Ultrasound-guided breast biopsy using a 10-gauge self-contained vacuum-assisted device

The purpose of this study was to evaluate the diagnostic value of a self-contained battery-driven vacuum-assisted breast biopsy (VABB) system for the sampling of breast masses under ultrasound guidance. Sixty-five patients with 70 lesions underwent percutaneous 10-gauge ultrasound-guided VABB using the coaxial technique. In 38 lesions, subsequent surgery and comparison of histology was performed. The remaining 32 cases were followed-up and defined as true negative after a cancer-free interval of 24 months. VABB revealed malignant histology in 28 (40%) cases. Twenty-four malignancies were confirmed after surgery. Four invasive cancers verified in VABB were not found during surgery because they were completely removed, as proved by a disease-free interval of 24 months. One cancer missed in ultrasound-guided VABB due to its small size was successfully diagnosed with stereotactic VABB and thus turned out to be false negative, resulting in an overall sensitivity of 96.6%. Forty-one patients were free of cancer during the follow-up period of at least 24 months. In conclusion, the self-contained VABB device is well suited for ultrasound-guided breast biopsies.     

Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy?

The purpose of this study was to determine the value of galactography-guided, stereotactic, vacuum-assisted breast biopsy (VABB) for the assessment of intraductal breast lesions and its potential as a therapeutic tool that could eliminate the need for surgical excision. Eighteen patients (median age 64 years, range 37–80) with nipple discharge and galactography-verified intraductal lesions underwent galactography-guided, stereotactic, 11-gauge VABB followed by surgery. Histopathology findings from VABB and subsequent surgery were compared. Underestimation and false-negative rates were assessed. After VABB, histopathology revealed invasive ductal carcinoma (IDC) in three (17%), ductal carcinoma in situ (DCIS) in six (33%), high-risk lesions in six (33%) and benign lesions in three (17%) cases. After surgical biopsy, histopathology confirmed the previously established diagnosis in 11 lesions (61%). The underestimation rate for high-risk lesions and DCIS was 50% (6/12). The false-negative rate was 7% (1/14). Histopathology examination after surgery showed that not a single lesion had been completely removed at VABB. Galactography-guided VABB is a feasible diagnostic tool. However, its value as a therapeutic procedure is limited because of the high number of underestimated and missed lesions and because of the histopathological detection of lesions’ remnants in every case. Surgical excision should be the therapeutic gold standard in cases of pathological nipple discharge and galactography abnormalities.     

Epithelial displacement after stereotactic 11-gauge directional vacuum-assisted breast biopsy

OBJECTIVE: Displaced epithelial fragments at percutaneous biopsy of ductal carcinoma in situ (DCIS) may mimic stromal invasion. This study was undertaken to determine the frequency of epithelial displacement in DCIS lesions of patients who underwent stereotactic 11-gauge directional vacuum-assisted breast biopsy. MATERIALS AND METHODS: We retrospectively reviewed 28 consecutive DCIS lesions in patients who underwent stereotactic 11-gauge directional vacuum-assisted breast biopsy followed by surgery. Surgical specimens were examined for histologic evidence of epithelial displacement, consisting of fragments of epithelium in artifactual spaces in breast parenchyma or in lymphovascular channels, accompanied by hemorrhage, fat necrosis, inflammation, hemosiderin-laden macrophages, or granulation tissue. RESULTS: The median number of specimens obtained per lesion was 14 (range, seven to 45). The median interval from stereotactic biopsy to surgery was 27 days (range, 10-59 days). Surgery revealed DCIS in 19 (68%) of 28 lesions, DCIS and infiltrating carcinoma in four lesions (14%), and no residual carcinoma in five lesions (18%). Reactive changes at the biopsy site were identified in all cases. Displacement of benign epithelium into granulation tissue at the stereotactic biopsy site was identified in two cases (7%). We found no evidence of displacement of malignant epithelium. CONCLUSION: Epithelial displacement is uncommon after stereotactic 11-gauge directional vacuum-assisted biopsy of the breast. We observed displacement of benign epithelium in two (7%) of 28 DCIS lesions and no displacement of malignant epithelium.     

