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Breast intervention: current and future roles

The Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK

Correspondence: Dr Steven Allen, The Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT;. E-mail: steven.allen{at}rmh.nhs.uk

Summary

• Imaging alone cannot always characterize a breast lesion, and triple assessment comprising clinical examination, imaging and pathology remains the gold standard.
  
• Breast intervention may be guided by mammography, ultrasound or more recently MRI.
  
• For the majority of diagnostic purposes relating to the breast, core biopsy is preferable to fine-needle aspiration, though the latter still has a role in certain situations.
  
• Vacuum-assisted biopsy (VAB) overcomes some of the shortfalls of core biopsy, and is increasingly utilized as a first-line technique for sampling microcalcifications.
  
• Interventional procedures, such as VAB, are being used selectively to therapeutically excise benign lesions such as fibroadenomas.
  

Interventional radiological techniques play an increasingly integral role in the management of breast disease, both benign and malignant. Tissue diagnosis remains key in the diagnosis of malignancy and increasingly uses radiological guidance to obtain tissue samples. Continued improvements in the accuracy of imaging techniques have facilitated the detection of smaller, earlier stage, and more subtle disease. This is exemplified by the development of MRI as a diagnostic modality, which has inevitably led to the evolution of MRI-guided biopsy techniques. Newer technologies, such as vacuum- and cauterization-assisted biopsy, may be used in both the diagnosis and the minimally invasive treatment of breast disease. This review examines the range and utility of breast intervention techniques currently in use and in development.