全视野数字化乳腺摄影对乳腺导管原位癌的诊断价值

目的 :探讨全视野数字化乳腺摄影(full-field digital mammography,FFDM)对乳腺导管原位癌(ductal carcinoma in situ,DCIS)的诊断价值。方法 :选择经手术病理证实的DCIS患者36例,分析其X线表现。患者术前均行FFDM检查。诊断标准采用美国放射学院(ACR)推荐的乳腺影像报告和数据系统(BI-RADS)。结果:病灶出现钙化23例;肿块16例,其中肿块伴钙化5例;局灶性致密伴钙化11例;结构扭曲伴钙化7例;阴性1例;致密乳腺建议其他检查1例。BI-RADS诊断:5类11例,4类19例,3类3例,2类、1类、0类各1例。FFDM诊断的敏感性91.67%,符合率83.33%。结论:DCIS的常见X线表现为恶性钙化、肿块,FFDM对乳腺DCIS有重要的诊断价值。     

数字化乳腺X线立体穿刺定位摄影技术在病灶切除术中的应用

目的:探讨全数字化乳腺X线引导术前病灶立体定位穿刺摄影技术的操作方法及临床应用价值。方法:对20例临床触诊阴性或疑似触及小肿块,而乳腺摄影有异常的患者,行数字化乳腺X线引导下术前病灶立体穿刺定位,病灶内留置导丝指导临床手术切除病灶。结果:20例患者,穿刺成功18例,2例失败。成功率达90%。病理诊断结果:4例纤维瘤伴乳腺增生;8例为乳腺腺体增生和钙化灶,部分增生活跃;2例为导管内癌,3例为浸润性乳腺癌Ⅰ期;1例原位癌。结论:全数字化乳腺X线引导下术前病灶立体定位穿刺摄影技术方便、快捷、定位准确率高,为临床上不可扪及乳腺病灶手术提供了有效的影像信息,达到了手术病灶切除范围更精确、组织损伤更小;病理诊断更准确。     

钼靶结合MRI对乳腺导管原位癌诊断价值的探讨

目的:分析乳腺导管原位癌的X线及MRI表现,评价钼靶结合MRI对DCIS术前诊断价值。方法:回顾性分析经手术病理证实的乳腺DCIS病例13例,所有病例均于术前行动态增强MRI和钼靶X线检查,同时行免疫组化标记。结果:①将病灶的X线表现分成恶性钙化、中间性钙化和非钙化3组,PR与C-erbB-2在3组中的分布有统计性意义(P<0.05);②13例病灶中11例MR表现为非肿块样强化,以BI-RADS分级中的4、5级为MR和X线检查的阳性指标,其正确诊断率差异无统计学意义(P>0.05)。结论:DCIS的钼靶X线表现可以作为乳腺DCIS的预后因子,乳腺MRI对导管原位癌及导管原位癌伴微浸润有特征性表现,钼靶X线和MR检查相结合能提高早期导管原位癌的检出率及正确诊断率。     

X线钼靶及立体定位活检在诊断乳腺腺病中的应用

目的探讨乳腺腺病的X线表现及在立体定位活检中的应用。方法分析2011年1月至2012年10月在我院就诊的60例乳腺腺病患者的临床资料及影像学表现。所有患者均经X线钼靶及立体定位活检手术病理证实。结果患者年龄29～84岁,平均45.2岁。14例患者可触及乳腺结节,7例患者有乳腺癌家族史。X线表现:38例(63%)X线表现为单纯钙化,其中簇状钙化24例,13例(22%)表现为单纯结节,6例(10%)结节内部或边缘伴钙化,3例(5%)表现为局部腺体密度增高或结构紊乱,其中1例伴钙化。结论钙化是乳腺腺病最常见的X线征象。乳腺腺病缺乏特异性影像学特征,全数字化乳腺X线立体定位核芯针穿刺活检或立体定位导丝导向切除活检可对病变的良、恶性作出鉴别。     