US-Guided Vacuum-Assisted Biopsy of Microcalcifications in Breast Lesions and Long-Term Follow-Up Results

Objective

To evaluate the diagnostic accuracy of the use of an ultrasonography (US)-guided vacuum-assisted biopsy for microcalcifications of breast lesions and to evaluate the efficacy of the use of US-guided vacuum-assisted biopsy with long-term follow-up results.

Materials and Methods

US-guided vacuum-assisted biopsy cases of breast lesions that were performed between 2002 and 2006 for microcalcifications were retrospectively reviewed. A total of 62 breast lesions were identified where further pathological confirmation was obtained or where at least two years of mammography follow-up was obtained. These lesions were divided into the benign and malignant lesions (benign and malignant group) and were divided into underestimated group and not-underestimated lesions (underestimated and not-underestimated group) according to the diagnosis after a vacuum-assisted biopsy. The total number of specimens that contained microcalcifications was analyzed and the total number of microcalcification flecks as depicted on specimen mammography was analyzed to determine if there was any statistical difference between the groups.

Results

There were no false negative cases after more than two years of follow-up. Twenty-nine lesions were diagnosed as malignant (two invasive carcinomas and 27 carcinoma in situ lesions). Two of the 27 carcinoma in situ lesions were upgraded to invasive cancers after surgery. Among three patients diagnosed with atypical ductal hyperplasia, the diagnosis was upgraded to a ductal carcinoma in situ after surgery in one patient. There was no statistically significant difference in the number of specimens with microcalcifications and the total number of microcalcification flecks between the benign group and malignant group of patients and between the underestimated group and not-underestimated group of patients.

Conclusion

US-guided vacuum-assisted biopsy can be an effective alternative to stereotactic-guided vacuum-assisted biopsy in cases where microcalcifications are visible with the use of high-resolution US.     

Sonographically Guided Core Biopsy of the Breast: Comparison of 14-Gauge Automated Gun and 11-Gauge Directional Vacuum-Assisted Biopsy Methods

Objective

To compare the outcomes of 14-gauge automated biopsy and 11-gauge vacuum-assisted biopsy for the sonographically guided core biopsies of breast lesions.

Materials and Methods

We retrospectively reviewed all sonographically guided core biopsies performed from January 2002 to February 2004. The sonographically guided core biopsies were performed with using a 14-gauge automated gun on 562 breast lesions or with using an 11-gauge vacuum-assisted device on 417 lesions. The histologic findings were compared with the surgical, imaging and follow-up findings. The histologic underestimation rate, the repeat biopsy rate and the false negative rates were compared between the two groups.

Results

A repeat biopsy was performed on 49 benign lesions because of the core biopsy results of the high-risk lesions (n = 24), the imaging-histologic discordance (n = 5), and the imaging findings showing disease progression (n = 20). The total underestimation rates, according to the biopsy device, were 55% (12/22) for the 14-gauge automated gun biopsies and 36% (8/22) for the 11-gauge vacuum-assisted device (p = 0.226). The atypical ductal hyperplasia (ADH) underestimation (i.e., atypical ductal hyperplasia at core biopsy and carcinoma at surgery) was 58% (7/12) for the 14-gauge automated gun biopsies and 20% (1/5) for the 11-gauge vacuum-assisted biopsies. The ductal carcinoma in situ (DCIS) underestimation rate (i.e., ductal carcinoma in situ upon core biopsy and invasive carcinoma found at surgery) was 50% (5/10) for the 14-gauge automated gun biopsies and 41% (7/17) for the 11-gauge vacuum-assisted biopsies. The repeat biopsy rates were 6% (33/562) for the 14-gauge automated gun biopsies and 3.5% (16/417) for the 11-gauge vacuum-assisted biopsies. Only 5 (0.5%) of the 979 core biopsies were believed to have missed the malignant lesions. The false-negative rate was 3% (4 of 128 cancers) for the 14-gauge automated gun biopsies and 1% (1 of 69 cancers) for the 11-gauge vacuum-assisted biopsies.

