Accuracy and complication rates of US-guided vacuum-assisted core breast biopsy: initial results

PURPOSE: To determine the accuracy and complications of vacuum-assisted core breast biopsy performed with ultrasonographic (US) guidance. MATERIALS AND METHODS: US-guided, vacuum-assisted breast biopsy with an 11-gauge device was performed in 71 lesions in 67 consecutive women (age range, 23-82 years; mean age, 52.9 years). Vacuum-assisted core biopsy findings were compared with excisional biopsy, mammographic follow-up, and clinical follow-up findings (follow-up, 1-19 months; mean, 9.2 months). Procedural complications and treatment were noted. RESULTS: Of 71 lesions, 18 (25%) were diagnosed as malignant at core biopsy; one (1%), as premalignant; 30 (42%), as specific benign; and 22 (31%), as nonspecific benign. Of 18 malignant diagnoses, one (6%) was benign at excision. The premalignant specimen was benign at excision. Of 52 benign findings, 51 (98%) were proved benign at excision, mammographic follow-up, or clinical follow-up. One benign finding was carcinoma at excision. In this case, the specimen did not include the carcinoma because of a technical problem recognized at the time of the percutaneous procedure. Five (7%) of 71 biopsies resulted in bleeding beyond 10 minutes. One (1%) patient experienced a vasovagal response. CONCLUSION: According to these data, US-guided vacuum-assisted core breast biopsy is accurate. There may be a slightly higher risk of bleeding, which may be related to the lack of breast compression during the procedure, when compared with biopsy performed with stereotactic guidance.     

Image-guided breast biopsy and management of high-risk lesions

Across several series, the sensitivity of sonographically guided 14-gauge core biopsy is 95%, and the repeat biopsy rate averages 11%. Success of stereotactic biopsy requires obtaining larger volumes of tissue when sampling calcifications; use of vacuum-assisted devices results in comparable sensitivities. For MR imaging-guided percutaneous biopsy,success rates of 95% to 99% have been achieved. Independent of guidance method or the amounts of tissue acquired, the following diagnoses on percutaneous biopsy should generally prompt excision: atypical ductal hyperplasia, lobular neoplasia, radial sclerosing lesions, benign and atypical papillary lesions, and possible phyllodes tumor. Mucocele-like lesions may merit excision. Columnar alteration without atypia probably does not require excision, although further study is needed.     

Stereotaxic core biopsy of breast lesions.

In 70 selected patients with suspect breast lesions at mammography, accurate, high-speed stereotaxic core-cut biopsy (SCCB) was performed with a biopsy gun. In 17 of the patients, no surgery was performed. The results of SCCB were normal in 11 of these patients; in six patients, the lesion disappeared after SCCB. In 53 of the patients, SCCB was followed by surgical biopsy. In 48 cases (91%), the results of SCCB and surgical biopsy were concordant. Of the 45 carcinomas found at surgery, 41 (91%) were correctly diagnosed with SCCB. There were no false-positive results. SCCB was nondiagnostic (no representative material sampled) in three patients (6%), and in two patients (4%) a false-negative result was obtained. The infiltrating character of the tumor was correctly diagnosed with SCCB in 80% of cases. These results confirm that this radiologic procedure is an acceptable alternative to excisional biopsy.     

Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy

Objectives

To determine the false-negative rate and to evaluate the clinical, radiologic or histologic features of false-negative results at ultrasound (US)-guided 14-gauge core needle biopsy (CNB).

Methods

A total of 3,724 masses from 3,308 women who had undergone US-guided 14-gauge CNB and who had a rebiopsy or at least 2 years’ follow-up were included. The histology of CNB was correlated with the rebiopsy or long-term imaging follow-up. In cases of missed cancer, the time interval between CNB and rebiopsy, the reasons for rebiopsy, and the procedural or lesion characteristics were analysed.