微钙化对早期乳腺导管原位癌的诊断价值

 目的 探讨微钙化在乳腺X线摄影筛查中对乳腺导管原位癌(ductal carcinoma in situ,DCIS)的诊断价值.方法 回顾性分析经乳腺X线摄影筛查及组织病理、免疫组化证实存在微小钙化灶的DCIS 58例.参照美国放射学会(ACR)颁布的乳腺病变BI - RADS有关钙化形态和分布的征象描述,记录钙化灶的形态、分布数据.全部病例均对照病理结果.采用Fisher确切概率法检验,探讨钙化形态和导管原位癌分级之间的相关性.结果 微钙化按外观与形态分成3类:(1)线形分支状钙化46例(79％);(2)成簇泥沙样钙化5例(8％);(3)微钙化伴粗大钙化7例(12％).所有58例DCIS患者中,低级别(1级)DCIS 14例(24％),中级别(2级)DCIS 35例(60％),高级别(3级)DCIS 9例(16％).不同级别原位癌的X线摄影钙化方式存在统计学差异(P＜0.01);原位癌分级与病灶内微钙化方式存在一定关联度(r=0.559,P＜0.01).结论 微钙化有助于DCIS的早期检出,其形态外观有助于判别其病理分级,正确认识乳腺X线摄影钙化可提高DCIS的诊断准确性.     

MRI对乳腺X线摄影中含成簇微钙化病变的诊断

目的：探讨乳腺磁共振成像对乳腺X线摄影中含成簇微钙化病变的鉴别诊断价值。方法：搜集行乳腺钙化灶立体定位下活检术或术前钩丝定位局切活检术的97例病例,所有患者术前均行乳腺X线摄影和MRI检查且病灶钙化表现为成簇微钙化灶,分析含不同形态成簇微钙化病变的MRI表现及其鉴别诊断价值,并与组织病理学结果进行对照。结果：病灶总数为97个,其中病理结果为良性者73个（75.3%）,恶性24个（24.7%）。良恶性病变乳腺X线上表现均以无定形钙化为主者,分别占57.5%（42/73）、37.5%（9/24）。MRI对含成簇微钙化的恶性病灶诊断的阳性预测值72.4%（21/29）高于乳腺X线摄影28.9%（22/76）（P=0.000）。MRI对含成簇无定形钙化的恶性病灶诊断的阳性预测值66.7%（8/12）高于乳腺X线摄影17.6%（9/51）（P=0.002）。MRI上节段性强化诊断恶性病变的阳性预测值为100.0%（9/9）;无强化对诊断含成簇钙化病变的阴性预测值为100.0%（9/9）。含成簇微钙化的恶性病变早期强化率平均值为109.6%±78.5%,高于良性病变62.8%±25.9%（P=0.000）。结论：MRI对含成簇微钙化特别是无定形成簇微钙化的乳腺病变具有较好的鉴别诊断价值。     

全数字化乳腺X线摄影二维钢丝定位的临床应用分析

目的探讨全数字化乳腺X线摄影立体穿刺定位活检术在隐匿性乳腺疾病临床诊断中的应用价值。方法对54例患者进行全数字化乳腺X线摄影立体穿刺定位活检术,手术病理结果进行对比分析。结果在接受SNLB检查的54例患者中有29例呈现簇状颗粒样、泥沙样、混合性钙化,直径≤10mm;8例结节伴钙化;12例单纯结节;5例局限性结构紊乱,呈现放射状毛刺或"星芒征"。所有患者定位满意,全部定位成功。手术病理结果:其中乳腺导管内原位癌17例、纤维腺瘤11例、腺病9例、导管上皮不典型增生5例、导管上皮增生4例、浸润性导管癌3例、导管内乳头状瘤2例、囊性增生病2例、粘液癌1例。结论全数字化乳腺X线摄影立体穿刺定位活检术可以有效应用全数字化乳腺X光机及配套进行立体定位活检系统,获得的病理诊断准确、可靠,可有效提高对早期乳腺癌的诊断能力,能够获得可靠的病理结果,并可对微创手术治疗提供精确的导向作用,同时完成诊断和治疗。     

