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Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions.
Radiol Med. 2008 Feb; 113(1):65-75.RM

Abstract

PURPOSE

We evaluated the reliability of stereotactic vacuum-assisted breast biopsies (VAB) from our personal experience.

MATERIALS AND METHODS

Between January 2003 and December 2005, 268 patients underwent VAB with an 11-gauge probe at our institution. Inclusion criteria were nonpalpable lesions, undetectable by ultrasound and suspected at mammography (microcalcifications, circumscribed mass, architectural distortion), for which cytology and/or core biopsy could not provide a definite diagnosis. Lesion mammographic patterns were microcalcifications in 186 cases (77.5%), mostly localised clusters (130/186: 70%); circumscribed mass with or without microcalcifications in 36 cases (15%) and architectural distortion with or without microcalcifications in 18 cases (7.5%). On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification, 16 cases (7%) were graded as highly suspicious for malignancy (BI-RADS 5), 81 (34%) as suspicious for malignancy (BI-RADS 4b), 97 (40%) as indeterminate (BI-RADS 4a) and 46 (19%) as probably benign (BI-RADS 3). Lesion size was <or=10 mm in 161 cases (67%) and >20 mm in only 38 cases (16%), 30 of which appeared as microcalcifications.

RESULTS

In 28/268 lesions (10.5%) the biopsy could not be performed (nonidentification of the lesion; inaccessibility due to location or breast size). In 12/240 (5%) biopsies, the sample was not representative. Pathology revealed 100/240 (42%) malignant or borderline lesions and 140/240 (58%) benign lesions. Among the malignant lesions, 16/100 (16%) were invasive carcinoma [infiltrating ductal carcinoma (IDC) or infiltrating lobular carcinoma (ILC)], 13/100 (13%) were microinvasive (T1mic), 35/100 (35%) were ductal carcinoma in situ (DCIS), 9/100 (9%) were lobular carcinoma in situ (CLIS). Among the borderline lesions, 27/100 (27%) were atypical epithelial hyperplasia [atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)]. In 9/100 surgically treated lesions (9%), there was discordance between the microhistological findings of VAB and the pathological results of the surgical procedure: 8/9 were underestimated by VAB (four ADH vs. DCIS, three DCIS vs. IDC, one ADH vs. IDC), and 1/9 was overestimated (T1mic vs. DCIS). Complications following VAB occurred in 9/240 patients (3.7%).

CONCLUSIONS

In our experience, VAB showed fair reliability in the diagnosis of nonpalpable breast lesions despite a portion of failed (10.5%), nonsignificant (5%) procedures and underestimated lesions (9%).

Authors+Show Affiliations

Servizio di Radiosenologia, Casa di Cura P. Pederzoli, Via Monte Baldo 19, 37019, Peschiera del Garda, Verona, Italy.No affiliation info available

Pub Type(s)

Journal Article

Language

eng ita

PubMed ID

18338128

Citation

Tonegutti, M, and V Girardi. "Stereotactic Vacuum-assisted Breast Biopsy in 268 Nonpalpable Lesions." La Radiologia Medica, vol. 113, no. 1, 2008, pp. 65-75.
Tonegutti M, Girardi V. Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions. Radiol Med. 2008;113(1):65-75.
Tonegutti, M., & Girardi, V. (2008). Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions. La Radiologia Medica, 113(1), 65-75. https://doi.org/10.1007/s11547-008-0226-0
Tonegutti M, Girardi V. Stereotactic Vacuum-assisted Breast Biopsy in 268 Nonpalpable Lesions. Radiol Med. 2008;113(1):65-75. PubMed PMID: 18338128.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions. AU - Tonegutti,M, AU - Girardi,V, Y1 - 2008/02/25/ PY - 2007/01/22/received PY - 2007/02/28/accepted PY - 2008/3/14/pubmed PY - 2008/4/26/medline PY - 2008/3/14/entrez SP - 65 EP - 75 JF - La Radiologia medica JO - Radiol Med VL - 113 IS - 1 N2 - PURPOSE: We evaluated the reliability of stereotactic vacuum-assisted breast biopsies (VAB) from our personal experience. MATERIALS AND METHODS: Between January 2003 and December 2005, 268 patients underwent VAB with an 11-gauge probe at our institution. Inclusion criteria were nonpalpable lesions, undetectable by ultrasound and suspected at mammography (microcalcifications, circumscribed mass, architectural distortion), for which cytology and/or core biopsy could not provide a definite diagnosis. Lesion mammographic patterns were microcalcifications in 186 cases (77.5%), mostly localised clusters (130/186: 70%); circumscribed mass with or without microcalcifications in 36 cases (15%) and architectural distortion with or without microcalcifications in 18 cases (7.5%). On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification, 16 cases (7%) were graded as highly suspicious for malignancy (BI-RADS 5), 81 (34%) as suspicious for malignancy (BI-RADS 4b), 97 (40%) as indeterminate (BI-RADS 4a) and 46 (19%) as probably benign (BI-RADS 3). Lesion size was <or=10 mm in 161 cases (67%) and >20 mm in only 38 cases (16%), 30 of which appeared as microcalcifications. RESULTS: In 28/268 lesions (10.5%) the biopsy could not be performed (nonidentification of the lesion; inaccessibility due to location or breast size). In 12/240 (5%) biopsies, the sample was not representative. Pathology revealed 100/240 (42%) malignant or borderline lesions and 140/240 (58%) benign lesions. Among the malignant lesions, 16/100 (16%) were invasive carcinoma [infiltrating ductal carcinoma (IDC) or infiltrating lobular carcinoma (ILC)], 13/100 (13%) were microinvasive (T1mic), 35/100 (35%) were ductal carcinoma in situ (DCIS), 9/100 (9%) were lobular carcinoma in situ (CLIS). Among the borderline lesions, 27/100 (27%) were atypical epithelial hyperplasia [atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)]. In 9/100 surgically treated lesions (9%), there was discordance between the microhistological findings of VAB and the pathological results of the surgical procedure: 8/9 were underestimated by VAB (four ADH vs. DCIS, three DCIS vs. IDC, one ADH vs. IDC), and 1/9 was overestimated (T1mic vs. DCIS). Complications following VAB occurred in 9/240 patients (3.7%). CONCLUSIONS: In our experience, VAB showed fair reliability in the diagnosis of nonpalpable breast lesions despite a portion of failed (10.5%), nonsignificant (5%) procedures and underestimated lesions (9%). SN - 0033-8362 UR - https://www.unboundmedicine.com/medline/citation/18338128/Stereotactic_vacuum_assisted_breast_biopsy_in_268_nonpalpable_lesions_ L2 - https://dx.doi.org/10.1007/s11547-008-0226-0 DB - PRIME DP - Unbound Medicine ER -