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.     

Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy

PURPOSE: To retrospectively determine the degree of underestimation of breast carcinoma diagnosis in papillary lesions initially diagnosed at core-needle biopsy. MATERIALS AND METHODS: Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant study. Mammographic database review (1994-2003) revealed core biopsy diagnoses of benign papilloma (n=38), atypical papilloma (n=15), sclerotic papilloma (n=6), and micropapilloma (n=4) in 57 women (mean age, 57 years). Excisional or mammographic follow-up (>or=2 years) findings were available. Patients with in situ or invasive cancer in the same breast or patients without follow-up were excluded. Findings were collected from mammography, ultrasonography, core technique, core biopsy, excision, and subsequent mammography. Reference standard was excisional findings or follow-up mammogram with no change at 2 years. Associations were examined with regression methods. RESULTS: In 38 of 63 lesions, surgical excision was performed; in 25 additional lesions (considered benign), follow-up mammography (24-month minimum) was performed, with no interval change. In 15 lesions, 14-gauge core needle was used; in 48, vacuum assistance (mean cores per lesion, 8.7). Carcinoma was found at excision in 14 of 38 lesions. Core pathologic findings associated with malignancy were benign papilloma (n=1), sclerotic papilloma (n=1), micropapilloma (n=2), and atypical papilloma (n=10). Frequency of malignancy was one (3%) of 38 benign papillomas, 10 (67%) of 15 atypical papillomas, two (50%) of four micropapillomas, and one (17%) of six sclerotic papillomas. Excisional findings included lobular carcinoma in situ (n=2), ductal carcinoma in situ (n=7), papillary carcinoma (n=2), and invasive ductal carcinoma (n=3). Low-risk group (micropapillomas and sclerotic and benign papillomas) was compared with high-risk atypical papilloma group. Core findings were associated with malignancy at excision for atypical papilloma (P=.006). Lesion location, mammographic finding, core number, or needle type were not associated (P>.05) with underestimation of malignancy at excision. CONCLUSION: Benign papilloma diagnosed at core biopsy is infrequently (3%) associated with malignancy; mammographic follow-up is reasonable. Because of the high association with malignancy (67%), diagnosis of atypical papilloma at core biopsy should prompt excision for definitive diagnosis.     

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.     

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.     

Stereotactic vacuum-assisted breast biopsy: results, follow-up and correlation with radiological suspicion

PURPOSE: The purpose of this study was to assess the accuracy and clinical usefulness of stereotactic vacuum-assisted biopsy (VAB) for diagnosing suspicious, nonpalpable, only mammographically detectable breast lesions. MATERIALS AND METHODS: We retrospectively evaluated the results of percutaneous stereotactic VAB with 11-gauge needles performed over a period of 34 months on 228 nonpalpable suspicious breast lesions detectable on mammography only [Breast Imaging Reporting and Data System (BI-RADS) 3: 25.9%; BI-RADS 4: 67.1%; BI-RADS 5: 7%]. The imaging histological concordance was ascertained for each lesion. In cases of discordance, repeat biopsy or surgical excision were recommended; in cases of benign lesions, we urged a follow-up of at least 6 months and for borderline and malignant lesions a surgical excision. We also evaluated concordance between VAB results and subsequent examinations (surgical excision or followup). RESULTS: VAB demonstrated 123 (54%) benign lesions (with six cases of imaging-histological discordance), 26 (11.4%) borderline lesions and 79 (34.6%) malignant lesions. We obtained a suitable post-VAB mammographic or histological evaluation for 78 benign lesions, 17 borderline lesions and 76 malignant lesions, with one (1.3%) false negative (FN) case, two (11.8%) underestimations of borderline lesions, 14 (18.4%) underestimations of malignant lesions and no (0%) false positive cases. We did not observe any postbiopsy complications or scars. CONCLUSIONS: Percutaneous histological VAB with an 11-gauge needle proved to be, as reported in previous studies, a reliable method for diagnosing nonpalpable, mammographically detectable only breast lesions, with an underestimation rate lower than core biopsy and a FN rate similar to that of surgical biopsy, without any significant complications.     

Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy.

