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Interventional Radiology

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Breast Cancer Essentials

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Abstract

Image-guided minimally invasive interventional procedures replaced open excisional biopsy for most breast lesions requiring a histological diagnosis. Complete imaging assessment of palpable and non-palpable lesions is mandatory for proper patient selection. Minimally invasive procedures such as ultrasound, stereotactic biopsy, tomosynthesis, or MRI guidance are safe, accurate, and cost-effective. Sensitivity of fine-needle aspiration (FNA), core needle biopsy (CNB), and vacuum-assisted biopsy (VAB) varies between 65 and 98%, 84 and 98%, and 95 and 100%; specificity varies between 34 and 98%, 96 and 99%, and 98 and 100% correspondingly. FNA has proven value in large palpable lesions, assessment of axillary lymph nodes, and treatment of symptomatic cysts. Core needle biopsy is more reliable than FNA and is the most frequently used biopsy tool for suspicious ultrasound lesions. Vacuum-assisted biopsy is the method of choice for lesions that require tissue sampling under stereotactic or MR guidance. Technical success of VAB varies between 98 and 99.6% depending on the guidance method. Imaging pathology correlation recommends a repeat biopsy, if there is a mismatch between histology and imaging or if histologically benign lesion increases at follow-up imaging after 6, 12, and 24 months. In all lesions of uncertain malignant potential (B3 lesions), further tissue sampling by surgical excision is recommended. Alternatively, VAB and close follow-up are acceptable for small lesions, particularly radial scars and papillary lesions. Severe complications are very low following minimal invasive biopsies (<0.5%) if adequate pre-procedure preparation, appropriate technique, and post-procedure patient care are in place.

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Author information

Authors and Affiliations

  1. Breast Imaging and Interventions, Breast Centre Osnabrück, FHH, Osnabrueck, Germany

    Alexander Mundinger

  2. Experimental Senology, University Women’s Hospital, Tuebingen, Germany

    Markus Hahn

  3. Department of Women’s Health, University Hospital Tübingen, Tuebingen, Germany

    Markus Hahn

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  1. Alexander Mundinger
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  2. Markus Hahn
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Correspondence to Alexander Mundinger .

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Editors and Affiliations

  1. European Academia of Senology, Düsseldorf, Germany

    Mahdi Rezai

  2. Dokuz Eylül University, Izmir, Turkey

    Mehmet Ali Kocdor

  3. University of Kocaeli, İzmit/Kocaeli, Turkey

    Nuh Zafer Canturk

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Mundinger, A., Hahn, M. (2021). Interventional Radiology. In: Rezai, M., Kocdor, M.A., Canturk, N.Z. (eds) Breast Cancer Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-73147-2_13

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  • DOI: https://doi.org/10.1007/978-3-030-73147-2_13

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