乳腺导管原位癌的全数字化钼靶X线诊断

目的探讨乳腺导管原位癌（BDCIS）的全数字化乳腺钼靶X线征象。方法回顾分析30例经手术及病理检查证实为BDCIS的全数字化乳腺钼靶X线表现。常规摄影双侧乳腺轴位（CC位）及侧斜位（MLO位）摄片。结果 30例中26例有病灶内钙化,其中单纯钙化18例,肿块伴钙化3例,结构扭曲伴钙化5例;3例为单纯肿块,其中,边缘光滑、密度均匀的圆形肿块2例,边缘有毛刺、密度不均匀的类圆型肿块1例;1例为单纯结构扭曲。结论 BDCIS全数字化乳腺钼靶X线表现以钙化为主,还应重视肿块、结构扭曲以及局部非对称致密影等征象。     

全数字化乳腺X线立体定位活检技术对早期乳腺癌诊断及治疗的指导意义

目的 探讨全数字化乳腺X 线立体定位活检技术对早期乳腺癌的诊断及治疗价值.方法回顾性总结40 例临床未触及病变,仅通过X线摄影发现乳腺微小病变的患者,应用全数字化X 线立体定位导丝导向切除活检术及核心针穿刺活检术. 结果 28 例导丝定位患者中,27例一次性成功,成功率达96.4%.12例乳腺核心针穿刺活检,1例乳腺癌漏诊,无乳腺癌误诊病例.结论 应用全数字化乳腺X线机及配套的立体定位活检系统,可有效提高对早期乳腺癌的诊断能力,并为其微创手术治疗提供精确的导向作用.     

全数字化乳腺X线三维定位创新技术在不可触及性病变术前定位的应用

目的 探讨全数字化乳腺X线引导下的三维立体定位创新技术对不可触及性乳腺病变术前定位的临床价值.方法 回顾性分析乳腺不可触及性病变并行术前定位的106例患者,根据乳房X线片(0°及90°)人工计算进针深度,定位时利用全数字化乳腺X线三维立体定位系统(GE Senogrphe DS)自动计算进针深度,将此值与人工计算的进针深度值相结合,再结合患者,定位前皮肤弹性以及腺体结构情况,调整进针深度,置入定位针,临床根据定位导丝位置对病变进行切除,术后再行X线摄影与术前对比,判断病变是否被完整切除.结果 全数字化乳腺X线引导下的三维立体定位系统对不可触及性乳腺病变的定位准确率达到100%,手术均能完整切除,11例出现不良反应,主要表现为晕厥,经休息、心理安抚及输液处理后均能较快恢复.结论 术前行乳腺X线引导下的三维立体定位可以提高乳腺不可触及性病变切除的准确性,简单易行,具有推广价值.     

Stereotactic vacuum-assisted breast biopsy (Mammotome biopsy) for non-palpable microcalcification on mammography

PURPOSE: The purpose of this study was to assess the benefits of stereotactic vacuum-assisted breast biopsy in patients with non-palpable microcalcification detected on mammography. METHODS: Between October 2001 and November 2003, stereotactic Mammotome biopsies were performed for 150 microcalcified lesions on mammography using the prone-type stereotactic vacuum-assisted breast biopsy system (Mammotest and Mammovision, Fischer, Denver, USA) . The mammography findings were classified according to the guidelines of The Japan Radiological Society/The Japan Association of Radiological Technologists. Ninety-eight cases were category 3, 38 were category 4, and 14 were category 5. RESULTS: All cases were determined to be cases of microcalcification by specimen radiography or histology. Complications were negligible. One hundred twenty of the cases were mastopathy, and 30 of them were breast cancer (14 were ductal carcinoma in situ, 7 were ductal carcinoma in situ with microinvasion, and 9 were invasive ductal carcinoma). Twenty-seven breast cancers were diagnosed as category 4 or 5 (51.9%) on mammography. The operative stages of 27 cases were as follows: 7 were stage 0, 17 were stage 1, and 3 were stage 2A. Twenty-four of 27 (88.9%) were early breast cancers. CONCLUSION: Mammotome biopsy is a safe and useful modality for the histological diagnosis of non-palpable microcalcifications.     

