data are presented as percentage/median (range). Median age was 59 years (range: 39-80 years), mammographic lesions were classified as calcifications 49% (44/89), soft tissue 39% (35/89), or mixed 11% (10/89). Median radiographic size was 7 mm (1-60 mm). Final pathology revealed ductal carcinoma in situ (DCIS) in 7% (6/89) and invasive cancer in 22% (20/89). Microscopically clear margins were obtained in 55% (11/20) of patients with invasive cancer. Of these, 82% (9/11) chose not to undergo further local surgical therapy. Eight patients remain disease free at 56 months (range: 41-95 months) follow-up. The ninth patient was deceased at 6 months from an unrelated cause. The overall complication rate was 3% (3/89). A definitive diagnosis was obtained in 100% of malignant and 87% of benign cases. Median waiting time was 19 days (range: 0-90 days). Our experience demonstrates that ABBI is an effective diagnostic tool for NPBLs. It is associated with minimal complications, and provides negative margins in over half of malignant cases. In selected patients with invasive cancer and negative margins, ABBI may obviate the need for further local surgical treatment. ABBI merits additional investigation as a therapeutic modality for early breast cancer.