Performance parameters for screening and diagnostic mammography: specialist and general radiologists

PURPOSE: To evaluate performance parameters for radiologists in a practice of breast imaging specialists and general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic mammographic studies. MATERIALS AND METHODS: Data (ie, patient age; family history of breast cancer; availability of previous mammograms for comparison; and abnormal interpretation, cancer detection, and stage 0-I cancer detection rates) were derived from review of mammographic studies obtained from January 1997 through August 2001. The breast imaging specialists have substantially more initial training in mammography and at least six times more continuing education in mammography, and they interpret 10 times more mammographic studies per year than the general radiologists. Differences between specialist and general radiologist performances at both screening and diagnostic examinations were assessed for significance by using Student t and chi(2) tests. RESULTS: The study involved 47,798 screening and 13,286 diagnostic mammographic examinations. Abnormal interpretation rates for screening mammography (ie, recall rate) were 4.9% for specialists and 7.1% for generalists (P <.001); and for diagnostic mammography (ie, recommended biopsy rate), 15.8% and 9.9%, respectively (P <.001). Cancer detection rates at screening mammography were 6.0 cancer cases per 1,000 examinations for specialists and 3.4 per 1,000 for generalists (P =.007); and at diagnostic mammography, 59.0 per 1,000 and 36.6 per 1,000, respectively (P <.001). Stage 0-I cancer detection rates at screening mammography were 5.3 cancer cases per 1,000 examinations for specialists and 3.0 per 1,000 for generalists (P =.012); and at diagnostic mammography, 43.9 per 1,000 and 27.0 per 1,000, respectively (P <.001). CONCLUSION: Specialist radiologists detect more cancers and more early-stage cancers, recommend more biopsies, and have lower recall rates than general radiologists.     

Stereotactic 11-gauge vacuum-assisted breast biopsy: a validation study

OBJECTIVE: The aim of our study was to determine the false-negative rate of stereotactic 11-gauge vacuum-assisted biopsy in a validation study of lesions that had subsequent surgical excision. MATERIALS AND METHODS: Retrospective review was performed of 318 lesions that underwent stereotactic 11-gauge vacuum-assisted biopsy and subsequent surgical excision. A false-negative case was defined as a pathologically proven cancer in which stereotactic biopsy yielded benign results without atypia. Medical records, imaging studies, and histologic findings were reviewed. RESULTS: False-negative findings were encountered at stereotactic 11-gauge vacuum-assisted biopsy in 3.3% (7/214) of pathologically proven cancers. False-negative findings occurred in 3.5% (4/115) of malignant calcification lesions versus 3.0% (3/99) of malignant masses (p = 1.0). The seven false-negative findings included five Breast Imaging Reporting and Data System (BI-RADS) category 5 lesions that yielded benign results at biopsy, one BI-RADS category 4 mass that benign breast tissue, and one BI-RADS category 4 cluster of calcifications in which no calcifications were retrieved. The false-negative rate was 10.0% (6/60) for radiologists who performed 15 or fewer previous stereotactic vacuum-assisted biopsy procedures versus 0.6% (1/154) for radiologists who performed more than 15 previous stereotactic vacuum-assisted biopsy procedures (p = 0.002). CONCLUSION: Stereotactic 11-gauge vacuum-assisted biopsy had a false-negative rate of 3.3% that diminished to 0.6% with experience. All false-negative findings could be prospectively identified because of failure to sample calcifications or imaging-histologic discordance.     

Core needle breast biopsy in patients undergoing anticoagulation therapy: preliminary results

