Step - by - step of ultrasound - guided core - needle biopsy of the breast : review and technique *

The most consistent indications for USguided CB of breast are listed on Table 1. Patients with imaging studies revealing findings as BI-RADS category 4 (approximately 20% to 40% are malignant) or BI-RADS 5 (about 95% are malignant) must undergo biopsy. Findings classified as BI-RADS 3 present a lower risk for malignancy (< 2.0%), but such findings do require short-term follow-up. In such category, the following situations are indicative for biopsy: difficulty in performing the short-term follow-up (geographic factors, pregnancy, plastic breast surgery) or which may cause psychological constraint to the patient; explicit will of the patient and/or assisting physician; Fine-needle aspiration biopsy (FNAB) was utilized for many years to investigate the breast tissue in the attempt to avoid surgical biopsy (gold standard). With the arrival of core biopsy, a better specimen quality could be obtained and it became possible to differentiate carcinomas in situ from invasive carcinomas. In cases of breast lesions, core biopsy (CB) is preferably performed, utilizing an imaging method as guidance – for example: ultrasonography (US) or stereotactic biopsy –, but it is still performed, with lower sensitivity, only by means of palpation. First described by Parker et al. in the early 1990’s, US-guided CB of breast is currently one of the main diagnostic methods for neoplastic breast diseases, and for lesions that are sonographically visible, is frequently considered the procedure of choice. The present study is aimed at detailing the main steps of US-guided CB of breast, including indications, advantages, limitaINTRODUCTION