Novel breast biopsy option appears promising: the combination procedure is time consuming but may save patients from unnecessary surgery.(GYNECOLOGY)

CHICAGO -- A novel procedure that combines mammographically guided hook-wire localization followed by ultrasound-guided sampling provides a minimally invasive alternative to stereotactic biopsy of breast calcifications.

The combination procedure was used in 57 groups of microcalcifications in 48 women, aged 41-79 years, who failed or were unable to have a stereotactic biopsy. The procedures were performed between January 2001 and September 2008 at Metro Health Medical Center, an inner-city county hospital in Cleveland.

In all, 52 of the 57 groups of microcalcifications were successfully sampled, resulting in a 9% failure rate, Dr. Jill J. Schieda and her colleagues reported at the annual meeting of the Radiological Society of North America. The procedure was considered a success if the targeted calcifications were identified on specimen radiography and in the specimen by pathology. There were no postprocedural adverse events.

Two of the five failures were due to the inability to place the hook wire sufficiently close to the targeted calcifications, and one was due to excessive patient motion. In one patient, the calcification was too close to the skin, and in another patient the procedure was technically successful but no microcalcifications were seen on radiography. Three of these five patients successfully underwent the procedure within 2-6 months of the first failed attempt.

"Although the combination procedure is time consuming, the patient may be saved from unnecessary surgery, which is definitely an advantage," said Dr. Schieda, a radiology resident at the hospital.

Approximately 3% of stereotactic biopsies are unsuccessful, typically because the calcification is not visible on mammography; excessive patient motion or the inability of the patient to get on the stereotactic table may also be problems.

In such ...