OBJECTIVE: We compared complication rates of core needle breast biopsy in patients with and without concurrent anticoagulation therapy. SUBJECTS AND METHODS: Experience with 501 14-gauge and 179 11-gauge core needle breast biopsies was recorded prospectively. We performed 18 (3%) of 680 procedures on patients undergoing anticoagulation therapy. Eleven biopsies were performed in eight women treated with warfarin, one in a patient treated with heparin, and six in six women treated with aspirin. Ten biopsies were performed with sonographic guidance and a 14-gauge automated biopsy gun. Eight biopsies were performed with an 11-gauge vacuum-assisted probe and stereotactic guidance. RESULTS: Hematomas occurred in three (38%) of eight anticoagulated patients undergoing 11-gauge vacuum-assisted stereotactic biopsy, measuring 13 mm, 17 mm, and 40 mm. In patients not known to be anticoagulated, small hematomas were mammographically evident in 77 (45%) of 171 biopsies performed with an 11-gauge probe, averaging 8 mm (range, 2-17 mm); only 13 (8%) of 171 had hematomas larger than 10 mm. Small hematomas, averaging 6 mm (range, 2-12 mm) were evident mammographically in 45 (45%) of 100 stereotactic biopsies using a 14-gauge automated biopsy gun; three (3%) experienced hematomas larger than 10 mm. A 10-mm hematoma was evident during one (10%) of the 10 biopsies performed in patients undergoing anticoagulation therapy under sonographic guidance using a 14-gauge automated biopsy gun; small hematomas (mean, 10 mm) were noted during seven (2%) of 391 corresponding sonographically guided biopsies in patients not undergoing anticoagulation therapy. CONCLUSION: No patients undergoing anticoagulation therapy experienced clinically important complications; preliminary results suggest rates of hematoma formation similar to those in the control group. As such, discontinuing anticoagulation medication before core needle breast biopsy may be unnecessary when the need for biopsy is urgent.     

Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast

OBJECTIVE: The purpose of this study was to compare the outcome of sonographically guided core biopsies performed with the 14-gauge automated gun with the outcome of those performed with the 11-gauge vacuum-assisted device. Outcome was defined in terms of missed tumors, the need (both immediate and delayed) for a second biopsy, histologic underestimation, and complication rates. MATERIALS AND METHODS: We retrospectively reviewed all sonographically guided core biopsies performed between January 1997 and August 2001. Before February 2000, biopsies were performed using the 14-gauge automated gun and after that time, with either the 14-gauge automated gun or the 11-gauge vacuum-assisted device. During the study period, 181 biopsies were performed with the 14-gauge automated gun and 100 with the 11-gauge vacuum-assisted device. RESULTS: The histologic results of the core biopsies were similar for the group who underwent biopsy with the 14-gauge automated gun and the group who underwent biopsy with the 11-gauge vacuum-assisted device: malignant, 19% versus 19%; benign, 78% versus 79%; and high-risk lesion or other, 3% versus 2%, respectively (p > 0.7). Complications were rare and similar for both methods: 2% for the 14-gauge automated gun and 3% for the 11-gauge vacuum-assisted device (p = 0.46). A second biopsy was recommended immediately after the first in 14% of the patients who underwent biopsy with the 14-gauge automated gun versus 17% of those who underwent biopsy with the 11-gauge vacuum-assisted device (p = 0.47). Recommendation for delayed rebiopsy due to interval change occurred in 2.5% of the patients who underwent biopsy with the 14-gauge automated gun method and 3% of those who underwent biopsy with the 11-gauge vacuum-assisted device (p = 0.94). CONCLUSION: No significant differences were found in the outcomes of sonographically guided core biopsies performed with the automated gun compared with those performed with the vacuum-assisted device in terms of missed cancers, underestimation, complications, or the need (immediate or delayed) for a second biopsy.     

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

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

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.     

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.     

Stereotactic breast biopsy of noncalcified lesions: a cost-minimization analysis comparing 14-gauge multipass automated core biopsy to 14- and 11-gauge vacuum-assisted biopsy

A decision model was used to compare the relative costs of the 14-gauge automated gun technique to the 14-gauge and 11-gauge vacuum-assisted techniques for stereotactic biopsy of noncalcified breast lesions. Probability and cost variables were estimated from clinical experience with 76 automated gun biopsies, seventy-eight 14-gauge vacuum-assisted biopsies and thirty-nine 11-gauge vacuum-assisted biopsies. The 14-gauge automated gun was the preferred strategy from a cost standpoint: the 14-gauge vacuum technique was 1.19 times more expensive, and the 11-gauge was 1.22 times more expensive.     

