Stereotaxic core needle biopsy of breast microcalcifications obtained using a standard mammography table with an add-on unit.

OBJECTIVE: To demonstrate the reliability of stereotaxic biopsy of indeterminate microcalcifications using a standard mammography table with an add-on unit. METHODS: In 121 cases of indeterminate microcalcifications, core biopsy was performed using a standard mammography table with an add-on stereotaxic unit. Microcalcifications were identified on radiography of core specimens. RESULTS: Microcalcifications and a definitive histologic diagnosis were obtained in 112 core biopsies (92.6%), with no significant complications. In 23 lesions frank malignancy was diagnosed, and all of these diagnoses were confirmed on surgery. Pathologic examination suggested carcinoma in 4 lesions, and open biopsy confirmed malignancy in 3 of these cases. Four lesions showed atypical ductal hyperplasia. Benign disease was diagnosed in 81 lesions, of which 78 remained stable on mammographic follow-up (mean 16 months later) and 3 were subjected to surgical biopsy (of which 1 was malignant and 2 were benign). Nine cases were technically unsatisfactory because microcalcifications were not sampled. CONCLUSION: Stereotaxic core biopsy performed with an add-on unit is a safe and reliable technique for biopsy of indeterminate microcalcifications. For successful biopsy, microcalcifications must be harvested. Pathologic results should be correlated with mammographic findings. The accuracy rate compares favourably with results reported using prone biopsy tables. In an era of cost containment, this alternative to prone biopsy tables could result in significant savings in terms of capital investment and use of hospital rooms. In this study, surgical biopsy could have been avoided in 64.5% of cases.     

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.     

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.     

Stereotactic core needle biopsy of nonpalpable breast lesions using a conventional mammography unit with an add-on device

OBJECTIVE: The purpose of this prospective study was to assess the accuracy of an add-on stereotactic unit for core needle biopsy of mammographic lesions. SUBJECTS AND METHODS. Between September 1994 and February 2001, 506 stereotactic core needle biopsies of mammographic lesions in 492 patients were performed in our center on a mammography unit with add-on stereotactic equipment. Of the initial 92 patients, 80 underwent stereotactic core needle biopsy and surgical excision simultaneously. In subsequent cases, surgical biopsy was performed after core biopsy in patients who had malignant or atypical histologic results or discordance between mammographic and pathologic findings. Follow-up mammography was advised for all patients whose core biopsy results were diagnosed as benign lesions. RESULTS: Histologic results for 506 lesions undergoing stereotactic core needle biopsy were as follows: 113 (22.3%) were malignant; 369 (72.9%), benign; and 24 (4.7%), atypical. Of 113 malignant lesions identified at stereotactic core needle biopsy, 111 were confirmed as malignant, whereas two showed no evidence of malignancy at surgical excision. Of 369 lesions diagnosed as benign at stereotactic core needle biopsy, 172 (46.6%) showed no change on follow-up mammography, 114 (30.9%) were lost to follow-up, and 83 (22%) underwent surgical excision. Of 24 lesions with atypical histology, 23 had surgical follow-up, six were malignant, nine were benign, and eight were confirmed as showing atypical histology. Stereotactic core needle biopsy of the 506 lesions was complicated by five (1.0%) cases of vasovagal attack and four (0.8%) cases of bleeding. The resulting sensitivity, specificity, and positive and negative predictive values were 98.3%, 93.0%, 86.0%, and 99.2% respectively. CONCLUSION: Biopsy with an add-on unit is safe, reliable, accurate, and cost-effective with results comparable to those reported for dedicated prone biopsy devices.     