PURPOSE: To evaluate the use of stereotactic directional vacuum-assisted biopsy (SDVAB) in diagnosing and managing papillary lesions of the breast. MATERIALS AND METHODS: The authors retrospectively reviewed the mammographic and histopathologic findings of 26 cases in which papillary lesions were diagnosed at SDVAB. In all cases, subsequent surgical excision (n = 20) or long-term imaging follow-up (n = 6) was performed and correlated with findings at SDVAB. RESULTS: SDVAB of 26 lesions yielded tissue that was classified as benign in 12, atypical in six, and malignant in eight. Of the 12 lesions that were diagnosed as histologically benign at SDVAB, six were surgically excised. Of these six lesions, five yielded benign correlative results. The sixth lesion was thought to be discordant with the imaging findings, and was surgically excised and determined to be malignant. Of the six benign lesions that were not surgically sampled for biopsy, five decreased in size and one was not seen at radiographic follow-up. Of the six lesions diagnosed as atypical at SDVAB that were surgically excised, one was benign and five were atypical. None proved to be malignant. Of the eight lesions diagnosed as malignant at SDVAB, surgical excision demonstrated ductal carcinoma in situ in all eight; two also had foci of invasive carcinoma. CONCLUSION: Benign and malignant papillary lesions of the breast can be reliably diagnosed at SDVAB when the SDVAB results correlate with the imaging findings. However, the extent of malignant papillary disease may be underestimated at SDVAB; in our study, invasive carcinoma was later discovered in 25% of patients with this diagnosis.     

Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the accuracy of ultrasound (US)-guided fine-needle aspiration (FNA), with radiographic follow-up or surgical excision, in conjunction with on-site cytopathologic support in the management of nonpalpable breast lesions. MATERIALS AND METHODS: The findings of 266 consecutive mammographically or sonographically identified, nonpalpable lesions (228 patients) that underwent US-guided FNA were examined retrospectively. Clustered microcalcifications did not undergo biopsy with this method. Patients who underwent follow-up excisional biopsy or mammography with a duration of at least 24 months were included in the study. RESULTS: In all, 117 lesions met criteria for inclusion, of which 85 (73%) were diagnosed as benign at cytopathologic evaluation and underwent mammographic follow-up of at least 24 months (range, 24-67 months; mean, 36 months). Thirty-two lesions (27%) had either malignant or atypical cytopathologic findings, for which surgery was recommended. Eleven (9%) of the 32 had malignant cytopathologic findings from initial US-guided FNA, which were confirmed at surgical excision. The remaining 21 lesions (18%) were diagnosed as atypical on the basis of US-guided FNA results. Of these, 18 lesions underwent excisional biopsy: Two were diagnosed as carcinoma (not otherwise specified), and 16 were diagnosed with a variety of benign disorders. The remaining three patients with atypical lesions chose mammographic follow-up rather than surgical diagnosis, and their conditions have remained stable for more than 24 months. Of the 85 benign cases, one changed during follow-up (12 months) and underwent repeat biopsy, with malignancy noted. The sensitivity of US-guided FNA in identifying malignant lesions was 93% (13 of 14), and the specificity of a benign finding was 100% (102 of 102). The positive and negative predictive values of US-guided FNA supported by on-site cytopathologic evaluation were 100% (13 of 13) and 99% (102 of 103), respectively. CONCLUSION: Supported by appropriately trained on-site cytopathologists and in conjunction with follow-up mammography, US-guided FNA appears to be efficacious in the management of patients with abnormal radiographic findings. It is quick, relatively inexpensive, and minimally invasive, and, in the presence of competent cytopathologists, should be the modality of choice.     

