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Stereotactic Histologic Biopsy in Breasts with Implants¹

¹ From the Department of Radiology, Palo Alto Medical Clinic, 795 El Camino Real, Palo Alto, CA 94301. From the 1999 RSNA scientific assembly. Received January 4, 2001; revision requested February 28; revision received May 1; accepted May 22. Partially supported by an educational grant from Biopsys to the Palo Alto Medical Foundation. Address correspondence to R.J.J. (e-mail: jackmanr@pamf.org).

PURPOSE: To describe our experience with stereotactic histologic biopsy in patients with breast implants.

MATERIALS AND METHODS: Thirty-one (1.3%) of 2,399 consecutive lesions on which stereotactic histologic biopsy was performed were in breasts containing implants. Biopsy difficulties were evaluated for lesions in breasts with and breasts without implants. Biopsy was performed on lesions in patients with implants prone on a dedicated table, with automated large-core (n = 13) or directional vacuum-assisted (n = 18) devices. Follow-up was surgical (11 of 11 malignancies and two of three high-risk lesions) and mammographic (one of three high-risk lesions and 17 of 17 benign lesions).

RESULTS: There were no implant ruptures, hematomas requiring drainage, infections requiring treatment, false-negative findings, or histologic underestimations. Difficulties with stereotactic histologic biopsy were more prevalent in breasts with implants and included positioning problems in 10 (50%) of 20 lesions in breasts with subglandular implants and zero (0%) of 10 with subpectoral implants, lesions seen on only one view in four (13%) of 31 lesions, specimen radiographs negative for calcifications in two (10%) of 20 lesions, prominent bleeding in two (6%) of 31 lesions, and suboptimally small tissue samples in three (10%) of 31 lesions.

CONCLUSION: Stereotactic histologic biopsy is safe in breasts with implants. Compared with that in breasts without implants, biopsy is often technically more difficult and may eventually prove less accurate.

Index terms: Biopsies, technology • Breast, biopsy, 00.1261, 00.1262, 00.1267 • Breast, prostheses • Breast neoplasms, diagnosis, 00.1261, 00.1262, 00.1267, 00.30

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