Sonographically guided biopsy of suspicious microcalcifications of the breast: a pilot study

OBJECTIVE: The purpose of this study is to evaluate the use of sonographic guidance for biopsy of mammographically detected suspicious microcalcifications. SUBJECTS AND METHODS: Twenty-three patients with suspicious microcalcifications detected on mammography (15 associated with masses or distortion; eight with microcalcifications alone) underwent sonographically guided core biopsy (n = 18) or sonographically guided needle localization before excision (n = 5). Microcalcifications were targeted, and specimen radiographs were obtained for each lesion, with the success of the procedure based on identifying microcalcifications on the specimen radiograph. For core biopsies, the number of cores obtained was compared with that in 49 control patients who underwent sonographically guided core biopsy of noncalcified masses. RESULTS: All 23 lesions (100%) were successfully biopsied under sonographic guidance, with microcalcifications seen on specimen radiographs in each case. Of 18 core biopsies, a mean of 8.7 cores was obtained compared with a mean of 5.5 cores in the control group (p<0.0001). Of 13 lesions sampled with core biopsy that subsequently underwent surgical excision, three (23%) were upgraded from atypical ductal hyperplasia to ductal carcinoma in situ (n = 1) and from ductal carcinoma in situ to invasive carcinoma (n = 2). Mammographically, most lesions contained more than 15 pleomorphic microcalcifications. On sonography, echogenic foci corresponded to microcalcifications in all but two cases in which broader echogenic regions were seen. When no mass or distortion was visible on mammography, sonography showed a mass or dilated ducts with internal echogenic foci. CONCLUSION: Microcalcifications identifiable on sonography can be successfully biopsied under sonographic guidance. Further study is necessary to determine whether targeting microcalcifications seen sonographically in the mass or duct can improve the rate of underestimation of disease compared with stereotactic core biopsy.     

Role of high magnification specimen radiography in surgical and core biopsies of the breast

The clinical relevance of a high magnification specimen radiography (HMSR) system in breast biopsies was evaluated and compared with conventional specimen radiography with a mammography system (SRM). 100 surgical biopsies of 72 patients and 248 core biopsies of 30 patients were examined in (a) maximal 20-fold HMSR in combination with storage phosphors and (b) 1.8-fold SRM using a film-screen system. Detection of calcifications/soft tissue lesions and the impact on management were evaluated. In surgical biopsies, SRM could detect only 22% of individual microcalcifications, 39% of calcified lesions and 67% of soft tissue lesions identified with HMSR. Calcifications down to 10 microns were identified with HMSR. In five biopsies, peripheral calcifications leading to additional resection were recognized only with HMSR; in three of these they were indicative of malignant tissue. In core biopsies, only 12% of individual microcalcifications seen with HMSR were identified with SRM. 52% and 16% of all cores were calcified on HMSR and SRM, respectively. Microcalcifications within cores were found only with HMSR in 41% of patients with calcified lesions. In conclusion, the better detectability of microcalcifications with HMSR led to justified additional tissue resections in surgical patients and reduced the number of core biopsies required in interventional patients.     

Stereotactic vacuum biopsy of calcifications with a handheld portable biopsy system: a validation study

To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.     

Automated stereotactic core needle biopsy of microcalcifications with correlation to surgical biopsy.

PURPOSE: To compare pathologic findings from stereotactic core and excisional biopsies in patients with microcalcifications in the breast. MATERIAL AND METHODS: Stereotactic core needle biopsies of 101 lesions with mammographic evidence of microcalcifications were performed with long-throw (2.2 cm) automated core biopsy devices fitted with 2.1-mm needles. The core specimens were placed on microscope slides and radiographed. The pathologic features of core and excisional specimens were compared. RESULTS: In 100 of the 101 breast lesions, a correct choice for an additional diagnostic procedure or definitive treatment could have been made upon histopathologic findings of the core needle biopsy. CONCLUSION: Stereotactic core needle biopsy is a reliable alternative to surgical biopsy of breast lesions with microcalcifications provided that specimen radiography has been performed to ensure that appropriate tissue has been obtained. Excisional biopsy may be avoided if microcalcifications are visible in radiographs of core biopsy specimen with benign histology.     