Conclusion

The outcomes of the sonographically guided core biopsies performed with the 11-gauge vacuum-assisted device were better than those outcomes of the biopsies performed with the 14-gauge automated gun in terms of underestimation, rebiopsy and the false negative rate, although these differences were not statistically significant.     

Stereotactic biopsy of noncalcified breast lesions: utility of vacuum-assisted technique compared to multipass automated gun technique

The purpose of this study was to evaluate the stereotactic 14-gauge, vacuum-assisted biopsy technique in diagnosing noncalcified breast lesions. Stereotactic biopsy of 116 noncalcified breast lesions was performed with either 14-gauge, vacuum-assisted technique or multipass, automated large-core technique. The number of core samples and time required for each biopsy were compared. Outcome for each technique was compared based on recommendations after the mammographic-histologic review process. Results from surgical excision and mammographic follow-up were reviewed. The vacuum-assisted technique obtained more tissue cores per lesion than the automated gun technique, showed marginal decrease in number of repeat biopsies for discordant results, and required fewer short-term follow-up mammograms, although the difference did not achieve statistical significance. The vacuum-assisted technique can be used successfully to sample noncalcified breast masses, with marginal improvement over the automated gun technique.     

The Clinical Utility of a Adding Lateral Approach to Conventional Vertical Approach for Prone Stereotactic Vacuum-Assisted Breast Biopsy

Objective

The purpose of this study is to evaluate the clinical utility of adding lateral approach to conventional vertical approach for prone stereotactic vacuum-assisted breast biopsies.

Materials and Methods

From April 2010 to May 2012, 130 vacuum-assisted stereotactic biopsies were attempted in 127 patients. While a vertical approach was preferred, a lateral approach was used if the vertical approach failed. The success rate of biopsies utilizing only a vertical approach was compared with that using both vertical and lateral approaches and the breast thickness for both procedures was measured and compared with that for vertical approach. In addition, pathology results were evaluated and the causes of the failed biopsies were analyzed.

Results

Of the 130 cases, 127 biopsies were performed and 3 biopsies failed. The success rate of the vertical approach was 83.8% (109/130); however, when the lateral approach was also used, the success rate increased to 97.7% (127/130) (p = 0.0004). The mean breast thickness was 2.7 ± 1 cm for the lateral approach and 4 ± 1.2 cm for the vertical approach (p < 0.0001). The histopathologic results in 76 (59.8%) of the biopsies were benign, 23 (18.1%) were high-risk lesions, and 28 (22.0%) were malignant. The causes of biopsy failure were thin breasts (n = 2) and undetected difficult lesion location (n = 1).

Conclusion

The addition of lateral approach to conventional vertical approach in prone stereotactic vacuum-assisted breast biopsy improved the success rate of stereotactic biopsy, especially in patients with thin breasts.     

Needle tract seeding after vacuum-assisted breast biopsy

Background: A matter of substantial concern regarding all needle biopsy techniques is seeding along the biopsy needle tract.

Purpose: To assess cell seeding along the needle tract of vacuum-assisted breast biopsy (VABB).

Material and Methods: The study included 21 patients with ductal carcinoma in situ (DCIS) and 10 patients with invasive ductal carcinoma (IDC) diagnosed by VABB for nonpalpable mammographic lesions. VABB (11G, on a Fischer table) was performed, and the duration of the procedure was measured. After surgery, the whole needle tract was embedded in paraffin blocks, stained with hematoxylin-eosin, and examined by a pathologist.

Results: Cases with dissemination of cancer cells in the needle tract were not observed (one-sided 97.5% CI 0-10.0%). In 2/31 (6.5%) cases (95% CI 0.8-21.4%), benign epithelial cell displacement was observed, and the duration of VABB was significantly longer in these two cases (52.5±3.5 min vs. 42.0±4.4 min for cases without benign cell displacement; P = 0.018, Mann-Whitney-Wilcoxon test for independent samples).

Conclusion: No displacement of malignant cells within the 11G needle tract was documented. Benign cell displacement was associated with longer VABB duration. The phenomenon of tumor cell dissemination along the needle tract is of questionable clinical significance when the treatment guidelines are followed.     

