1 minimally invas ive breast b iopsy : the breast imager ’ s perspect ive

Since the initial implementation of film-screen mammography in the 1970s as a screening exam for breast cancer, breast imaging has evolved by leaps and bounds. Today’s breast imager utilizes multiple imaging modalities including full-field digital mammography (FFDM), ultrasound (US), and magnetic resonance imaging (MRI), and more recently, molecular imaging techniques including breastspecific gamma imaging (BSGI) and positron emission mammography (PEM) to aid in the evaluation of breast pathology. With these advances came the ability to diagnose smaller, non-palpable, and earlier-stage breast cancers. This carries with it the challenge of developing imageguided methods to provide a pathologic diagnosis in an accurate, cost-effective, and safe manner. The subsequent development of multi-modality techniques for minimally invasive, image-guided breast biopsy has largely occurred to help solve this diagnostic challenge. The initial techniques for obtaining pathologic diagnoses of non-palpable, radiologic lesions included more invasive open surgical techniques, such as blind quadrantectomy or segmentomy. However, high rates of reexcision were reported. Therefore, the next development was preoperative internal needle and wire localization techniques, utilizing mammographic guidance. Wire-guided surgical breast biopsy was, until recently, the “gold standard” for the diagnosis of non-palpable radiographically detected breast lesions. However, this technique continued to be fraught with pitfalls, including inexact wire placement, dislodgement or fracture of placed wires, and a recovery rate of the radiographic abnormality anywhere from 2% to 20%. However, one of the most consistent trends in medicine has been the steady strive to develop technology that allows physicians to accurately and safely diagnose and treat patients via ever less invasive methods. Breast imaging and intervention has undergone great changes over the past several decades, due to the development of image-guided minimally invasive technologies. These techniques are now available utilizing all traditional forms of breast imaging, including mammographic (stereotactic), US, MRI and most recently, nuclear medicine guidance to include BSGI and PEM.