Stereotactic and sonographic large-core biopsy of nonpalpable breast lesions: results of the Radiologic Diagnostic Oncology Group V study

RATIONALE AND OBJECTIVES: To determine the diagnostic accuracy of stereotactically and sonographically guided core biopsy (CB) for the diagnosis of nonpalpable breast lesions. MATERIALS AND METHODS: Twenty-two institutions enrolled 2,403 women who underwent imaging-guided fine needle aspiration followed by imaging-guided large-CB of nonpalpable breast abnormalities. All mammograms were reviewed for study eligibility by one of two breast imaging radiologists. The protocol for image-guided biopsy, using either ultrasound (USCB) or stereotactic (SCB) guidance, was standardized at all institutions and all biopsy specimens were over-read by one of three expert pathologists. Patients with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, or lobular neoplasia on CB underwent surgical excision. Those with negative CB but suspicious ("discordant") pre-biopsy mammography also underwent surgical excision. Patients having a negative CB that was concordant with the pre-biopsy mammography suspicion were assigned to follow-up mammography at 6, 12, and 24 months following CB. RESULTS: A gold standard diagnosis based on definitive histopathologic diagnosis, mammography follow-up, or an imputed gold standard diagnosis was established for 1,681 patients. Of 310 cases with a gold standard diagnosis of invasive breast carcinoma, 261 (84.2%) were invasive carcinoma, 31 (10%) were ductal carcinoma in situ (DCIS), four (1.3%) were ADH, one (0.3%) was a non-breast cancer, and 13 (4.2%) were benign on CB. For 138 cases with a gold standard diagnosis of DCIS, 113 (81.9%) were DCIS, 20 (14.5%) were ADH, and five (3.6%) were benign on CB. For 57 cases (13 masses, 44 calcifications) with an initial CB diagnosis of ADH, atypical lobular hyperplasia or lobular neoplasia, 20 (35.1%) had a gold standard diagnosis of DCIS (4 masses, 16 calcifications) and four (7.0%) had a gold standard diagnosis of invasive cancer (4 calcifications). Of 144 cases (22 masses, 122 calcifications) with an initial CB diagnosis of DCIS, 31 (21.5%) had a gold standard diagnosis of invasive cancer (10 masses, 21 calcifications). The sensitivity, specificity and accuracy for CB by either imaging guidance method in this trial were .91, 1.00, and .98, respectively. The sensitivity, predictive value negative, and accuracy of CB for diagnosing masses (.96, .99, and .99, respectively) were significantly greater (P < .001) than for calcifications (.84, .94, and .96, respectively). The sensitivity (.89) of SCB for diagnosing all lesions was significantly lower (P = 0.029) than that of USCB (.97) because of the preponderance of calcifications biopsied by SCB versus USCB. There was no difference between USCB and SCB in sensitivity, predictive value negative, or accuracy for the diagnosis of masses (97.3, 98.9, and 99.2, respectively for USCB; 95.6, 98.5, and 98.9 respectively for SCB). CONCLUSION: Percutaneous, imaged-guided core breast biopsy is an accurate diagnostic alternative to surgical biopsy in women with mammographically detected suspicious breast lesions.     

