Sonographically guided directional vacuum-assisted breast biopsy using a handheld device.

OBJECTIVE: The goal of this study was to show that one can safely remove all sonographic evidence of masses in the breast less than or equal to 1.5 cm in greatest dimension using the 11-gauge handheld Mammotome, thereby reducing the possibility of a false-negative diagnosis and other shortcomings of the automated core biopsy device. SUBJECTS AND METHODS: Over a 12-week period (May 3--July 31, 2000), 124 sonographically guided breast biopsies were performed in 113 patients, using a new handheld directional vacuum-assisted biopsy device. All lesions that were less than or equal to 1.5 cm were biopsied using a handheld Mammotome; an attempt was made to continue the biopsy until no sonographic evidence of the lesion remained. RESULTS: Of these 124 lesions, 14 had infiltrating ductal carcinomas, four had infiltrating ductal carcinomas with associated ductal carcinoma in situ, one had infiltrating lobular carcinoma, one had ductal carcinoma in situ, three had atypical ductal hyperplasias, one had atypical lobular hyperplasia, and one had phyllodes tumor. Only one infiltrating ductal carcinoma was entirely removed histologically at Mammotome biopsy. There were no underestimates of disease. No cases of epithelial displacement were observed in any of the surgical excisions of malignancies. The remaining 99 lesions were benign. CONCLUSION: The handheld Mammotome diminishes the shortcomings of the automated core biopsy device. It reduces the possibility of false-negatives and underestimation of disease. It eliminates the need for multiple insertions and reduces the likelihood of epithelial displacement. As a result, we now use this device for all sonographically guided biopsies of breast masses smaller than 1.5 cm and recommend that others consider it for such use.

Mammographic halo sign revisited.

PURPOSE: To determine whether increased silver halide deposition accounts for some curvilinear areas of hyperlucency (halo signs) that surround breast masses on screen-film mammograms. MATERIALS AND METHODS: Breast images obtained in 43 women (aged 30-67 years; mean, 48.6 years) that showed a halo sign were selected from the authors' teaching files. Optical magnification (x8.0-12.5) of the masses with halos was used to establish the pattern of silver halide deposition in the film emulsion. RESULTS: True radiolucent halos, differentiated from Mach bands by means of the increased silver halide deposition in the film emulsion, were identified in 44 masses in 36 women. Partial true radiolucent halos were identified in 32 (73%) of 44 masses. Thirty-eight (86%) of the 44 masses were cysts; three (7%), fibroadenomas; two (4%), infiltrating ductal carcinomas; and one (2%), axillary lymph node metastasis. True radiolucent halos were more common in growing benign and malignant lesions. CONCLUSION: A halo is not always a perceptual illusion.