New Breast Biopsy Exam Is Less Invasive

A suspicious spot showed up on her mammogram, so Miriam Schneider’s doctor referred her to a surgeon. He, in turn, recommended a surgical biopsy be done on her left breast to determine whether the abnormality was malignant.

Schneider, a 46-year-old North Hollywood resident, had been this route before. Four years ago, she had undergone a surgical biopsy of the other breast, the results of which had turned out benign. But she dreaded another biopsy, especially because it might require a general anesthesia.

Then she heard of a new procedure that is quicker and cheaper and can be done with a local anesthetic. Called stereotactic automated large-core needle biopsy, it is available at a limited number of hospitals but gaining popularity quickly, say some radiologists. Some surgeons, however, say the technique is still in an evolutionary phase and not the best approach for every woman.

The entire procedure usually takes about an hour, says Dr. Frederick Taber, director of outpatient radiology at Valley Presbyterian Hospital in Van Nuys.

A woman lies on her stomach on a padded examination table. The breast to be examined is suspended through an opening. Under the table, out of the patient’s sight, are the needle and X-ray equipment.

The breast is compressed and then X-rays are taken. A computer helps determine the exact location of the abnormality. The skin is anesthetized and then the needle is inserted. More X-rays are taken to verify that the needle position is correct and then tissue samples are taken. Taber inserts the needle about five times to be sure sufficient samples are extracted.

Pathology results are usually complete in two days.

“This test is much easier on women,” says Taber. “There is no general anesthesia. A woman can walk out of here.”

Schneider, who recently underwent the procedure (her spot was benign), agrees. “It was no big deal,” she says. “I went to the gym the next day.” To minimize swelling and bleeding, Taber suggests women slip a small ice pack inside their brassiere for a day.

In contrast, a traditional surgical biopsy--about 500,000 are performed each year--might require a general anesthesia, longer recovery time and retrieval of a larger tissue sample. As a result, the surgical procedure often leaves a visible scar; the new technique does not, Taber says.

The total cost of the new procedure is about a third to a half the traditional technique, doctors say.

“There is a place for this new technique, but I think that place is still in evolution,” says Dr. Lawrence Wagman, director of general oncologic surgery at the City of Hope National Medical Center, Duarte.

While some critics worry that the new procedure is not yet proven, in a comparison study, the stereotactic procedure proved as accurate as the traditional technique in detecting cancer.

In a study, 102 women had biopsies done with both the old and the new method. The methods yielded the same results in all but four of the women. Two lesions missed by the new method were picked up by the traditional technique; two other lesions were missed by the old method but picked up by the new, according to a report in the journal Radiology.

“It’s as accurate as the old method,” says Dr. A. K. Raja Rao, a radiologist at St. Vincent Medical Center, where the test is also available.

Taber says nearly everyone is a candidate. His patients have included a woman with breast implants and a woman seven weeks pregnant. “Some lesions are difficult (to biopsy by the new method),” Rao says. “If lesions are very close to the chest wall, it could be difficult.”

Says Wagman: “If the results on stereotactic biopsy of a suspicious lesion do not show cancer or are inconclusive, I recommend that women consider a traditional biopsy.” The decision depends, he says, on the degree of suspicion of cancer, family history, prior breast problems, the patient’s level of concern and age.

About 110 of the new units are in operation nationwide, according to Fisher Imaging Corp., the manufacturer.