Sonographic detection and sonographically guided biopsy of breast microcalcifications

OBJECTIVE: The purpose of this study was to evaluate the ability of sonography to depict and guide biopsies of mammographically suspicious microcalcifications and to reveal the mammographic features and histologic outcomes of lesions amenable to sonographically guided biopsy. SUBJECTS AND METHODS:. Suspicious clusters of microcalcifications without other mammographic abnormalities were evaluated on sonography before biopsy and divided into two groups: those with and those without microcalcifications seen on sonography. Sonographically detected lesions underwent sonographically guided biopsy; lesions not seen on sonography underwent mammographically guided biopsy. Imaging features and histologies were correlated, and the positive predictive value of sonography was determined. RESULTS: Of 111 lesions (105 patients), 26 lesions (23%) were identified and underwent sonographically guided biopsy; 85 lesions (77%) were not identified sonographically. The diameters of microcalcification clusters in the sonographically identified group were significantly larger (p = 0.0005) and contained larger numbers of microcalcification particles (p = 0.038) compared with clusters not identified sonographically. Sonographically identified lesions were seen as masses (77%) or dilated ducts (23%) with echogenic foci. Sonographically identified lesions were more likely to be malignant than those not seen on sonography (69% vs 21%, respectively; p < 0.00002). Of 38 malignant lesions, those visible on sonography were more likely to be invasive than those not seen on sonography (72% vs 28%, respectively; p = 0.018). In malignant lesions undergoing core biopsy and surgical excision, the extent of disease was underestimated less with sonographically guided biopsy (7%, 1/15) than with stereotactic biopsy (33%, 5/15). CONCLUSION: Suspicious microcalcifications are seen infrequently on sonography (23%) but, when detected, can be successfully biopsied with sonographic guidance and more frequently are malignant and represent invasive cancer than those seen on mammography alone.     

11-gauge vacuum assisted directional biopsy of breast calcifications, using upright stereotactic guidance

To assess the use of a prototype vacuum assisted biopsy device on a standard upright mammography unit, using a slightly modified digital stereotactic add-on component. A group comprised of 42 sequential patients, who had been recalled from an asymptomatic mammographic screening programme, were studied. All 42 were recalled for assessment of small clusters of microcalcification, graded as indeterminate. Group 1 (21 patients) were biopsied using 14-gauge automated large core needle biopsy. Group 2 (21 patients) were biopsied using 11-gauge vacuum assisted biopsy. Both groups had mammographic guidance on the same upright mammographic unit (Siemens 3000), with Opdima Digital Stereotactic add-on. A total of 86% of specimen radiographs in Group 2 patients (vacuum assisted biopsy) showed successful sampling of the calcifications, compared to 62% of Group 1 patients (14-gauge automated large core biopsies). This study shows that vacuum assisted biopsy is possible using upright stereotactic mammography units. The technique shows promise as a biopsy tool, offering larger cores compared to 14-gauge automated large core biopsy, while requiring less space and lower purchase price compared to dedicated prone biopsy tables. The technique also offers access to biopsy in patients with posterior lesions and for patients who cannot tolerate prone positioning.     

Digital imaging improves upright stereotactic core biopsy of mammographic microcalcifications

AIM: This comparative study was carried out to assess the effect of using digital images compared to conventional film-screen mammography on the accuracy of core biopsy of microcalcifications using upright stereotactic equipment. MATERIALS AND METHODS: The biopsy results from a consecutive series of 104 upright stereotactic 14-gauge core biopsies performed with conventional X-ray (Group A) were compared with 40 biopsies carried out using stereotaxis with digital imaging (Group B). In all cases specimen radiography was performed and analysed for the presence of calcifications. Pathological correlation was then carried out with needle and surgical histology. RESULTS: The use of digital add-on equipment increased the radiographic calcification retrieval rate from 55 to 85% (P < 0.005). The absolute sensitivity of core biopsy in pure ductal carcinoma in situ (DCIS) cases rose from 34 to 69% (P < 0.03), with the complete sensitivity increasing from 52 to 94% (P < 0.005). For DCIS with or without an invasive component the absolute sensitivity rose from 41 to 67% (P = 0.052), while the complete sensitivity was 59% before and 86% after the introduction of digital imaging (P < 0.04). CONCLUSION: Digital equipment improves the performance of upright stereotactic core biopsy of microcalcifications, giving a significantly increased success rate in accurately obtaining calcifications. This leads to an improvement in absolute and complete sensitivity of core biopsy when diagnosing DCIS.     