Benign breast lesions: minimally invasive vacuum-assisted biopsy with 11-gauge needles patient acceptance and effect on follow-up imaging findings

PURPOSE: To evaluate patient acceptance of stereotactic or ultrasonographically (US) guided directional vacuum-assisted 11-gauge needle biopsy of breast lesions and short- and long-term changes at mammography and US resulting from the procedure. MATERIALS AND METHODS: For 91 benign lesions that had been sampled at either stereotactic or US-guided directional vacuum-assisted breast biopsy performed with 11-gauge needles, clinical, mammographic, and US changes were evaluated 1 week after biopsy; 6-month follow-up findings were available for 74 lesions. The subjective outcome of the procedure and patient satisfaction were assessed on the basis of a patient-completed questionnaire that incorporated a multistage scoring system. Statistical analysis of scores for condition for both biopsy methods was performed with the chi2 test. RESULTS: Adverse events occurred during the procedure in four patients. Clinically visible hematomas were observed at 1-week follow-up in 79% of patients. Densities were observed on mammograms in 46% of patients 1 week after biopsy; hematomas with a maximum diameter of 2 cm were seen on sonograms in 74%. Six months after biopsy, mammography revealed discrete architectural changes in one case. No abnormalities were found at 6-month follow-up US. Fifteen patients had various complaints during the procedure; six reported feeling constrained during the first few days after biopsy, and one patient was not satisfied with the cosmetic result. No patient reported a retrospective preference for surgical biopsy instead of directional vacuum-assisted biopsy. Analysis of scores for the stereotactic and US-guided methods revealed a significant difference (P <.001) in favor of the stereotactic method for condition during biopsy, while scores for condition in the first days after biopsy were more equally distributed between the two methods (P =.386). CONCLUSION: Directional vacuum-assisted 11-gauge needle biopsy of the breast is well accepted by patients and rarely produces changes that may alter the mammographic or sonographic appearance of the breast at 6-month follow-up.     

乳腺可疑微钙化灶金属标记夹放置的筛选条件及近期移位的影响因素

目的 探讨乳腺微钙化灶活检过程中放置金属标记夹的筛选条件和影响标记夹移位的因素.方法 108例患者中的114处乳腺微钙化灶做了11 G真空辅助立体定位活检.活检后在每一处病灶都放置了标记央,采用Gel Mark Ultra(82处)或MicroMark Ⅱ标记央(32处).所有钙化簇按照直径和(或)分布被划分成直径<10、10～20、>20 mm的单簇和多簇钙化,并判断金属夹放置的筛选条件.在乳腺X线片上直接测量标记夹和活检部位的距离,按照<10、10～20、>20 mm分成3组.结果 直径<10 mm(25例)和直径10～20 mm之间的单簇钙化(20例)中分别有88.0%(22例)和70.0%(14例)的病灶在活检后显示钙化被取净,直径>20 mm的单簇钙化(17例)没有病灶能被取净.65.8%(75/114)的标记夹准确定位,39个标记夹发生移位,其中34个(87.2%)是沿针道移位,即"手风琴效应"移位.4例患者在活检部位发生大血肿,其中只有1例标记夹能准确定位.结论 直径<20 mm的单簇钙化及多簇钙化灶在活检后都需要放置标记夹,只有直径>20 mm的单簇钙化不需要放置.影响标记夹近期移位的主要因素是"手风琴效应"和血肿.     

MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience

Purpose

The purpose of this study was to compare three different biopsy devices on false-negative and underestimation rates in MR-guided, vacuum-assisted breast biopsy (VABB) of MRI-only lesions.

Methods

This retrospective, single-center study was IRB-approved. Informed consent was waived. 467 consecutive patients underwent 487 MR-guided VABB using three different 8-10-gauge-VABB devices (Atec-9-gauge,A; Mammotome-8-gauge,M; Vacora-10-gauge,V). VABB data (lesion-type, size, biopsy device, histopathology) were compared to final diagnosis (surgery, n?=?210 and follow-up, n?=?277). Chi-square, and Kruskal–Wallis tests were applied. P values?<?0.05 were considered significant.