Percutaneous imaging-guided core breast biopsy: 5 years' experience in a community hospital

OBJECTIVE: This study reports the results of a percutaneous imaging-guided core breast biopsy program in a community hospital. MATERIALS AND METHODS: We reviewed the prospectively collected results of our imaging-guided core biopsy program during its first 5 years (1994-1998). A total of 1333 lesions (94% of which were Breast Imaging Reporting and Data System (BI-RADS) assessment category 4) were sampled in 1183 patients. Patients with BI-RADS assessment category 5 lesions were referred to surgeons. Stereotactic guidance was used for the core biopsy of 506 lesions, and sonography was used to guide the predominantly 16-gauge needle core biopsy of 827 solid masses. RESULTS: One hundred forty-seven cancers were diagnosed in 1333 biopsies, resulting in a positive yield of 11%. Of 1020 patients with benign, concordant core biopsy results, 981 (96%) had at least one follow-up imaging examination within 36 months of the biopsy. Nineteen (2%) of these 1020 patients had a suspicious change at follow-up; 18 of these patients underwent surgical excision with benign findings. No cancers were found at imaging follow-up or by tumor registry linkage. All malignant core biopsy results were confirmed as malignant at surgical excision (positive predictive value 100%). Twenty-two patients with atypical ductal hyperplasia at core biopsy had subsequent surgery, and 12 (55%) of them were found to have cancer at surgery. CONCLUSION: An imaging-guided core biopsy program, developed and implemented by a small group of radiologists in a community hospital, can achieve successful results and provide an important service to patients and a cost-effective alternative to surgical biopsy. Our program emphasized sonographic guidance and achieved high follow-up compliance.     

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.     

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.     

Mammography-guided stereotactic fine-needle aspiration cytology of nonpalpable breast lesions: prospective comparison with surgical biopsy results

We assessed the usefulness of fine-needle aspiration cytology (FNAC) in evaluating nonpalpable breast abnormalities by prospectively performing stereotactic mammography-guided FNAC on 100 women undergoing surgical excisional biopsy. Mammographic and cytologic diagnoses, on a scale of 1 (benign) to 4 (malignant), were assigned for each case and compared with the surgical pathologic diagnosis. Sensitivity and specificity were examined at different diagnostic cutoff points for regarding a mammographic or cytologic diagnosis as positive or negative. Of the 100 breast biopsy specimens, 70 were benign and 30 were malignant. For both mammography and FNAC, the optimal diagnostic cutoff point was between diagnosis 2 (mammography, probably benign; cytology, atypical) and 3 (mammography and cytology both suspicious for malignancy). At this cutoff point, FNAC had a sensitivity of 0.77 and specificity of 1.00, vs 0.73 sensitivity and 0.79 specificity for mammography. Pearson coefficient analysis revealed significant correlations between both mammographic and FNAC diagnoses and surgical pathology (p less than .001 for both). Our results suggest that use of mammography-guided FNAC may reduce the number of breast biopsies performed for benign lesions.     

Sonographically-Guided 14-Gauge Core Needle Biopsy for Papillary Lesions of the Breast

Objective

We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy.

Materials and Methods

Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.

Results

Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%).

Conclusion

Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.     

Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary?

OBJECTIVE:. This study was conducted to evaluate the outcome of cases of radial scar diagnosed by percutaneous core needle biopsy. MATERIALS AND METHODS: Of 198 nonpalpable lesions diagnosed with radial scars found at core needle biopsy, 157 lesions constituting the study group had undergone surgical excision (n = 102) or mammographic surveillance after biopsy for at least 24 months (median, 38 months; n = 55). Mammographic lesion type, lesion size, biopsy guidance method, biopsy device, number of specimens per lesion, and presence of atypical hyperplasia at percutaneous biopsy were retrospectively analyzed. Results were compared with histologic findings at surgery or mammographic findings during surveillance. RESULTS:. Carcinoma was found at excision in 28% (8/29) of lesions with associated atypical hyperplasia at percutaneous biopsy and 4% (5/128) of lesions without associated atypia (p < 0.0001). In the latter group, carcinoma was found at excision in 3% (2/60) of masses, 8% (3/40) of architectural distortions, and 0% (0/28) of microcalcification lesions. Malignancy was missed in 9% (5/58) of lesions biopsied with a spring-loaded device and in 0% (0/70) of lesions biopsied with a directional vacuum-assisted device (p = 0.01); and in 8% (5/60) of lesions sampled with less than 12 specimens per lesion and 0% (0/68) sampled with 12 or more specimens (p = 0.015). Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the presence of malignancy. CONCLUSION:. Diagnosis of radial scar based on core needle biopsy is likely to be reliable when there is no associated atypical hyperplasia at percutaneous biopsy, when the biopsy includes at least 12 specimens, and when mammographic findings are reconciled with histologic findings. When the lesion diagnosed by core needle biopsy as radial scar does not meet these criteria, excisional biopsy is indicated.     