DIMA enlargement mammography in microcalcifications: a prospective study with ROC analysis

The purpose of this study was to investigate whether the four-fold magnification mammography (direct magnification, DIMA) technique would perform better than conventional 1.5-fold magnification mammography in the differentiation of breast microcalcifications into benign and malignant. Fifty patients with non-palpable microcalcifications detected by mammography were examined immediately prior to surgical biopsy using both a conventional (1.5-fold) and the DIMA (fourfold) magnification mammography techniques. The microcalcifications were classified by five experienced radiologists using morphological criteria. A receiver operating characteristics curve (ROC) analysis of the sensitivity and specificity of both techniques in assessing malignancy was then carried out. The DIMA mammography technique was slightly but non-significantly superior to the conventional method in detecting malignancy (p > 0.05). Coarse granular and pleomorphic calcifications were detected more frequently with the DIMA technique. Coarse calcifications were significantly more frequently associated with histologically benign findings, whereas fine granular calcifications were significantly more likely to be malignant lesions. Assessment of malignancy associated with microcalcifications using morphological criteria is not significantly improved by mammography techniques with higher magnification.     

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 breast biopsy: recumbent biopsy using add-on upright equipment

OBJECTIVE: The purpose of the study was to show that stereotactic breast biopsy can be performed effectively and accurately using add-on stereotactic equipment when it is performed with the patient in a decubitus or recumbent position. MATERIALS AND METHODS: We retrospectively reviewed the results of 225 stereotactic core breast biopsies performed during a 42-month period. The biopsies were performed using a reclining mammography chair and add-on stereotactic equipment. Procedures were performed with the patient in the right or left lateral decubitus position or upright. Patients with benign biopsy results were followed up mammographically at 6 months initially, then yearly. RESULTS: Of the 225 lesions biopsied stereotactically, 205 lesions (91%) were biopsied with the patient in the decubitus (right or left) position and 20 (9%) biopsied with the patient upright. Pathology results were classified as abnormal in 45 lesions (20%) and normal in 180 lesions (80%). All but one of the abnormal lesions were followed up with surgical excision. One hundred thirty-four of the 180 benign lesions have been followed up with at least one 6-month mammogram (follow-up range, 6-40 months), and none of the lesions has been subsequently proven malignant. CONCLUSION: Stereotactic core biopsy can be performed effectively and accurately using standard add-on equipment when it is performed with the patient in the decubitus position. This approach obviates the use of dedicated prone stereotactic equipment.     

Direct magnification mammography in combination with computed radiography. First clinical results

Summary Introduction: The combination of direct magnification mammography and computed radiography provides an improvement in spatial resolution of storage phosphor-based digital systems. A clinical study comparing conventional and digital direct magnification mammograms was performed. Methods: 100 survey mammograms in 1.5- or 1.7-fold magnification and 50 4-fold spot magnification views were obtained with a prototype direct magnification mammography system and a storage phosphor-based digital system. An intraindividual comparison of these with previous conventional radiograms of the same patients was carried out. Results: The diagnostic value of digital survey mammograms using the direct magnification technique is comparable to that of conventional radiograms of the breast, especially with regard to the identification of microcalcifications and lesions and the clinical consequences. Spot magnification views performed with this combination of techniques allowed improvement in the evaluation of microcalcifications. In 15 % of cases, diagnostic procedures were adjusted accordingly. Conclusion: The combination of the direct magnification technique with digital storage phosphor radiography systems allows the performance of digital mammography by improving the overall spatial resolution. The diagnostic value of digital direct magnification survey mammograms was comparable to that of conventional mammograms. Digital 4-fold spot magnification views improved visualisation of the morphologic aspects of microcalcifications.      

A comparison of digitized storage phosphors and conventional mammography in the detection of malignant microcalcifications

The detectability of malignant tumor-derived microcalcifications with conventional mammography was compared to that with digital images (2000 X 2510 pixels by 10 bits) derived from a storage phosphor-based digital radiography system capable of 5 line pair/mm resolution at identical exposure factors (30 kVp, 250 mAs, 65 cm film-focus distance). Microcalcifications (50-800 microns in diameter) were randomly superimposed on a preserved human breast specimen. ROC analysis based on 480 observations made by four readers indicated that the ability to detect the calcifications with digital images (ROC area = 0.871 +/- 0.066) was equivalent to conventional mammography (ROC area = 0.866 +/- 0.075) despite lower spatial resolution. With digital mammography, 62% of all clusters were correctly localized, but only 23.6% of the individual calcifications were counted. With conventional mammography 61% of all clusters were correctly localized, but significantly more of the individual calcifications (31.5%) were counted.     

