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Jack E. Meyer, MD; Darrell N. Smith, MD; Susan C. Lester, MD; Carolyn Kaelin, MD; Pamela J. DiPiro, MD; Christine M. Denison, MD; Roger L. Christian, MD; Susan C. Harvey, MD; Donna-Lee G. Selland, MD; Sara M. Durfee, MD

JAMA. 1999;281:1638-1641.

Context  An increasing number of nonpalpable abnormalities requiring breast biopsy are being identified due to the widespread use of screening mammography. Large-core needle biopsy (LCNB) has become an alternative to surgical excision.

Objective  To determine whether LCNB is a safe and accurate technique to evaluate nonpalpable abnormalities found on breast imaging studies.

Design and Setting  Case series at an institutional referral center from August 1, 1991, to December 31, 1997.

Patients  A total of 1643 women with 1 or more suspicious breast abnormalities received LCNBs (n=1836 lesions).

Intervention  The LCNB of the breast uses a 14- or 11-gauge needle with stereotactic localization or ultrasound guidance.

Main Outcome Measure  Utility and potential limitations of LCNB compared with the criterion standard, surgical excision after wire localization.

Results  Of the 1836 breast lesions sampled, 444 (24%) were found to be malignant. A total of 412 (22%) were found to be malignant on the initial LCNB and 202 repeat biopsies yielded 32 additional malignancies. Complications were infrequent: 1 patient experienced a superficial infection and 1 developed a pneumothorax after LCNB.

Conclusion  Image-guided LCNB is a reliable diagnostic alternative to surgical excision of suspicious nonpalpable breast abnormalities.

Author Affiliations: Departments of Radiology (Drs Meyer, Smith, DiPiro, Denison, Harvey, Selland, and Durfee), Surgery (Drs Kaelin and Christian), and Pathology (Dr Lester), Brigham and Women's Hospital, Boston, Mass.

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