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.     

Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up

PURPOSE: To determine the rate and causes of false-negative findings and histologic underestimates at stereotactic biopsy of nonpalpable breast lesions. MATERIALS AND METHODS: Stereotactic, 14-gauge, automated, large-core needle biopsy (LCNB) was performed in 483 consecutive nonpalpable breast lesions. Excision was advised for the 143 carcinomas, 25 atypical ductal hyperplasia (ADH) lesions, and five radial scars. Mammographic follow-up was advised for the benign lesions without a repeat biopsy. RESULTS: Of the 310 benign lesions, 259 underwent mammographic follow-up at 6-85 months (median, 55 months) without repeat biopsy, 48 underwent repeat biopsy and three were lost to follow-up. On the basis of the histologic diagnosis of carcinoma at surgical biopsy, diagnosis with LCNB was not correct (i.e., disease was underestimated at histologic examination) in 14 (58%) of 24 ADH lesions and two (40%) of five radial scars. Two (1.2%) of 161 lesions with a final diagnosis of carcinoma were benign at LCNB but malignant at repeat biopsy (i.e., false-negative findings at LCNB). Repeat biopsy was prompted by mammographic progression at 6 and 18 months after LCNB. CONCLUSION: The false-negative rate with LCNB was 1.2% in this study and 4.0% in the literature. The presence of carcinoma in ADH and radial scar lesions was often underestimated.     

立体定位穿刺活检术对乳腺微小病变定性诊断的探讨

目的提高乳腺X线立体定位核芯针活检(SCNB)、立体定位穿刺导丝定位活检(SNLB)对乳腺微小病变的定性诊断准确性及成功率。方法回顾性分析了118例乳腺微小病变立体定位穿刺导丝定位活检及核芯针活检的病理资料,并与手术病理结果进行对照。结果SCNB 33例中31例活检成功,24例行外科手术,恶性病变8例,良性病变16例,诊断符合率为87.5%,误诊3例(12.5%),7例随访。2例出现迷走神经反应,未完成检查。拟行SNLB 85例,83例定位成功,其中80例定位满意,满意率94%,3例定位偏离,2例定位失败,恶性病变30例,良性病变53例。结论SCNB及SNLB是目前对乳腺微小病灶定性诊断的主要方法,通过合理选择应用可提高诊断准确性及成功率。     

Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T

The feasibility of large-core-needle magnetic resonance imaging (MRI)-guided breast biopsy at 3 T was assessed. Thirty-one suspicious breast lesions shown only by MRI were detected in 30 patients. Biopsy procedures were performed in a closed-bore 3-T clinical MR system on a dedicated phased-array breast coil with a commercially available add-on stereotactic biopsy device. Tissue sampling was technically successful in 29/31 (94%) lesions. Median lesion size (n = 29) was 9 mm. Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%). At follow-up of these lesions, 15 lesions showed no malignancy, no information was available in three patients and two lesions turned out to be malignant (one lesion at surgical excision 1 month after biopsy and one lesion at a second biopsy because of a more malignant enhancement curve at 12-months follow-up MRI). Nine biopsy results showed a malignant lesion (31%) which were all surgically removed. No complications occurred. MRI-guided biopsy at 3 T is a safe and effective method for breast biopsy in lesions that are occult on mammography and ultrasound. Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result.     

