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|Year : 1982 | Volume
| Issue : 2 | Page : 98-100
Drill biopsy as an outpatient procedure for definitive diagnosis of breast swellings (a preliminary communication).
Kamdar MS, Bapat RD, Bhaktani KC, Desai MB, Kulkarni AG, Rajaram SS, Chitale AR
|How to cite this article:|
Kamdar M S, Bapat R D, Bhaktani K C, Desai M B, Kulkarni A G, Rajaram S S, Chitale A R. Drill biopsy as an outpatient procedure for definitive diagnosis of breast swellings (a preliminary communication). J Postgrad Med 1982;28:98-100
|How to cite this URL:|
Kamdar M S, Bapat R D, Bhaktani K C, Desai M B, Kulkarni A G, Rajaram S S, Chitale A R. Drill biopsy as an outpatient procedure for definitive diagnosis of breast swellings (a preliminary communication). J Postgrad Med [serial online] 1982 [cited 2020 May 28];28:98-100. Available from: http://www.jpgmonline.com/text.asp?1982/28/2/98/5574
Different forms of biopsies have been advocated for pre-operative diagnosis of breast lumps. The traditional approach has utilised incisional or excisional biopsy under general anaesthesia, frozen section diagnosis and immediate mastectomy. Today many women have reservation about biopsy and possible immediate mastectomy due to the fear that the breast might be removed unnecessarily because of an occasional error in diagnosis on frozen section biopsy. Hence there is an increasing emphasis on outpatient biopsy-under local anaesthesia-which is inexpensive and gives more time for complete pathologic review and for discussion with the patient.
Aspiration cytology is one such method. It gives an accuracy rate greater than 90% but a negative cytology does not rule out cancer. Furthermore, in addition to positive cytology findings, unless there is roentgenographic and clinical evidence of cancer, an open biopsy should be done before the breast is removed. These disadvantages can be overcome with the help of a pneumatic drill biopsy.
This procedure was done in the outpatient department of the K.E.M. Hospital, Bombay. Fifty female patients who presented with breast lumps were subjected to this procedure. All of them were above the age of 30 years. The duration of the lump varied from 15 days to 2 years. The size of the lump varied from 2 to 10 cm.
Under local anaesthesia, a stab incision was made and the drill introduced into the lump. The drill rotates at a speed of 15,000 rpm and cores out a cylinder of tissue (1 to 2 cm long) which is then dislodged with a syringe into the preservative fluid.
Twenty-five out of these 50 patients were also subjected to aspiration cytology at the same time.
All the 50 cases were subjected to surgery and the diagnosis confirmed.
The results are presented in [Table 1] below:
A large number of operative procedures on the female breast would be avoided if an accurate diagnosis of breast swellings could be made. Pneumatic drill biopsy provides a highly accurate diagnosis in such swellings. In the present series, when the tissue obtained was adequate (i.e. in 42 out of 47 cases-89.4%) the diagnostic accuracy was 100%. Similar high rates of diagnostic accuracy have been reported by Deeley and Pollock and Steel and Winstanley. In comparison to this, the diagnostic accuracy of aspiration cytology varies from 70% to 95.2%. In the present series the diagnostic accuracy was 94.4% (177 out of 18 cases with adequate aspirate). Thus there is a small but definite risk of an erroneous diagnosis. This makes frozen section biopsy mandatory after aspiration cytology.
The tissue obtained by drill biopsy showed no artefacts of crushing and was as satisfactory as incisional biopsy tissue.
A possible theoretical disadvantage of drill biopsy could be dissemination of the malignancy.,  Deeley and Polock and Steel and Winstanley have noted specifically the absence of invasion of the biopsy tract by the neoplasm. Burn et al, in a series of rat experiments, have found that following drill biopsy there was no increase in the incidence of circulating tumour cells, distant metastases or recurrent tumours after local excision. The other advantage of this easy procedure is the absence of any complications like bleeding or infection.
We would like to thank the Dean, K.E.M. Hospital, Bombay, for allowing us to use the hospital records.