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.     

Learning curve for stereotactic breast biopsy: how many cases are enough?

OBJECTIVE: The objective of this study was to evaluate the learning curve for stereotactic breast biopsy. MATERIALS AND METHODS: Retrospective review was performed of 923 consecutive lesions that underwent stereotactic breast biopsy performed by one of six radiologists. Four hundred fourteen lesions had 14-gauge automated core biopsy, and 509 subsequent lesions had vacuum-assisted biopsy (14-gauge in 163 and 11-gauge in 346). Medical records were reviewed to determine the technical success rate and false-negative rate as a function of operator experience. RESULTS: For 14-gauge automated core biopsy, a significantly lower technical success rate was seen for the first five cases of each radiologist than for subsequent cases (25/30 = 83.3% versus 366/384 = 95.3%, p < 0.02) and for the first 20 cases than for subsequent cases (90/100 = 90% versus 284/296 = 95.9%, p < 0.05). For 11-gauge vacuum-assisted biopsy, a significantly lower technical success rate was seen for the first five cases than for subsequent cases (17/20 = 85.0% versus 310/322 = 96.3%, p < 0.05) and for the first 15 cases than for subsequent cases (54/60 = 90.0% versus 273/283 = 96.5%, p = 0.03). The false-negative rate was higher for the first 15 cases compared with subsequent cases both for stereotactic 14-gauge automated core biopsy (4/31 = 12.9% versus 3/115 = 2.6%, p < 0.04) and for stereotactic 11-gauge vacuum-assisted biopsy (2/27 = 7.4% versus 0/85 = 0%, p < 0.06). CONCLUSION: A learning curve exists for stereotactic breast biopsy. Significantly higher technical success rates and lower false-negative rates were observed after the first five to 20 cases for 14-gauge automated core biopsy and after the first five to 15 cases for 11-gauge vacuum-assisted biopsy. Even after a radiologist has experience with stereotactic biopsy, changes in equipment may result in a new learning curve.     

Cost-effectiveness of stereotactic 11-gauge directional vacuum-assisted breast biopsy

OBJECTIVE: The purpose of our study was to determine the frequency with which stereotactic 11-gauge directional vacuum-assisted breast biopsy obviated a surgical procedure and to calculate cost savings attributable to that biopsy method. MATERIALS AND METHODS: We retrospectively reviewed 200 consecutive solitary nonpalpable lesions on which stereotactic 11-gauge directional vacuum-assisted breast biopsy was performed. Cost savings were calculated using Medicare reimbursements. Mammograms, histologic findings, and medical records were reviewed. RESULTS: Stereotactic 11-gauge directional vacuum-assisted biopsy obviated a surgical procedure in 151 (76%) of 200 lesions, including 112 (73%) of 154 calcific lesions and 39 (85%) of 46 masses. Reasons for not obviating a surgical procedure in 49 lesions (25%) included recommendation for surgical biopsy in 35 lesions (18%), small carcinomas treated by excision in 10 lesions (5%), and histologic underestimation in four lesions (2%). Stereotactic 11-gauge directional vacuum-assisted biopsy decreased the cost of diagnosis by S264 per case, a 20% ($264/$1289) decrease in the cost of diagnosis compared with surgical biopsy. Of 200 lesions that had stereotactic 11-gauge directional vacuum-assisted biopsy, 106 (53%) would not have been amenable to 14-gauge automated core biopsy because of their small size, their superficial location, or inadequate breast thickness. CONCLUSION: Stereotactic 11-gauge directional vacuum-assisted breast biopsy obviated a surgical procedure in 76% of lesions, yielding a 20% decrease in cost of diagnosis compared with surgical biopsy. Although savings per case are modest, 11-gauge directional vacuum-assisted biopsy expands the spectrum of lesions amenable to stereotactic biopsy, increasing cost savings in the population.     

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.     

Learning curve for add-on stereotactic core needle breast biopsy

Purpose: To evaluate the learning curve for an add-on 14 G stereotactic core needle biopsy (SCNB).

