Stereotactic biopsy of the breast using a decubitus table: comparison of histologic underestimation rates between 11- and 8-gauge vacuum-assisted breast biopsy

Kyoung Eun Lee,Hak Hee Kim,Hee Jung Shin,Joo Hee Cha

doi:10.1186/2193-1801-2-551

Abstract

PurposeTo evaluate efficacy of the stereotactic vacuum-assisted breast biopsy(SVAB) using a decubitus table and to compare histologic underestimation rate between 11gauge(G)- and 8G-probes.Materials and methodsPathologic results of SVAB using a decubitus table of 210(120 with 11G; 90 with 8G)-procedures in 208-women(median age, 48.8 years; range, 27-73 years) were retrospectively reviewed. SVAB was performed for suspicious microcalcification without mass on MMG and US. Surgury was performed for the diagnosis of malignant or high-risk lesion (65(31.0%)). Patients with benign diagnosis (120(57.1%)) underwent MMG follow-up (mean, 340-days). Histologic underestimation was defined as the need to upgrade ADH to DCIS or IDC, and DCIS to IDC at surgery. We analyzed the difference of procedure time, core number and core weight between 11G- and 8G-groups. Statistical significance was determined with chi-square test and 95%-CI for histologic underestimation, and student T-test for comparing two-groups.ResultsTargeting was successful in all 210-biopsies on specimen radiographs. Mean core number, core weight and procedure time were 17.5 (17.5 ± 4.9), 1.57 g (1.57 ± 0.56), 34.5 min (34.5 ± 16.4) with 11G-probe, and 9.6 (9.6 ± 6.2), 1.83g (1.83 ± 0.93), 22.1 min (22.1 ± 12.5) with 8G-probe. Findings in 120 (57.1%) of the biopsies were benign, 36 (17.2%) were high-risk, and 54 (25.7%) were malignant. Two (6.25%) of 32 cases of ADH were upgraded to DCIS in 11G-group, and 2 (9.09%) of 22 in 8G-group. No case of DCIS was upgraded to IDC. There was no increase of complication in 8G-group than 11G-group.ConclusionSVAB using a decubitus table is safe and effective method for the evaluation of suspicious microcalcification, and there was no significant difference between 11G- and 8G-probes. But, SVAB with 8G-probe is significantly more time efficient and effective procedure.

Highlights

Stereotactic vacuum-assisted breast biopsy (SVAB) is wellestablished reliable, less invasive and cost effective method alternative to traditional needle localization biopsy
Two (6.25%) of 32 cases of Atypical ductal hyperplasia (ADH) were upgraded to Ductal carcinoma in situ (DCIS) in 11G-group, and 2 (9.09%) of 22 in 8G-group
No case of DCIS was upgraded to Invasive ductal carcinoma (IDC)

Summary

Introduction

Stereotactic vacuum-assisted breast biopsy (SVAB) is wellestablished reliable, less invasive and cost effective method alternative to traditional needle localization biopsy A technique using add-on stereotactic unit with the patient in the decubitus position is used increasingly to avoid patient movement and syncope (Welle et al 2000; Doyle et al 1999). The decubitus table (DBITM table, Medical Positioning Inc, Washington, Kansas, U.S.A.) has been developed and used with add-on stereotactic unit. Increasing needle diameter of SVAB allows larger samples of tissue to be obtained. Increasing sample weights has resulted significantly decreased rates of histologic upgrade between 11- and 14-guage needles (Darling et al 2000). Larger biopsy needle has not decrease the upgrade rate of ADH between 9- and 11-gauge needles (Eby et al 2009). SVAB using an 8-gauge needle has not been evaluated well on English literature

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