Extension of ductal carcinoma in situ: histopathological association with MR imaging and mammography.

The purpose of this study is to evaluate the capability of breast MRI (magnetic resonance imaging) and mammography in determining tumor extent and the detectability of ductal carcinoma in situ (DCIS) in association with histopathological features. Thirty women with breast cancer underwent 3D dynamic MRI. Twelve women had pure DCIS and 18 women had DCIS with microinvasion. We analyzed the results of preoperative MRI and mammography with histopathologic results, retrospectively. The mean lesion size was 55.1 mm from the histopathologic results. Twenty-six lesions were detected through the MRI (a sensitivity of 86.7%). MRI depicted eight lesions without mammographically detected microcalcification. In seven cases, MRI showed tumor extent accurately compared with mammography, and the combined diagnosis improved the accuracy of evaluating tumor extent. MRI can complement mammography in guiding surgical treatment of DCIS by providing better assessment of the extent of the lesion.     

Predictive factors for invasive cancer in surgical specimens following an initial diagnosis of ductal carcinoma in situ after stereotactic vacuum-assisted breast biopsy in microcalcification-only lesions

PURPOSE

The aim of this study was to determine the incidence of invasive breast carcinoma in patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) by stereotactic vacuum-assisted biopsy (SVAB) performed for microcalcification-only lesions, and to identify the predictive factors of invasion.

METHODS

From 2000 to 2010, the records of 353 DCIS patients presenting with microcalcification-only lesions who underwent SVAB were retrospectively reviewed. The mammographic size of microcalcification cluster, presence of microinvasion within the cores, the total number of calcium specks, and the number of calcium specks within the retrieved core biopsy specimen were recorded. Patients were grouped as those with or without invasion in the final pathologic report, and variables were compared between the two groups.

RESULTS

The median age was 58 years (range, 34–88 years). At histopathologic examination of the surgical specimen, 63 of 353 patients (17.8%) were found to have an invasive component, although SVAB cores had only shown DCIS preoperatively. The rate of underestimation was significantly higher in patients with microcalcification covering an area of 40 mm or more, in the presence of microinvasion at biopsy, and in cases where less than 40% of the calcium specks were removed from the lesion.

CONCLUSION

Invasion might be underestimated in DCIS cases diagnosed with SVAB performed for microcalcification-only lesions, especially when the mammographic size of calcification is equal to or more than 40 mm or if microinvasion is found within the biopsy specimen and less than 40% of the calcifications are removed. At least 40% of microcalcification specks should be removed from the lesion to decrease the rate of underestimation with SVAB.Because of the widespread use of breast screening mammography, the number of women diagnosed with ductal carcinoma in situ (DCIS) has increased dramatically in recent years. DCIS is a noninvasive form of breast cancer, accounting for up to 30% of breast cancers in screening populations and approximately 5% of breast carcinomas in symptomatic patients (1–3). DCIS has a variety of mammographic presentations, but the most common mammographic feature is microcalcification (4). Indeed 80%–90% of DCIS lesions present with microcalcifications only, without any accompanying mass lesions (4). Other findings such as masses, nodular abnormalities, dilated retroareolar ducts, architectural distortions, and developing densities have also been reported (5).Ultrasound-guided biopsy is often the method of choice for sonographically visible breast lesions as it provides easy access for biopsy. However, in cases when the abnormality seen on mammography is not visible on ultrasonography, stereotactic biopsy is the recommended sampling method. For microcalcification-only lesions with no accompanying mass, ultrasonography often fails to identify the site of the lesion; hence, stereotactic biopsy is used more frequently.In most breast units, stereotactic 14-gauge automated core biopsy has been replaced by stereotactic vacuum-assisted biopsy (SVAB) using 8- to 11-gauge needles (6). Large core SVAB allows larger samples to be obtained in a shorter period of time compared with samples obtained using automated core biopsy devices (7). Moreover, this technique has the advantage of a single insertion in the area of interest compared with automated core biopsy devices, which require repeated insertions. Several published articles have shown that SVAB decreased the rate of cancer underestimation and the rate of failure to retrieve breast microcalcifications (8).The management of noninvasive and invasive breast cancers is different and therefore, an accurate preoperative diagnosis is crucial for adequate surgical planning. Underestimation of DCIS lesions occurs when an invasive component is found after surgery, which had been missed at the initial preoperative sampling. The underestimation rate of stereotactic 14-gauge automated core biopsy in DCIS was reported as 16%–35% (9–11), while that of SVAB was 5%–29% (6, 9, 11–13).The purpose of this study was to determine the rate, causes, and predictive factors of underestimation of invasive carcinoma in patients diagnosed with DCIS following SVAB of microcalcification-only lesions.     