Results

Final diagnosis was malignant in 104 (21.4 %), high risk in 64 (13.1 %) and benign in 319 (65.5 %) cases. Eleven of 328 (3.4 %) benign-rated lesions were false-negative (1/95, 1.1 %, A; 2/73, 2.7 %, M; 8/160 5.0 % V; P?=?0.095). Eleven high-risk (11/77, 14.3 %) lesions proved to be malignant (3/26, 11.5 % A; 4/12, 33.3 % M; 4/39, 10.3 % V; P?=?0.228). Five of 34 (14.7 %) DCIS were upgraded to invasive cancer (2/15, 13.3 %, A; 1/6, 16.6 % M; 2/13, 15.3 %, V; P?=?0.977). Lesion size (P?=?0.05) and type (mass vs. non-mass, P?=?0.107) did not differ significantly.

Conclusion

MR-guided VABB is an accurate method for diagnosis of MRI-only lesions. No significant differences on false-negative and underestimation rates were observed between three different biopsy devices.

Key Points

? MR-guided VABB is an accurate procedure for the diagnosis of MRI-only lesions. ? Similar false-negative and underestimation rates allow all three different MR-guided VABB devices for clinical application. ? High-risk lesions should undergo surgery due to a substantial underestimation rate. ? Agreement between MR-guided VABB and final diagnosis (benign/malignant) was 95.5% (465/487).

     

Calcifications highly suggestive of malignancy: comparison of breast biopsy methods.

OBJECTIVE: The purpose of this study was to compare the usefulness of, and cost of diagnosing with, different breast biopsy methods for women with calcifications highly suggestive of malignancy. MATERIALS AND METHODS: One hundred thirty-nine women with calcifications highly suggestive of malignancy underwent diagnostic biopsy. Of these, 89 women had stereotactic biopsy with a 14-gauge automated needle (n = 25), 14-gauge vacuum-assisted probe (n = 17), or 11-gauge vacuum-assisted probe (n = 47); and 50 women had diagnostic surgical biopsy. Medical records were reviewed. Cost savings for stereotactic biopsy were calculated using Medicare data. RESULTS: The median number of operations was one for women who had stereotactic biopsy versus two for women who had diagnostic surgical biopsy. The likelihood of undergoing a single operation was significantly greater for women who had stereotactic rather than surgical biopsy, among all women (61/89 [68.5%] vs. 19/50 [38.0%], p < 0.001) and among women treated for breast cancer (55/77 [71.4%] vs. 6/37 [16.2%], p = 0.0000001). Stereotactic 11-gauge vacuum-assisted biopsy, as compared with 14-gauge automated core or 14-gauge vacuum-assisted biopsy, was significantly more likely to spare a surgical procedure (36/47 [76.6%] vs. 16/42 [38.1%], p = 0.0005). Stereotactic 11-gauge vacuum-assisted biopsy resulted in the greatest cost reduction, yielding savings of $315 per case compared with diagnostic surgical biopsy; for women with solitary lesions, stereotactic 11-gauge biopsy decreased the cost of diagnosis by 22.2% ($334/$1502). CONCLUSION: For women with calcifications highly suggestive of malignancy, the use of stereotactic rather than surgical biopsy decreases the number of operations. Stereotactic 11-gauge vacuum-assisted biopsy, as compared with 14-gauge automated core or 14-gauge vacuum-assisted biopsy, is significantly more likely to spare a surgical procedure and has the highest cost savings.     

Magnetic resonance-guided biopsy of suspicious breast lesions with a handheld vacuum biopsy device

Purpose: To evaluate a handheld vacuum-assisted device system for magnetic resonance image (MRI)-guided breast lesion biopsy.

Material and Methods: In 32 patients, a total of 42 suspicious breast lesions (mean diameter 7.5 mm for mass lesions, 11.6 mm for non-masslike diffuse lesions) seen with MRI (no suspicious changes in breast ultrasound or mammography) were biopsied (27 lateral, 15 medial) using a 10G vacuum-assisted breast biopsy device under MR guidance. Histology of biopsy specimens was compared with final histology after surgery or follow-up in benign lesions.