MR-guided stereotactic breast biopsy: technical aspects and preliminary results

AIM: To assess the feasibility and accuracy of cytologic and microhistologic breast biopsy using a MR imaging-guided stereotactic system with MR-compatible non-magnetic needles. MATERIALS AND METHODS: Between December 2001 and September 2002, cytologic and microhistologic sampling of 14 lesions (12 patients) was performed in our radiology department using a commercially available MR-guided stereotactic device. MR-compatible non-magnetic needles or mixed kit (non-magnetic coaxial needle + conventional ferromagnetic needle) were used. Of the 12 patients examined, 2 were undergoing MR examination because of genetic/familial risk, 4 during post-operative follow-up and the remaining 6 for contradictory mammographic and sonographic findings. Ten of the 14 lesions were visible on MR alone. The mean lesion diameter was 12 mm (range 5-30 mm). RESULTS: The procedure was relatively simple and feasible. The procedure took 45 minutes on average. The cytologic samples were adequate in 4/14 cases (29%). The diagnosis was absence of malignant cells in one case, ductal carcinoma in one case and suspected carcinoma in two cases. The cytologic diagnosis was confirmed by core biopsy, and by post-operative histology in the malignant lesions. The remaining 10/14 (71%) cytologic samples were inadequate for diagnosis. All the microhistologic samples (100%) were considered sufficient for diagnosis and yielded diagnosis of benignity in 9/14 (60%) lesions and malignancy in 5/14 (40%). Two patients with benign diagnosis underwent surgery, which confirmed the diagnosis. The remaining seven patients were evaluated by follow-up MRI; the first follow-up at 3 months showed no significant changes. Post-operative histology of the 5 lesions with malignant microhistologic diagnosis confirmed the nature of the lesions. CONCLUSIONS: MR-guided stereotactic biopsy is a simple, fast and safe procedure comparable to the interventional breast procedures performed under mammography and ultrasound guidance. The stereotactic device used ensures correct positioning of the needle into the lesion. The new dedicated non-magnetic needles and the mixed kit provide quantitatively and qualitatively adequate tissue for the histologic analysis. On the basis of our initial experience, we conclude that the procedure is feasible and accurate and can therefore be recommended for routine clinical use.     

A comparison of 14 and 12 gauge needles for core biopsy of suspicious mammographic calcification

This study was carried out to compare the efficacy of 14 vs 12 G needles in stereotactic core biopsy of mammographic calcification. A consecutive series of 100 impalpable mammographic calcifications, without an associated mass and requiring stereotactic core biopsy were randomly allocated to either 14 G or 12 G needle sampling. All biopsies were performed using an upright stereotactic digital unit (Senovision GE) and a Bard automated biopsy gun. Core biopsy results were categorized as either normal, benign, atypical ductal hyperplasia, suspicious of ductal carcinoma in situ (DCIS), DCIS or invasive cancer. The radiographic calcification retrieval rates, complete and absolute sensitivity for malignancy of DCIS and DCIS with an invasive focus were obtained by comparison of core results with surgical histology. Radiographic calcification retrieval was achieved in 86% when using 14 G and 12 G needles. The absolute sensitivity and complete sensitivity for diagnosing DCIS were the same with 12 G and 14 G needles (72% versus 71% and 93% versus 94%, respectively). The use of 12 G needles does not appear to confer benefit over the use of 14 G needles in the diagnosis of mammographic calcification.     

Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy,eliminating the recommendation for surgical excision?

PURPOSE: To determine if a subset of atypical ductal hyperplasia (ADH) lesions diagnosed at 11-gauge, directional, vacuum-assisted, prone, stereotactic biopsy fit the "probably benign" definition of a less than 2% chance of being carcinoma at subsequent surgical excision. MATERIALS AND METHODS: Clinical, mammographic, and stereotactic biopsy features in 104 consecutive nonpalpable ADH lesions were correlated with the presence of carcinoma at lumpectomy. The results were analyzed with chi(2) statistic, with P <.05 indicative of significant difference. RESULTS: Surgical excision revealed carcinoma in 22 (21%) of 104 ADH lesions. The lowest incidences of carcinoma (each P <.02) were 16% (15 of 92) in patients with no personal history of breast carcinoma, 13% (nine of 67) when maximum lesion diameter was less than 10 mm, and 8% (three of 36) when 100% of the mammographic lesion was removed at stereotactic biopsy. CONCLUSION: No clinical, mammographic, or biopsy features alone or in combination could be used to define a substantial subset of probably benign lesions with a less than 2% chance of carcinoma at lumpectomy.