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.     

Analogic versus digital mammographic examination a radiological study of mammary microcalcifications on 52 surgical samples

PURPOSE: Digital mammography is known to have lower spatial resolution compared to conventional analogic mammography. The aim of this study was to evaluate whether this physical feature could compromise the perception of microcalcifications in radiological findings. MATERIALS AND METHODS: Fifty-two surgical samples of non-palpable breast lesions with microcalcifications were imaged using both techniques. The images were examined by four different radiologists. Data processing was limited to comparing the number of microcalcifications found on the conventional and digital images, in both standard and magnified modality. The cases were classified into 3 groups according to the number of calcifications demonstrated in the surgical sample: less than 10, 10 to 30, and more than 30. The differences in the count of microcalcifications with the two acquisition modalities were evaluated with the Kappa test. In order to compare the differences we synthesised by percentage those cases exhibiting a larger or lesser number of calcifications. RESULTS: The Kappa test was 0.546 in standard analogic vs standard digital, 0.582 in magnified analogic vs magnified digital, 0.828 in standard analogic vs magnified analogic and 0.492 in standard digital vs magnified digital. The most significant results were observed on comparing the magnifications produced with the two modalities: in 25% of cases, digital magnification detected more calcifications than did traditional magnification. The number of cases where standard digital images allowed the detection of more calcifications than standard analogic images was significant, although less important (17.8%). CONCLUSIONS: The study was able to provide data that confirm the overall equivalence of the two techniques, as far as subtle mammographic findings (such as microcalcifications) are concerned. In particular, as applied to the series we examined, there is a cautious advantage in favour of the digital technique. More clinical studies, on larger series, will be necessary for a further and more thorough comparison of the two techniques, so that the results might be consistently useful in clinical practice.     

Stereotactic breast biopsy: en bloc excision of microcalcifications with a large-bore cannula device.

OBJECTIVE: Breast calcifications pose a significant diagnostic and procedural dilemma. We evaluated en bloc stereotactic excision of indeterminate and suggestive microcalcifications for histologic diagnosis using a large-bore cannula biopsy device. MATERIALS AND METHODS: We retrospectively reviewed 61 groups of microcalcifications removed with a large-bore cannula biopsy device from 59 patients (age range, 35-72 years old). The cannula diameter was 20 mm in 47 cases, 15 mm in nine cases, and 10 mm in five cases. The median lesion diameter was 6.6 mm (range, 4-17 mm). The procedure was performed by radiologists in an outpatient setting, with patients undergoing local anesthesia. All patients with a diagnosis of malignancy underwent surgery. RESULTS: In all instances, microcalcifications were removed in a single pass, in a single intact tissue specimen, through a maximum skin incision of 2 cm (0.8 inch). Twenty-five malignancies, 34 benign lesions, and two cases of lobular carcinoma in situ were identified. Sixteen malignancies were noninvasive and nine were invasive. No residual tumor was found at surgery in six of the 18 cases with involved margins and in five of the seven cases with uninvolved margins. One case of lobular carcinoma in situ with involvement of the margins additionally showed ductal carcinoma in situ at surgery. CONCLUSION: Mammographically identified microcalcifications are excised en bloc with the large-bore cannula biopsy device, providing a stereotactically localized tissue sample that is comparable with that obtained with open surgical biopsy and allows evaluation of the margins. This surgical radiologic procedure may represent a valid alternative, in selected patients, to conventional surgical biopsy after radiologic localization.     