Results: In all biopsies, technical success was achieved. Histology revealed 11 lesions with ductal carcinoma in situ (DCIS) or invasive cancer, three with intermediate lesions (LCIS) and 28 with benign breast lesions (adenosis, infected hematoma). In one patient with discordant results of MRI and histology, surgical excision revealed medullary cancer. In the follow-up (mean 18 months) of the histological benign lesions, no breast cancer development was observed. Besides minor complications (hematoma, n = 6), with no further therapeutic interventions, no complications occurred.

Conclusion: MRI-guided breast lesion biopsy using a handheld vacuum-assisted device is a safe and effective method for the work-up of suspicious lesions seen with breast MRI without changes in mammography or ultrasound. In the case of discordant histology of vacuum biopsy and breast MRI appearance, surgical excision is recommended.     

The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography?

The purpose of this study was to evaluate the clinical value of bilateral breast magnetic resonance (MR) imaging (MRI) in patients showing suspicious microcalcifications on mammography and negative ultrasound findings. Fifty patients underwent MRI before stereotactic vacuum-assisted breast biopsy (SVAB). MR findings were classified into five types for interpretation, and types 4 and 5 were considered malignant. SVAB revealed 13 carcinomas and 37 benign lesions. Malignant lesions were more frequently found in cases of positive MRI diagnoses than in negative MRI diagnoses (P < 0.001). Mammography had a sensitivity of 100%, a specificity of 24% and an accuracy of 44%, whereas mammography plus MRI had a sensitivity of 85%, a specificity of 100% and an accuracy of 96%. In the evaluation of mammographically detected microcalcifications, bilateral breast MRI is of good diagnostic value and may alter the indications for SVAB.     

Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI

The aim of this study was the evaluation of the diagnostic usefulness of ductal or segmental enhancement in dynamic breast MRI. Segmental and ductal enhancement have been established as the breast MRI hallmarks of intraductal breast cancer (DCIS); however, the positive predictive value of this imaging finding is still unknown. In our study, we analysed the overall prevalence of a segmental or a linear enhancement pattern on breast MRI for an unselected cohort of patients. The aim was to evaluate the diagnostic usefulness of segmental or linear enhancement. Second, we asked whether biopsy was necessary also in the absence of mammographic findings suggestive of DCIS. Prospective, consecutive evaluation of 1,003 patients undergoing bilateral dynamic breast MRI. Studies were interpreted by two experienced breast radiologists. A diagnostic or screening two-view mammogram was available for all patients. Biopsy or short-term breast MRI follow-up was recommended for patients showing a segmental or a linear enhancement pattern on breast MRI. The patients final diagnoses were established by imaging guided excisional or core biopsy or by clinical plus conventional imaging follow-up for a period of 2 years. The prevalence of segmental or linear enhancement was determined for patients with a final diagnosis of benign breast disease compared with those with a diagnosis of breast cancer. One hundred twenty patients had invasive breast cancer, 24 patients had DCIS and 859 patients had unsuspicious breast MRI or benign breast disease. A segmental or a linear enhancement pattern was found for 50/1,003 (5%) patients (17 DCIS, 33 benign breast diseases). Accordingly, the positive predictive value of segmental and linear enhancement is 34% (17/50); the specificity of this criterion is 96% (826/859). For 4/24 (17%) patients, DCIS was visible as segmental or linear enhancement on dynamic breast MRI, whereas no abnormalities were visible on the corresponding mammogram. The overall prevalence of a ductal or a segmental enhancement pattern on breast MRI is low. But this finding has a high specificity and a moderate positive predictive value for intraductal neoplastic changes. We conclude that if segmental or linear enhancement is identified on breast MRI further work-up is necessary. We recommend either direct MR-guided vacuum-assisted core biopsy or short-term follow-up breast MRI within 3 months. If ductal enhancement then persists, MR-guided biopsy should be recommended even in the absence of mammographically visible signs of DCISThis revised version was published online in May 2005 with corrections to Figs. 3c, 4c and 5c.     

