Image-guided Breast Biopsy Research Articles

Tips and Tricks for Image-Guided Breast Biopsies: Technical Factors for Success.

Image-guided biopsy is an integral step in the diagnosis and management of suspicious image-detected breast or axillary lesions, allowing for accurate diagnosis and, if indicated, treatment planning. Tissue sampling can be performed under guidance of a full spectrum of breast imaging modalities, including stereotactic, tomosynthesis, sonographic, and MRI, each with its own set of advantages and limitations. Procedural planning, which includes consideration of technical, patient, and lesion factors, is vital for diagnostic accuracy and limitation of complications. The purpose of this paper is to review and provide guidance for breast imaging radiologists in selecting the best procedural approach for the individual patient to ensure accurate diagnosis and optimal patient outcomes. Common patient and lesion factors that may affect successful sampling and contribute to postbiopsy complications are reviewed and include obesity, limited patient mobility, patient motion, patients prone to vasovagal reactions, history of anticoagulation, and lesion location, such as proximity to vital structures or breast implant.

Assessing the Correlation between Allostatic Load and False-Positive Image-Guided Breast Biopsies.

Background: Allostatic load (AL) is the accumulation of physiological dysregulation attributed to repeated activation of the stress response over a lifetime. We assessed the utility of AL as a prognostic measure for high-risk benign breast biopsy pathology results. Method: Eligible patients were women 18 years or older, with a false-positive outpatient breast biopsy between January and December 2022 at a tertiary academic health center. AL was calculated using 12 variables representing four physiological systems: cardiovascular (pulse rate, systolic and diastolic blood pressures, total cholesterol, high-density lipoprotein, and low-density lipoprotein); metabolic (body mass index, albumin, and hemoglobin A1C); renal (creatinine and estimated glomerular filtration rate); and immune (white blood cell count). Multivariable logistic regression was used to assess the association between AL before biopsy and breast biopsy outcomes controlling for patients' sociodemographics. Results: In total, 170 women were included (mean age, 54.1 ± 12.9 years): 89.4% had benign and 10.6% had high-risk pathologies (radial scar/complex sclerosing lesion, atypical ductal or lobular hyperplasia, flat epithelial atypia, intraductal papilloma, or lobular carcinoma in-situ). A total of 56.5% were White, 24.7% Asian, and 17.1% other races. A total of 32.5% identified as Hispanic. The mean breast cancer risk score using the Tyrer-Cuzick model was 11.9 ± 7.0. In multivariable analysis, with every one unit increase in AL, the probability of high-risk pathology increased by 37% (odds ratio, 1.37; 95% confidence interval, 1.03, 1.81; p = 0.03). No significant association was seen between high-risk pathology and age, ethnicity, breast cancer risk, or area deprivation index. Conclusion: Our findings support that increased AL, a biological marker of stress, is associated with high-risk pathology among patients with false-positive breast biopsy results.

Radiologist Accuracy in Predicting Pathology in Breast Imaging

Introduction: Breast cancer, the most prevalent cancer in women and second only to lung cancer in female mortality, has seen rising incidence, especially during the 1980s and 1990s due to increased mammography screening. Screening’s primary goal is early tumor detection, reducing mortality by over 40%. Yet, it has downsides, including false-positive cases of benign biopsies and potential increased patient anxiety and stress. The average recall rate from screening mammograms is 5-10%. Among women requiring biopsy, the anticipated rate of malignant findings range between 30-50%. With the evolution of image-guided breast biopsy techniques, concerns have risen regarding the escalating frequency of breast biopsies. The possible causes are overlapping imaging characteristics of benign and malignant pathologies, patients’ anxiety, litigation risk and radiologist years of experience. A radiologists’ ability to predict breast histology from imaging findings remains an understudied domain. This study’s core purpose is to comprehensively analyze the ability of a radiologist to predict benign versus malignant results to provide guidance in reducing the number of benign biopsies. Methods: This prospective study involved radiologists completing survey sheets when recommending biopsies and when performing the biopsy, predicting benign vs malignant, specific pathology, with confidence interval. Predictions were compared to the final biopsy results to determine accuracy. All patients who underwent biopsy at our institutions were included in the data. Data was categorized as either concordant or discordant when comparing predicted pathology results to actual. Results: The accuracy of radiologist prediction from initial diagnostic imaging when compared to actual pathology results in the study population is 71% (95% CI,61.8%-79.37%) with a sensitivity of 75 % (95% CI, 60.4%-86.36%). The accuracy of radiologist prediction at biopsy when compared to actual pathology results is 80.79% (95% CI, 75.89%-85.08%) with sensitivity of 79.77% (95% CI, 73%-85.49%). The accuracy of less to moderately experienced radiologists to highly experienced radiologists is similar, 78.2% vs 81.0%. Further analysis of specific pathology prediction reveals that fibroadenoma is the most common benign pathology encountered, the prediction of which by imaging alone/at biopsy is 65%/68%. In the malignant category, invasive ductal carcinoma is the most common pathology encountered where the prediction is 68%/85%. Conclusions: This data will potentially help radiologists gain confidence in watching likely benign lesions based on imaging features (assigned as BIRADS 3) to reduce benign biopsies.

