US-guided automated large-core breast biopsy.

To evaluate the efficacy of ultrasound (US)-guided automated large-core percutaneous needle breast biopsy, biopsy of 181 ultrasonographically suspicious breast lesions was performed by using a long-throw biopsy gun and 14-gauge needles with continuous US guidance. A "freehand" technique with either 5.0- or 7.5-MHz linear-array transducers was used. Needle core diagnoses were compared with surgical diagnoses in the 49 lesions subsequently surgically excised. The remaining 132 cases were followed for 12-36 months. Agreement between needle-core and surgical diagnoses in the 49 lesions was 100%. This group included 34 cancers (28 infiltrating ductal, two mucinous, one mixed infiltrating ductal and lobular, and one each of intraductal, infiltrating lobular, and tubular carcinoma). To date, no cancers have been found in the other 132 cases. The procedure time averaged 20 minutes, and no complications occurred. With an accuracy approaching that of excisional biopsy, US-guided needle core biopsy provides an alternative to surgery.

Nonpalpable breast lesions: stereotactic automated large-core biopsies.

One hundred two patients with mammographically suspicious, nonpalpable lesions underwent stereotactic breast biopsy with a biopsy gun and an automated 14-gauge cutting needle. After biopsy, a localization wire was placed and surgical biopsy performed. There was agreement of the histologic results from the gun biopsy and the surgical biopsy specimens in 98 cases (96%), including 22 of 23 carcinomas (96%) (kappa = 0.936). The gun biopsy yielded findings that led to the correct diagnosis in two cases involving lesions that were missed at surgical biopsy; two lesions found at surgery were missed at gun biopsy. The results of this study suggest that the use of 14-gauge needles improves agreement between surgical and needle core biopsy findings and that stereotactic biopsy with an automated needle and gun can be an acceptable alternative to surgical biopsy in women with mammographically suspicious breast lesions.

Stereotactic breast biopsy with a biopsy gun.

One hundred three patients underwent stereotactic breast biopsy with an 18-, 16-, or 14-gauge cutting needle and a biopsy gun. After biopsy, a localization wire was placed and surgical biopsy performed. There was agreement of the histologic results in 89 cases (87%) including 14 of 16 cancers (87%) (kappa = 0.806). The gun biopsy yielded the correct diagnosis in four cases involving a lesion (including one cancer) that was missed at the surgical biopsy. Nine cases in which the lesion was missed at gun biopsy can be related to insufficient needle size, the greater difficulty in using one of the two stereotactic devices, and early inexperience with the technique. A 14-gauge needle was used in the last 29 biopsies, the results of which agreed with the surgical pathologic findings in 28 cases (97%). With greater experience, stereotactic-guided large-gauge automated percutaneous biopsy may prove to be an acceptable alternative to surgical biopsy in women with breast masses suspected at mammography.

Lactation failure due to insufficient glandular development of the breast.

With the present increased incidence of breast-feeding, clinicians need to be prepared to identify and manage problems in lactation. Most problems are related to insufficient knowledge, inappropriate routines, and lack of confidence and are easily managed or prevented by prenatal education, anticipatory guidance, and adequate support. Increasing evidence exists that primary causes of lactation failure also occur and can preclude successful lactation, even among highly motivated women. Three cases are presented in which lactation failure is believed to stem from insufficient glandular tissue within the breasts. Supportive history for this entity include absence of typical breast changes with pregnancy and failure of postpartum breast engorgement to occur. Associated physical findings included a unilateral underdeveloped breast in each woman and palpable patchy areas of glandular tissue in one case. Breast diaphanography, or transillumination, substantiated clinical findings in the two cases in which it was performed. Both multiparous women had a previous unsuccessful breast-feeding experience, whereas the primiparous woman had immediate family members with a history of lactation failure. All three women benefited psychologically from the interpretation that lactation failure was not due to their breast-feeding performance, and each elected to continue nursing long-term despite the need for formula supplement. These cases are presented to emphasize that primary causes of lactation failure do exist and to alert clinicians to the historical and physical findings suggestive of inadequate glandular tissue as an etiology of previously unexplained lactation failure. Preserving the "every woman can nurse" myth contributes to perpetuating a simplistic view of lactation and does a disservice to the small percentage of women with primary causes of unsuccessful lactation.