Material and Methods: A total of 231 non-palpable breast lesions that had undergone add-on SCNB were evaluated in this prospective study. Five radiologists performed their first three biopsies under supervision. Subsequent, independently performed, biopsies were also evaluated. The samples were collected in three different containers: the first sample in container A, the second and third samples in container B, and subsequent samples in container C (available for four radiologists from the first biopsy on). Technically successful biopsies and false-negative rate in three container combinations (A, A+B, A+B+C) were reported as a function of operator experience.

Results: Technically unsuccessful biopsies occurred significantly more often in microcalcifications than in masses (14.9% versus 3.8%; P = 0.04). For microcalcifications, the rate of successful biopsies was 75% (18/24) for the first 5 biopsies and 87.8% (79/90) for the subsequent biopsies (P = 0.335); rates for the masses were 95.7% (22/23) and 96.3% (79/82) (P = 1.0), respectively. A tendency was noted for the false-negative rate to be higher for the first five biopsies in three container combinations than in subsequent cases.

Conclusion: Our results support the existence of a learning curve, especially in the biopsy of microcalcifications. More than three mentor-guided biopsies are needed.     

Evaluation of the stereotactic 8G vacuum-assisted breast biopsy in the histologic evaluation of suspicious mammography findings (BI-RADS IV)

PURPOSE: The purpose of this study was to evaluate the potential of the new 8G stereotactic vacuum-assisted breast biopsy (ST-driver, Mammotome; Ethicon Endosurgery) in the histologic evaluation of BI-RADS IV microcalcifications. MATERIALS AND METHODS: Fifty-eight patients with 61 mammographic BI-RADS IV microcalcifications underwent stereotactic vacuum-assisted breast biopsy (SVAB). The new 8G system was mounted on the ST driver, which was formerly used only with the hand-held version under sonographic guidance. The evaluation criteria for each biopsy were minimally invasive and operative histologies, the time needed for biopsy, the amount of bleeding, number of rotations and specimen, the degree of resection, and the complications. RESULTS: Fifty-eight of 61 biopsies were technically successful because > or = 50% were resected (29 x 100%, 8 x 90%, 5 x 80%, 6 x 70%, 3 x 50%, 3 x 0%). In 7 cases with representative biopsies of segmental suspicious microcalcifications, the degree of resection could not be exactly measured. All but 2 biopsies were performed without clinically relevant complications and after gaining enough specimens (? 12.6 specimen, 1.85 rotations). Those 2 patients showed evidence of severe bleeding into the breast tissue and operative revision had to be performed (3.5%). The size of intramammary hematoma was measurable in 27 biopsies and showed a range from 0.5 to 5 cm (? 2.7 cm). The average external bleeding was still low with 16 mL (5-80 mL). In 3 of 61 lesions, it was not possible to gain representative tissue as a result of displacement of the lesion after introducing or shooting the needle. The average time needed for all biopsies was 28.2 minutes for all but 5 very complicated biopsies, which took 16.1 minutes. The histologic findings with further operative workup were: 10 ductal carcinomas in situ (DCIS), 4 atypical ductal hyperplasias, 1 atypical lobular hyperplasias (ALH), 3 lobular carcinomas in situ (LCIS), and 6 invasive ductal carcinomas. In 7 of 12 of the initial DCIS histologies, the operative histology was also DCIS, whereas in 4 of 12, no residual malignant tumor was found. In 1 of 12 patients with an initial DCIS histology, operative histology revealed invasive ductal cancer (8.3%). The cases with lobular lesions (ALH, LCIS) did not show any evidence for residual tissue in the operative workup. Most frequent benign histologies were mastopathy (13), ductal hyperplasia (9), fibroadenoma (8), and sclerosing adenosis (5). The control examinations (maximum 1 year) did not show any signs for a false-negative biopsy. CONCLUSION: The 11-G SVAB has proven to be a perfect adjunct to the existing breast biopsy methods. The new 8G SVAB speeds up the method when used for the same size of lesions and enables the user to representatively biopsy lesions up to 3 cm in diameter. The method is still minimally invasive; however, the amount of hematomas as well as clinically relevant complications is increased.     

Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy

OBJECTIVE: This review was undertaken to determine the reliability of the histologic diagnosis of atypical ductal hyperplasia (ADH) made from tissue obtained by 11-gauge stereotactically guided directional vacuum-assisted biopsy of impalpable breast lesions. MATERIALS AND METHODS: Four hundred twenty-two 11-gauge stereotactically guided vacuum-assisted breast biopsies were performed at our institution between November 5, 1996, and June 30, 1998. Biopsies were performed with the patient prone on a dedicated stereotactic biopsy table. A directional vacuum-assisted biopsy device was used. Eight to 24 cores (mean, 13.4) were harvested from each lesion. Radiography of core specimens was performed in cases in which the target lesion contained microcalcifications. Twenty (4.7%) of the 422 biopsies yielded a histopathologic diagnosis of ADH. Surgical excision of 16 of the 20 lesions was subsequently performed. We compared the histopathologic results of the core extracted and the corresponding surgically excised tissue. RESULTS: Of the 16 surgically excised lesions, four (25.0%) retained the diagnosis of ADH. Four (25%) were upgraded to carcinoma: Two (12.5%) were ductal carcinoma in situ without comedonecrosis, one (6.3%) was invasive carcinoma, and one (6.3%) was tubular carcinoma. Of the remaining eight surgically excised lesions, six (37.5%) were interpreted as benign fibrocystic changes with ductal hyperplasia without atypia, and two (12.5%) were interpreted as lobular carcinoma in situ. CONCLUSION: Because ADH was underdiagnosed in 25% of the lesions, we recommend that surgical excision be performed whenever ADH is found in tissue obtained from 11-gauge directional vacuum-assisted breast biopsy.     

Rapid 3D reconstruction guided embolization for catastrophic bleeding following vacuum assisted breast biopsy; A case report and review of the literature

The most clinically significant complication associated with stereotactic core needle biopsy of the breast is hematoma formation, which only occurs in less than 1% of biopsies and may require treatment. Cases of uncontrollable bleeding, refractory to repeated compression, resulting from biopsy are exceedingly rare. We present a case of catastrophic, uncontrollable bleeding and large hematoma formation resulting from stereotactic vacuum-assisted breast biopsy of a breast mass identified in screening mammography. Percutaneous embolization was planned and guided using 3D reconstructions from computed tomographic angiography, and bleeding was successfully controlled with micro-coil embolization.     

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.     

Clinical experience with MRI-guided vacuum-assisted breast biopsy

OBJECTIVE: The objective of our study was to evaluate a new commercially available method of MRI-guided vacuum-assisted breast biopsy using an open coil and a closed 1.5-T scanner. MATERIALS AND METHODS: Consecutive MRI-guided vacuum-assisted breast biopsies of 38 lesions in 28 women performed between May and September 2003 at two practice sites in the United States were retrospectively reviewed. Lesion characteristics including size, morphology, and enhancement were recorded. Times to perform each procedure, defined as the time from the start of the first localizing scan to the final scan after biopsy, were recorded. Histologic results for all lesions were obtained, and surgical, imaging, or clinical follow-up was performed. RESULTS: Enhancing masses and foci ranged from 2.5 to 19 mm. Nonmasslike enhancements ranged from 6 to 70 mm. All 38 biopsies (100%) were technically successful, and no complications were associated with any of the biopsy procedures. The average time to perform the 19 single-site MRI-guided procedures was 38 min (range, 23-57 min). The 11 multiple-site biopsies performed in a single breast averaged 59 min (range, 51-68 min), and eight bilateral biopsies averaged 64 min (range, 46-80 min). Histologic results from vacuum-assisted breast biopsy revealed malignancy in 14 lesions (37%), atypical ductal hyperplasia in two lesions (5%), and benign findings in 22 lesions (58%). One of two lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery, for an overall cancer yield of 40% (15/38). CONCLUSION: This new method of MRI-guided vacuum-assisted breast biopsy is a safe, effective, and time-efficient means of MRI-guided tissue sampling.     

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.     

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.