Stereotactic excisional breast biopsy performed by interventional radiologists using the advanced breast biopsy instrumentation system

The Advanced Breast Biopsy Instrumentation (ABBI) system, which uses surgical cannulas up to 20 mm in diameter, is an alternative to conventional surgical biopsy for the diagnosis of non-palpable breast lesions. Since the need for radiological skill outweighs the surgical content of the technique, we evaluated the feasibility of complete management of the procedure by interventional radiologists. 35 of the 111 patients originally scheduled for the procedure were excluded, three because the lesion could not be visualized and 32 because of insufficient thickness of the compressed breast. The procedure had to be abandoned in one case due to a technical failure. 77 stereotactic excisional breast biopsy procedures were performed using the ABBI system in 75 patients with suspicious non-palpable mammographic lesions. The procedure was carried out under local anaesthesia in the radiology department, using a dedicated Lorad (R) radiographic system. 31 (40%) masses without calcifications, 11 (14%) masses with calcifications and 35 (46%) clusters of microcalcifications without tumour mass were sampled. 43 (56%) benign lesions and 34 (44%) malignant lesions were diagnosed. The overall mean diameter of the lesions was 8.7 mm (range 3-22 mm). All 34 patients with malignancies and lobular carcinoma in situ subsequently underwent surgery, the results of which are reported. Three (4%) haematomas were detected and aspirated percutaneously. Two technical problems occurred: an ABBI cannula malfunction, and a computer failure of the digital imaging system during the procedure. The average procedure time was 80 min and the cost of each procedure was 2,800,000 Italian lire (1555 US$). It is concluded that tissue sampling with the ABBI system can be performed entirely by radiologists without significant problems. The procedure was well tolerated by all patients. The quality of the biopsy specimen was identical to that of a surgical specimen but with the advantages of stereotactic precision for localization of the lesion.     

Breast US in patients who had microcalcifications with low concern of malignancy on screening mammography

PURPOSE: To review ultrasound (US) findings in patients who have suspicious microcalcifications with low concern of malignancy (BI-RADS category 4A) on screening mammography and to evaluate helpful findings in differentiating benign and malignant lesions. MATERIALS AND METHODS: Between August 2005 and July 2006, 192 patients showed microcalcifications only, without mass or associated density, on screening mammography. Among them, we selected 82 patients who had microcalcifications with low concern of malignancy (category 4A) that were pathologically confirmed by surgical excision after wire localization (n=23) or biopsy (n=59). Breast US was performed in 37/82 cases and we analyzed the US findings for the calcification areas in these patients, evaluating the findings with benign or malignant pathological results. We correlated US findings with mammographic calcifications using mammography-guided 2D-localization for the calcifications before US examination. RESULTS: There were 12 malignant lesions (32.4%) including 3 invasive ductal carcinomas (IDC), one microinvasive ductal carcinoma (MIDC), 8 ductal carcinoma in situ (DCIS) and 25 benign lesions (67.6%) including 2 atypical ductal hyperplasias (ADH). IDC showed calcifications within heterogeneous hypoechoic parenchyma or calcifications within complex hypoechoic masses of taller-than-wide shape on US. One MIDC showed calcifications within heterogeneous hypoechoic parenchyma and six DCIS showed negative findings, or calcifications with a small nodule, or only calcifications on US. The most common positive US finding in benign lesions was cysts with calcifications. In 24/37 cases (64.8%) with negative US findings, 18 (75%) were benign lesions and 6 (25%) were DCIS. CONCLUSION: In patients with category 4A microcalcifications without associated findings on screening mammography, negative US findings had a high rate of benign results (18/24, 75%). Visible calcifications within heterogeneous hypoechoic parenchyma or mass on US increased the probability of malignancy.     

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.     

Digital spot mammography using an add-on upright unit: diagnostic application in daily practice

INTRODUCTION: To present the use of digital spot mammography (DSM) in a diagnostic practice. METHODS AND PATIENTS: Digital spot images of 779 women requiring a spot compression or a spot magnification view were collected. The digital images were acquired on a digital spot upright unit using a 61 mm x 61 mm field of view. Lesions reported included masses, calcifications, and areas of distortions. RESULTS: 1065 lesions required additional views with DSM. Lesions reported included masses (n = 113), masses and microcalcifications (n = 53), spiculated masses (n = 34), architectural distortions (n = 16), and microcalcifications (n = 849). DSMs were considered to be adequate in 97.7% of patients. Unsatisfactory exams resulted from difficulties encountered in targeting the area of interest at the beginning of our experience. CONCLUSION: DSM, most commonly used to perform interventional procedures, can also be used in a diagnostic practice taking advantage of post-processing of images not available with conventional spot compression and magnification.