Abstract
The use of screening mammography in asymptomatic women has increased the number of non-palpable suspicious breast abnormalities, which require histologic evaluation to define whether they are benign or malignant. In the last decade, the introduction of digital breast tomosynthesis (DBT), a pseudo-three-dimensional mammographic application, has increased the diagnostic accuracy of digital mammography through the detection of abnormal findings that are seen only at DBT and which need to be assessed (Houssami et al., Breast 26:119–134, https://doi.org/10.1016/j.breast.2016.01.007, 2016).
Women with suspicious breast lesions identified on mammography or DBT are indicated for biopsy to obtain definitive tissue diagnosis. In these cases, needle biopsy should be the first option to avoid diagnostic surgical biopsies. A minimally invasive procedure offers better options compared to surgical biopsy: firstly, it reduces the physical and psychological stress of the patient, and secondly, it overcomes the problem of scarring after a surgical biopsy, which may impair future imaging (Yu et al., Breast Cancer Res Treat 120(2):469–479. https://doi.org/10.1007/s10549-010-0750-1, 2010). Consequently, open surgical biopsy is now obsolete for most indications.
Since it is well accepted, quick, readily accessible, and less costly, ultrasound-guided biopsy should be done for all lesions visible at ultrasound. Any lesions visualized at mammography (MX) or DBT but sonographically occult may instead undergo stereotactic biopsy, which should be guided by MX or DBT (Huang et al., Tech Vasc Interv Radiol 17(1):32–39. https://doi.org/10.1053/j.tvir.2013.12.006, 2014).
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Bernardi, D., Sabatino, V. (2022). Stereotactic Guided Breast Interventions. In: Fuchsjäger, M., Morris, E., Helbich, T. (eds) Breast Imaging . Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-94918-1_4
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