Predicting invasion in mammographically detected microcalcification

AIM: To identify pre-operative factors which predict presence of invasive disease within mammographically detected malignant microcalcification. MATERIALS AND METHODS: A retrospective analysis was undertaken of 116 serial stereotactic core needle biopsies (SCNBs) performed on malignant mammographic calcification. Final surgical pathology was correlated with pre-operative features (clinical, radiological and core histology) in an attempt to predict the presence of an invasive component. RESULTS: Thirty-eight clusters contained invasive carcinoma. The sensitivity of SCNB for invasion was 55%. Clinical features, calcium morphology and cluster size were not shown to be predictive of invasive disease. Ductal carcinoma in situ (DCIS) of high grade on core histology and increasing number of calcifications were predictive of increased risk of invasion (high grade core biopsy DCIS and > 40 calcifications 48% invasive at surgical histology; high grade core biopsy DCIS and < 40 calcifications 15% invasive; non-high grade core biopsy DCIS 0% invasive). CONCLUSIONS: Identification of those clusters diagnosed as DCIS by percutaneous biopsy which are likely to harbour an invasive component is possible. It would seem reasonable to consider staging the axilla at therapeutic surgery in these patients.     

Two-year follow-up of stereotactically guided 9-G breast biopsy: a multicenter evaluation of a self-contained vacuum-assisted device

PurposeTo evaluate the performance of a self-contained, battery-driven, vacuum-assisted breast biopsy (VABB) system for the sampling of clustered breast microcalcifications and masses under stereotactic guidance.Methods and materialsA total of 144 patients (median age: 56 years; range: 21–87 years) in four European breast centers underwent percutaneous 9-gauge (G), stereotactic-guided VABB. The median lesion size was 11 mm (range 2–60 mm). Patients were biopsied in the prone (n=125) or upright position (n=19). All patients were followed up for at least 24 months.ResultsThe stereotactic procedure was successful in 142 (98.6%) of 144 cases, with two cases cancelled due to either severe patient motion (one case) or failure to detect faint calcifications (one case). A median of 12 specimens per procedure was obtained. In 39 cases (27.5%), the suspicious lesion could no longer be detected mammographically after the biopsy procedure. The histological diagnosis was malignancy in 45 (31.7%) cases. One case of atypical ductal hyperplasia diagnosed preoperatively was upgraded to ductal carcinoma in situ (DCIS) at operation, giving an overall sensitivity of 97.7% for the vacuum-assisted biopsy procedure. In two cases where DCIS was diagnosed at vacuum-assisted biopsy, the malignant tissue was apparently completely removed and could no longer be found at operation. No serious complications occurred. During the follow-up period, no breast cancers appeared at the location of biopsy. Six patients dropped out during the follow-up period.ConclusionThe self-contained, vacuum-assisted biopsy device is well suited for stereotactically guided breast biopsies, having demonstrated excellent sensitivity and specificity in the preoperative workup of mammographically detected breast lesions after 2 years of follow-up.