Optimization of image-guided sampling techniques in breast cancer

This thesis focused on two important preoperative image‐guided tissue sampling procedures in the diagnostic work‐up of radiologically suspect breast lesions: stereotactic biopsy of screen‐detected breast lesions and preoperative axillary lymph node biopsy. In the first part of the thesis we studied how to further improve the already high diagnostic performance of stereotactic needle biopsy of nonpalpable breast lesions. First, we investigated whether it would be possible to predict underestimated invasiveness, the main issue in image guided breast biopsy, with a multivariable model based on routinely available clinical, radiological and histopathological variables. Conjointly, we studied the utility of the novel radiofrequency assisted Breast Lesion Excision System (BLES) for diagnosing nonpalpable, radiologically suspect breast lesions. The second part of the thesis focused on preoperative axillary lymph node biopsy. We assessed the value of conventional gray‐scale ultrasound‐guided axillary lymph node biopsy by performing a meta‐analysis that addressed the question: What proportion of women with a negative preoperative lymph node biopsy result is subsequently proven to have a positive sentinel node at SNB? Additionally, we conducted a first‐in‐man experimental study to assess safety and feasibility of minimally invasive complete sentinel node excision by combining microbubble contrast enhanced ultrasound with two different breast biopsy devices. In routine clinical practice, sentinel node excision is currently performed by open surgical excision.