Underestimation rate of lobular intraepithelial neoplasia in vacuum-assisted breast biopsy

Objectives

To evaluate the underestimation rate and clinical relevance of lobular neoplasia in vacuum-assisted breast biopsy (VABB).

Methods

A total of 161 cases of LN were retrieved from 6,435 VABB. The histological diagnosis was ALH (atypical lobular hyperplasia) in 80 patients, LCIS (lobular carcinoma in situ) in 69 patients and PLCIS (pleomorphic lobular carcinoma in situ) in 12 patients. Seventy-six patients were operated on within 2 years after VABB and 85 were clinically and radiologically monitored. The mean follow-up was 5.2 years, and the prevalence of malignancy was evaluated in the group of 85 patients.

Results

The clinico-pathological characteristics significantly favouring surgery were larger lesions, occurrence of a residual lesion following VABB and histological LCIS and PLCIS subtypes. The VABB underestimation rate as compared to surgery was 7.1 % for ALH, 12 % for LCIS and 50 % for PLCIS. Overall, 11 of the 148 patients included in this survival analysis developed an ipsilateral tumour.

Conclusion

Although obtained retrospectively in a relatively small series of patients, our data suggest that only patients with a diagnosis of PLCIS in VABB should be treated with surgery, whereas patients with ALH and LCIS could be monitored by clinical and radiological examinations.

Key Points

? The treatment of ALH and LCIS in VABB is still debated ? Some authors favour radical treatment and others a more conservative approach ? Only patients with PLCIS in VABB should be treated by surgery     

Stereotactic histologic biopsy with patients prone: technical feasibility in 98% of mammographically detected lesions

OBJECTIVE: The purpose of this retrospective study was to determine which mammographically detected lesions in need of imaging-guided biopsy could undergo prone, stereotactic biopsy. MATERIALS AND METHODS: From July 1991 through June 2001, 1687 consecutive patients (age range, 29-94 years; median age, 58 years) with 1894 lesions were referred by clinicians in a multispecialty clinic. The patients underwent stereotactic, prone, histologic biopsy of 1851 lesions (98%) and needle-localized breast biopsy of 43 lesions (2%). We performed stereotactic biopsies successively with 14-gauge automated large-core devices and 14- or 11-gauge vacuum-assisted devices. We evaluated lesions by patient, breast, lesion, and procedural variables to determine why stereotactic biopsy was not performed. RESULTS: Of 1851 lesions referred for stereotactic biopsy, biopsies were canceled in 42 lesions (2%) not considered suspicious enough to warrant biopsy. Of 1809 lesions in which stereotactic biopsy was considered to be warranted, stereotactic biopsy was canceled for technical reasons in 29 lesions (2%). Of 43 lesions referred for surgical biopsy, stereotactic biopsy was thought to be technically problematic in five (12%). Inability to accomplish a stereotactic biopsy in 34 (2%) of 1852 lesions needing a biopsy was due to proximity to the chest wall (n = 10, 29%), inadequate lesion visualization unrelated to lesion depth (n = 19, 56%), and patient factors (n = 5, 15%). CONCLUSION: Stereotactic biopsy had a technical success rate of 98% (1780/1809) and was used for histologic diagnosis in 96% (1780/1852) of mammographically detected lesions. Inadequate lesion visualization accounted for 85% (29/34) of stereotactic biopsy failures.     

Detection of Contralateral Breast Cancer Using Diffusion-Weighted Magnetic Resonance Imaging in Women with Newly Diagnosed Breast Cancer: Comparison with Combined Mammography and Whole-Breast Ultrasound