Results

Of 1,706 benign CNBs, 50 additional malignancies were found at excision (false-negative rate, 2.5% of 1,982 with a final diagnosis of malignancy). Of 50 false negatives, 41 were found immediately of which 28 had rebiopsy because of imaging-histological discordance. Regarding the frequency of malignancy according to the reasons for rebiopsy, suspicious imaging finding (24%) showed significantly higher frequency than suspicious clinical findings or request (1%). Regarding the characteristics except invasiveness, no significant differences in false-negative rates were found.

Conclusions

Most false negatives were found immediately and imaging-histological discordance was the most important clue. Careful correlation of clinical, radiological and histological results as well as appropriate follow-up is essential.

     

US-guided core biopsy of the spleen in children

PURPOSE: To evaluate the safety, diagnostic yield, and clinical benefits of performing ultrasonography (US)-guided percutaneous splenic core biopsy in children. MATERIALS AND METHODS: US-guided splenic core biopsy was performed in 30 children aged 6 months to 15.3 years (mean, 7.0 years), with focal lesions in 27 patients and homogeneous splenomegaly in three. Four patients underwent repeat biopsy to identify changes in splenic disease. Four types of biopsy needles were used in this series. General anaesthesia was used in 21 patients and conscious sedation in nine. Medical records were reviewed to assess diagnostic accuracy, influence on treatment, and biopsy-related complications. RESULTS: All biopsies were performed without complication. Among the 30 biopsies, an accurate diagnosis was obtained in 25 (83%), a false-negative result was obtained in two (7%), and three (10%) were nondiagnostic. All conclusive results influenced treatment decisions. The mean number of needle passes was 2.7 per patient (range, 2-5 passes). Use of needles was 50%-100% successful in the acquisition of adequate tissue cores. Use of the 18-gauge needle was always successful in the safe acquisition of adequate tissue, with a maximum of three passes. CONCLUSION: US-guided splenic core biopsy is a minimally invasive, simple, and safe procedure for use in children. It provides relatively high diagnostic accuracy while minimizing complications when compared with alternative, more invasive procedures.     

US-guided transcutaneous tru-cut biopsy of laryngo-hypopharyngeal lesions

Objective  

To evaluate the feasibility and performance of ultrasound-guided transcutaneous tru-cut biopsy (USGTCB) in selected patients (with stenosis of airways or difficult intubation or contraindication to general anaesthesia) with untreated or previously treated suspicious laryngo-hypopharyngeal masses.     

Imaging-guided core needle biopsy of papillary lesions of the breast

OBJECTIVE: Our objective was to assess the incidence of papillary lesions of the breast diagnosed at imaging-guided core needle biopsy and the need for surgical excision after a benign diagnosis. MATERIALS AND METHODS: This retrospective study included 1374 patients with consecutive suspicious breast lesions that underwent either mammography or sonographically guided large-core needle breast biopsy. Fifty-seven lesions (4%) were classified as papillary lesions. Eleven of the 57 cases were lost to follow-up (n = 6) or had not yet shown 2 years of stability (n = 5) and were excluded from this study. The remaining 46 papillary lesions constitute our study population. RESULTS: Surgical excision was performed in 17 (37%) of 46 papillary lesions. In the group of patients whose lesions were recommended for excision because carcinoma was identified at core biopsy, surgical excision revealed one false-positive and two true-positive diagnoses. In four cases, histologic diagnoses of the excisional biopsy and the core needle biopsy were discordant. One false-positive finding at core needle biopsy initially was interpreted as invasive ductal carcinoma on the basis of core needle biopsy specimens. In three false-negative findings, the initial diagnosis at core needle biopsy was upgraded after surgical excision. Two cases of papilloma with adjacent atypical ductal hyperplasia and one of atypical papilloma were upgraded to ductal carcinoma in situ after surgical excision. Imaging follow-up was performed in the remaining 29 patients. All lesions were stable or had decreased in size during the 2-year follow-up period. The negative predictive value of core needle biopsy for excluding malignancy among the papillary lesions diagnosed in our study was 93%. CONCLUSION: When the histologic diagnosis is benign, our data suggest that papillary lesions may be safely managed with imaging follow-up rather than with surgical excision. However, atypical papillary lesions or those associated with atypia require surgical excision because histologic underestimation occurs at a frequency similar to that in other atypical lesions undergoing core needle biopsy.     

