Each of the mentioned methods has its advantages and limitations in daily use. Depending on the knowledge and skill of the radiologist performing the procedure, the outcome of these interventions will also depend.

     The basic criteria for determining the type of biopsy that the radiologist will perform and with which imaging method the intervention will be controlled determines whether the change is palpable or not, as well as under which method the lesion in the breast is more clearly displayed. Of course, the conditions in which we work, i.e. the equipment at our disposal, are decisive in all of this, so that in some centers in Serbia, stereotaxic biopsies are not performed because the health institutions do not have the appropriate equipment.

     The goal of imaging-guided biopsies is to safely provide an adequate amount of tissue required for pathohistological analysis to establish a precise diagnosis. Imaging-guided biopsies make it possible to establish a pathohistological diagnosis, which avoids the need for an “open” surgical biopsy in a high percentage, which  saves money within the health system, and patients avoid unnecessary hospitalization and all the potential complications that surgical intervention entails. The experience of the Center for Imaging Diagnostics of the Institute of Oncology of Vojvodina, where these types of biopsies are performed daily, is that depending on the histopathological diagnosis, we apply excision of the change, in some cases we follow the changes intensively radiologically, or some patients return to the routine screening program. In some centers, thick needle biopsies are necessarily preceded by FNAB. If FNAB does not enable a diagnosis, or if the FNAB findings do not correlate with the clinical and radiological findings, then a biopsy with a thick needle must be performed. Of course, if microcalcifications are visualized on the patient’s mammogram, without an underlying mass, then a thick needle biopsy under mammography control (VAB) must be performed, as a standard in all centers that have this equipment.

     After the biopsy, the radiologist should have an insight into the histopathological findings, in order to make a decision on further treatment in relation to the biopsied lesion. If it is proven that the change is histologically malignant, adequate oncological treatment follows, but if the radiological presentation of the change is “suspicious” BI RADS 4, and the pathohistological findings do not show any atypia or clearly indicate a malignant change, then the radiologist who performed the biopsy, brings the decision whether to monitor the change intensively radiologically or to biopsy it again. If the radiological finding is BI RADS 5 – a highly suspicious lesion, and the obtained histopathological finding after the biopsy does not confirm malignancy, then the radiologist indicates an examination with a magnet (MR mammography), repeats the biopsy or refers the patient to a consultative examination.

     For the sake of more reliable findings and a better outcome for the patient, teamwork is always necessary, it is necessary for the radiologist and the pathologist to cooperate and exchange opinions on a daily basis. If there is a discrepancy between the radiological and pathological, as well as the clinical findings, there are two ways to arrive at an adequate diagnosis: either to repeat the biopsy in an identical manner, as the initial one, or biopsy with the use of a needle of a larger diameter (thicker needle). It is usual that after a core biopsy, VAB is performed in the next intervention, or (which depends primarily on the pathologist’s findings) the change is surgically excised, in order to evaluate it as a whole. There are also cases when after a biopsy with a thick needle, bearing in mind the benign histological findings, we opt for radiological monitoring. In such cases, the patient is followed by the first radiological control in 6 months. Such an approach is applied if it is a change in the breast that has grown relatively quickly, and has a benign radiological, ultrasound aspect, with a histopathological finding that it is a fibroadenoma. In that case, we consider the change to be definitely benign, but its faster growth indicates the need for ultrasound control in 6 months.

    There is no point in radiologically controlling solid lesions and zones of microcalcifications in a time interval shorter than 6 months. In addition to radiologists and pathologists who decide on these changes, it is necessary to form a multidisciplinary team in the institution, which will consider each case individually and make the best decision on the further treatment of patients, in order to arrive at the right diagnosis and adequately treat the patient. A multidisciplinary team for breast diseases should consist of a surgeon, a radiologist, a pathologist, an internist-oncologist and a radiation oncologist.