ObjectiveTo compare the screening performance of diffusion-weighted (DW) MRI and combined mammography and ultrasound (US) in detecting clinically occult contralateral breast cancer in women with newly diagnosed breast cancer.Materials and MethodsBetween January 2017 and July 2018, 1148 women (mean age ± standard deviation, 53.2 ± 10.8 years) with unilateral breast cancer and no clinical abnormalities in the contralateral breast underwent 3T MRI, digital mammography, and radiologist-performed whole-breast US. In this retrospective study, three radiologists independently and blindly reviewed all DW MR images (b = 1000 s/mm² and apparent diffusion coefficient map) of the contralateral breast and assigned a Breast Imaging Reporting and Data System category. For combined mammography and US evaluation, prospectively assessed results were used. Using histopathology or 1-year follow-up as the reference standard, cancer detection rate and the patient percentage with cancers detected among all women recommended for tissue diagnosis (positive predictive value; PPV₂) were compared.ResultsOf the 30 cases of clinically occult contralateral cancers (13 invasive and 17 ductal carcinoma in situ [DCIS]), DW MRI detected 23 (76.7%) cases (11 invasive and 12 DCIS), whereas combined mammography and US detected 12 (40.0%, five invasive and seven DCIS) cases. All cancers detected by combined mammography and US, except two DCIS cases, were detected by DW MRI. The cancer detection rate of DW MRI (2.0%; 95% confidence interval [CI]: 1.3%, 3.0%) was higher than that of combined mammography and US (1.0%; 95% CI: 0.5%, 1.8%; p = 0.009). DW MRI showed higher PPV₂ (42.1%; 95% CI: 26.3%, 59.2%) than combined mammography and US (18.5%; 95% CI: 9.9%, 30.0%; p = 0.001).ConclusionIn women with newly diagnosed breast cancer, DW MRI detected significantly more contralateral breast cancers with fewer biopsy recommendations than combined mammography and US.     

Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates

PURPOSE: To measure the effect of biopsy device, probe size, mammographic lesion type, lesion size, and number of samples obtained per lesion on the ductal carcinoma in situ (DCIS) underestimation rate. MATERIALS AND METHODS: Nonpalpable breast lesions at 16 institutions received a histologic diagnosis of DCIS after 14-gauge automated large-core biopsy in 373 lesions and after 14- or 11-gauge directional vacuum-assisted biopsy in 953 lesions. The presence of histopathologic invasive carcinoma was noted at subsequent surgical biopsy. RESULTS: By performing the chi(2) test, independent significant DCIS underestimation rates by biopsy device were 20.4% (76 of 373) of lesions diagnosed at large-core biopsy and 11.2% (107 of 953) of lesions diagnosed at vacuum-assisted biopsy (P <.001); by lesion type, 24.3% (35 of 144) of masses and 12.5% (148 of 1,182) of microcalcifications (P <.001); and by number of specimens per lesion, 17.5% (88 of 502) with 10 or fewer specimens and 11.5% (92 of 799) with greater than 10 (P <.02). DCIS underestimations increased with lesion size. CONCLUSION: DCIS underestimations were 1.9 times more frequent with masses than with calcifications, 1.8 times more frequent with large-core biopsy than with vacuum-assisted biopsy, and 1.5 times more frequent with 10 or fewer specimens per lesion than with more than 10 specimens per lesion.     

Percutaneous vacuum-assisted core breast biopsy with upright stereotactic equipment. Indications,limitations and results

Purpose:
To assess the usefulness of stereotactic vacuum-assisted core breast biopsy (VCBB) performed using a stereotactic add-on device and film-screen technology with the patient in an upright seated position. Material and Methods:
We reviewed a series of 129 women with non-palpable mammographic abnormalities who required stereotactic VCBB from December 1999 to November 2000. Twenty-seven (20.9%) cases were excluded due to difficulties in keeping the correct position during the procedure, while the other 102 (79.1%) underwent successful VCBB. Patients with lesions consisting of either atypical ductal hyperplasia or lobular carcinoma in situ were considered for excisional biopsy. Patients with either ductal carcinoma in situ or infiltrating breast cancer were referred for definitive surgery. The results of stereotactic VCBB were correlated to the subsequent surgical histology. Results:
Stereotactic VCBB was interrupted because of bleeding in 1 case and vasovagal reaction in 5 cases. Two haematomas occurred after the procedure. Overall underestimation rate was 10.5%. No new lesions were discovered after a mean follow-up of 18.7 months. Conclusion:
Stereotactic VCBB performed using a standard add-on device with the patient in an upright seated position and analog technology is feasible in about 80% of cases, has a low complication rate, is not significantly time-consuming, and can offer the same accuracy as dedicated prone equipment.