Biopsy is still the gold standard for diagnosing breast lesions. In 2005, an international consensus panel of experts in breast disease agreed that minimally invasive breast biopsy is the diagnostic "procedure of choice" for breast abnormalities detected on imaging.

In fact, some of these same gentler methods for acquiring tissue samples are also being successfully used to remove benign breast lesions that cause some women concern and discomfort. MIP for breast surgery to treat breast malignancies is also being investigated.

Compared to traditional open surgical biopsy, women who undergo breast biopsy with MIP usually experience:

• Little or no scarring
• Quick recovery
• No unnecessary surgical excisions

How Minimally Invasive Breast Biopsies Are Performed ^{4, 8}

The three major techniques for percutaneous tissue acquisition include:

• Large-core biopsy (using a 12- to 14-gauge needle)
• Vacuum-assisted biopsy (using a 7- to 11-gauge needle)
• Larger tissue-acquisition methods

Very small incisions are needed to accommodate the needles, which may be guided by ultrasonography, X-ray, or MRI.

One benefit of diagnosing cancer preoperatively is that it allows for optimal work-up and treatment planning. In addition, clear margins are much more likely to be obtained once surgery is undertaken.

For larger (greater than 1 cm) BI-RADS 4 or 5 masses, a 14-gauge or larger-core needle biopsy can be used.

For small microcalcifications (1 cm or less), complete percutaneous excision using a vacuum-assisted device is preferred. This reduces sampling errors and more reliably characterizes the lesion's pathologic parameters.

Whenever the minimally invasive biopsy removes all or a large portion of a lesion, the surgeon may also insert a marking device during biopsy.

MIP for Removing Benign Breast Masses ³

Vacuum-assisted biopsy devices can also be used to remove benign palpable breast masses. This method has been used successfully to excise masses ranging from 1.5 to 3.0 cm. Although these lesions are low-risk, some women prefer to have them removed because they can cause discomfort and anxiety.

What's Ahead: MIP for Removing Breast Malignancies ⁸

While still investigational, tools for percutaneously removing cancerous lesions are being developed. Interstitial ablative therapies are also being studied. These include laser therapy, radiofrequency, high-frequency focused ultrasonography, cryoablation, and microwaves.

As with all operative procedures, be sure to discuss surgical risks with your patients.