A twin convolutional neural network with hybrid binary optimizer for multimodal breast cancer digital image classification

There is a wide application of deep learning technique to unimodal medical image analysis with significant classification accuracy performance observed. However, real-world diagnosis of some chronic diseases such as breast cancer often require multimodal data streams with different modalities of visual and textual content. Mammography, magnetic resonance imaging (MRI) and image-guided breast biopsy represent a few of multimodal visual streams considered by physicians in isolating cases of breast cancer. Unfortunately, most studies applying deep learning techniques to solving classification problems in digital breast images have often narrowed their study to unimodal samples. This is understood considering the challenging nature of multimodal image abnormality classification where the fusion of high dimension heterogeneous features learned needs to be projected into a common representation space. This paper presents a novel deep learning approach combining a dual/twin convolutional neural network (TwinCNN) framework to address the challenge of breast cancer image classification from multi-modalities. First, modality-based feature learning was achieved by extracting both low and high levels features using the networks embedded with TwinCNN. Secondly, to address the notorious problem of high dimensionality associated with the extracted features, binary optimization method is adapted to effectively eliminate non-discriminant features in the search space. Furthermore, a novel method for feature fusion is applied to computationally leverage the ground-truth and predicted labels for each sample to enable multimodality classification. To evaluate the proposed method, digital mammography images and digital histopathology breast biopsy samples from benchmark datasets namely MIAS and BreakHis respectively. Experimental results obtained showed that the classification accuracy and area under the curve (AUC) for the single modalities yielded 0.755 and 0.861871 for histology, and 0.791 and 0.638 for mammography. Furthermore, the study investigated classification accuracy resulting from the fused feature method, and the result obtained showed that 0.977, 0.913, and 0.667 for histology, mammography, and multimodality respectively. The findings from the study confirmed that multimodal image classification based on combination of image features and predicted label improves performance. In addition, the contribution of the study shows that feature dimensionality reduction based on binary optimizer supports the elimination of non-discriminant features capable of bottle-necking the classifier.

Continuity of Radiologists Between Diagnostic Breast Imaging and Image-Guided Breast Biopsy: Impact on Patient-Reported Biopsy Morbidity Experiences.

To determine whether continuity of care between diagnostic breast imaging and subsequent image-guided breast biopsy could reduce patient-reported biopsy-related morbidity. This was a prospective, pragmatically randomized, 2-arm health utilities analysis of 200 women undergoing diagnostic breast imaging followed by US- or stereotactic-guided breast biopsy at a single quaternary care center from September 3, 2019, to April 10, 2023. Breast biopsy-naive women with a BI-RADS 4 or 5 finding at diagnostic imaging were randomly scheduled for the typically first available biopsy appointment. One day after biopsy, enrolled patients were administered the Testing Morbidities Index (TMI). The primary outcome was the difference in TMI summary utility scores in patients who did vs did not have the same radiologist perform diagnostic imaging and biopsy. Response rates were 63% (100/159) for the different radiologist cohort and 71% (100/140) for the same radiologist cohort; all respondents answered all questions in both arms. Mean time to biopsy was 7 ± 6 days and 10 ± 9 days, and the number of participating radiologists was 11 and 18, respectively. There was no difference in individual measured domains (pain, fear, or anxiety before procedure; pain, embarrassment, fear, or anxiety during procedure; mental or physical impact after procedure; all P >.00625) or in overall patient morbidity (0.83 [95% CI, 0.81-0.85] vs 0.82 [95% CI: 0.80-0.84], P = .66). Continuity of care between diagnostic breast imaging and image-guided breast biopsy did not affect morbidity associated with breast biopsy, suggesting that patients should be scheduled for the soonest available biopsy appointment rather than waiting for the same radiologist.