Uncommon high-risk lesions of the breast diagnosed at stereotactic core-needle biopsy: clinical importance

PURPOSE: To assess the outcome of papillary lesions, radial scars, or lobular carcinoma in situ (LCIS) diagnosed at stereotactic core-needle biopsy (SCNB). MATERIALS AND METHODS: Retrospective review of 1,236 lesions sampled with SCNB yielded 22 papillary lesions, nine radial scars, and five LCIS lesions. Diffuse lesions such as papillomatosis, papillary ductal hyperplasia, papillary ductal carcinoma in situ (DCIS), and atypical lobular hyperplasia were not included. The mammographic findings, associated histologic features, and outcome were assessed for each case. RESULTS: Sixteen papillary lesions were diagnosed as benign at SCNB. Of these, five were benign at excision, and 10 were unremarkable at mammographic follow-up. At excision of an unusual lesion containing a microscopic papillary lesion, DCIS was found. Three of four papillary lesions suspicious at SCNB proved to be papillary carcinomas; the fourth had no residual carcinoma at excision. Eight of nine radial scars were excised, which revealed atypical hyperplasia in four scars but no malignancies. One LCIS lesion was found at excision to contain DCIS. CONCLUSION: Benign or malignant papillary lesions were accurately diagnosed with SCNB in the majority of cases. Cases diagnosed as suspicious for malignancy or with atypia or unusual associated histologic findings should be excised. No malignancies were found at excision of radial scars diagnosed at SCNB. Surgical removal of these lesions following SCNB may not be routinely necessary. DCIS was found in one lesion diagnosed as LCIS at SCNB, which suggests that removal of these lesions may be prudent.     

US-guided breast biopsy with an automated cutting needle

The authors report their experience on the use of a biopsy gun for histological sampling in the field of breast lesions. The use of cytological sampling by (FNAB) fine needle aspiration biopsy has been preferred so far, because it has been thoutht to be simpler, less risky and reliable. Nevertheless, the cytological sampling shows a number of drawbacks such as the need for passes to get sufficient cellular material, frequent problems in diagnosing benign lesions and the decisive influence of the operator's skill. By using a biopsy gun for histological sampling these disadvantages are eliminated. In this case, in fact, the validity of the sample is not influenced by the operator's skill; fewer passes are necessary and their validity does not depend on the nature of the lesion. The personal series of cases involves 91 patients subjected to histological sampling for suspected lesions. Two different kinds of needles were used with one an 18 G diameter and a 23-mm extension of the sytlet, as well as a sampling window 17 mm; the other with the same diameter and extension of the stylet, as as a sampling window 8 mm. The first needle was used in all 91 patients, and the second only in 30. The results were not influenced by the employ of the different kinds of needles. A total of 268 samples were made and 110 lesions were discovered, 79 of which were malignant and 31 benign (fibroadenoma, fibrocystic change and epitheliosis). Three carcinomas were not found (3 false-negative) and one specimen was inadequate. The values of sensibility, specificity and diagnostic accuracy of the method were, respectively, 96.2%, 100% and 97.2%, with 3.8% false-negative due to three cases where the lesion was not centred for guidance mistake.     

CT-guided core needle biopsy of breast lesions visible only on MRI

OBJECTIVE: As breast MRI has become more widely used, the need to biopsy suspicious lesions visible only on MRI has increased. A small percentage of these lesions are not amenable to MR-guided biopsy. We report our technique of CT-guided core needle biopsy of breast lesions. CONCLUSION: CT-guided core needle biopsy is a safe and effective method for sampling breast lesions visible only on MRI when MR-guided biopsy is not feasible.     

Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions

AIM: To evaluate scar formation of impalpable breast lesions with benign histological outcome using stereotactic 11-gauge vacuum-assisted core biopsy (VACB). MATERIALS AND METHODS: Two hundred and ten lesions with benign histology for which follow-up mammograms were available, were assessed for scar formation at the biopsy site. All biopsies were performed using stereotactic VACB with 11-gauge needle. The incidence of post-biopsy scar formation and the number of specimens removed were determined. RESULTS: In 4.3% (9/210) of the lesions for which a biopsy was performed with 11-gauge directional vacuum-assisted technique, the follow-up mammogram revealed a scar formation. Of these, six were minimal scars, two were moderate scars and one was a marked scar. Minimal and moderate scars were diagnosed on imaging only. However, the case with marked scar formation required tissue diagnosis to rule out malignancy. CONCLUSION: Although uncommon, scar formation can be seen in the follow-up mammograms after percutaneous breast biopsies. It is important that the radiologist interpreting follow-up mammograms is aware of the features of this lesion and its relationship to the biopsy procedure.     

乳腺立体定位核芯针活检的病理组织学低估原因分析

目的 分析乳腺立体定位核芯针活检的病理组织学低估的原因,以期引起临床多学科的重视及客观对待.方法 2000年9月至2005年9月,对146例乳腺病变患者(179个病变)进行立体定位核芯针病变部位穿刺活检,发生病理组织学低估21个.病变均不可触及(NPBL),根据乳腺影像报告和数据系统(BI.RADS),活检前诊断BI-RADS m类6个,Ⅳ类12个,V类3个,影像表现为钙化16个,肿块2个,不对称性致密1个,星芒征2个.结果 活检为纤维囊性乳腺病并导管上皮不典型增生11个,手术诊断为导管原位癌7个,伴早期浸润4个;活检为重度乳腺导管不典型增生3个,手术诊断为原位癌1个,原位癌伴早期浸润2个;活检为乳腺导管原位癌3个,手术证实均为浸润性癌;活检为乳头状病变4个,手术证实为原位癌及伴早期浸润各1个、浸润性导管癌及乳腺导管内乳头状腺癌各1个.结论 乳腺核芯针活检的病理组织学低估与立体定位技术、病变本身及医师的认识有关,放射科医师应熟练掌握活检技术并力求全面取材,当穿刺活检结果与影像表现不符时,应重新评价病变的实际病理诊断.     

Experimentally induced small-bowel tumor in rabbits: US-guided percutaneous 18-gauge core biopsy

PURPOSE: To evaluate the safety and diagnostic yield of percutaneous 18-gauge core biopsy for an experimentally induced small-bowel tumor in a rabbit model. MATERIALS AND METHODS: Small-bowel tumors were induced by injecting VX2 tumor into 20 rabbits. After 3 weeks, the small bowel was filled with 100 mL of 2% diluted contrast agent containing methylene blue by using a 5-F catheter. Fifty biopsy firings for small-bowel tumor were performed with ultrasonographic (US) guidance by using an 18-gauge automatic gun. Computed tomography (CT) was performed before and immediately after biopsy. Any procedure-related complications, including leakage of air or fluid, hematoma, and perforation as seen at CT and identified at laparotomy, which was performed 48 hours after biopsy, were evaluated. White blood cell (WBC), red blood cell, and platelet counts; hemoglobin and hematocrit levels; and erythrocyte sedimentation rate were also obtained before and 48 hours after biopsy. Comparison was performed with paired t test. The diagnostic yield was calculated, and the specimen was evaluated whether fragments of mucosa were included or not. RESULTS: No contrast agent leakage or pneumoperitoneum suggesting perforation was identified at CT or laparotomy. Fluid leakage was observed with manual squeezing at two biopsy sites (4%). In two rabbits, hemoperitoneum was observed at CT or laparotomy. Hematoma larger than 3 cm was observed in six rabbits. WBC count and erythrocyte sedimentation rate slightly increased, and red blood cells, hemoglobin, hematocrit, and platelets counts had decreased slightly after biopsy but were not significant (P >.05). Definitive histologic diagnosis of tumor was obtained in 44 (88%) of 50 biopsy sites. Fragments of mucosa were observed in 13 (28%) specimens of 10 rabbits. CONCLUSION: Core biopsies of small-bowel tumor can be performed safely with an 18-gauge gun without severe complications and allow histologic diagnosis of small-bowel tumor with a good diagnostic yield.