Imaging Modalities for Breast Cancer: Role of the Radiologist

Breast cancer is the third most common cancer in the world after lung and colon , and overall the commonest cancer among women in India. Early detection and diagnosis help in providing early treatment to the patients thereby significantly impacting overall survival rate. The different imaging modalities at our disposal include ultrasonography, mammography and magnetic resonance imaging and computed tomography. Over and above, nowadays with emergence of breast conservative surgery for early stage cancers the role of the radiologist in performing various imaging guided breast interventions is also evolving. Imaging guided breast biopsies, marker placement, stereotactic biopsy, wire localization are some of the commonly performed procedures by breast radiologists in addition to other pain and palliation measures as described later in the article. In this review / perspective article, therefore, we try to discuss the salient features of the common imaging modalities available for breast cancer detection and staging as well as explore the emerging role of imaging guided interventions for breast cancer in this era of multidisciplinary approach.

CLINICAL VALUE OF MAGNETIC RESONANCE IMAGING-GUIDED CORE NEEDLE AND VACUUM-ASSISTED BREAST BIOPSIES

Breast cancer is the most common oncological disease in women. When changes in the breasts are not visible on an ultrasound or mammogram, they can be detected by a magnetic resonance imaging (MRI) scan. A biopsy of the breast tissue is performed to examine the changes and predict the most suitable further treatment method. Most often, a core needle biopsy is performed under ultrasound or mammography guidance, but if lesions are only visible on MRI images, the biopsy should be performed under MRI control. MRI-guided biopsy is a relatively new diagnostic method. The aim of our study was to assess the clinical value of MRI-guided core nee­dle and vacuum-assisted core needle breast biopsies. We conducted a systematic literature analysis. Articles were retrieved from PubMed and ClinicalKey electronic data­bases. Eligible articles were selected based on inclusion and exclusion criteria. 12 articles were included from 512 publications. We conclude that MRI -guided core needle and vacuum-assissted core needle biopsies are a safe and effective method of taking a breast tissue biopsy, allowing you to assess abnormalities that are not visible on mammography or ultrasound. MRI-guided biopsy is appropriate for all patients with suspicious lesions seen only on MRI, irrespective of breast cancer risk, as ma­lignant lesions are likely to be found in ~21% of patients. MRI-guided core needle biopsies have a low compli­cation rate. The diagnostic performance of MRI-guided core needle biopsy (sensitivity ~ 93%) is comparable to the diagnostic performance of other image-guided breast biopsy techniques.

Bleeding Events After Image-Guided Breast Biopsies: Comparison of Patients Temporarily Discontinuing Versus Maintaining Antithrombotic Therapy During Biopsy.

BACKGROUND. Antithrombic (AT) therapy is commonly temporarily discontinued before breast core needle biopsy (CNB), introducing risks of thrombotic events and diagnostic delay. OBJECTIVE. The purpose of this article was to compare the frequency of postbiopsy bleeding events among patients without AT use, patients temporarily discontinuing AT therapy, and patients maintaining AT therapy during breast CNB. METHODS. This retrospective study included 5302 patients (median age, 52 years) who underwent image-guided breast or axillary CNB between January 1, 2014, and December 31, 2019. From January 1, 2014, to December 31, 2016, patients temporarily discontinued all AT therapy for 5 days before CNB; from January 1, 2017, to December 31, 2019, patients maintained AT therapy during CNB. Immediate postbiopsy mammograms were reviewed for imaging-apparent hematoma. Patients were called 24-48 hours after biopsy and asked regarding palpable hematoma and breast bruise. The EMR was reviewed for clinically significant postbiopsy hematoma (i.e., hematoma requiring drainage, primary care or emergency department visit for persistent symptoms, or hospital admission). Bleeding events were compared among groups, including Firth bias-reduced multivariable logistic regression analysis. RESULTS. During CNB, 4665 patients were not receiving AT therapy, 423 temporarily discontinued AT therapy, and 214 maintained AT therapy. Imaging-apparent hematoma occurred in 3% of patients without AT use, 6% of patients discontinuing AT therapy, and 7% of patients maintaining AT therapy (p = .60 [discontinuing vs maintaining]). Palpable hematoma occurred in 2% of patients without AT use, 4% of patients maintaining AT therapy, and 4% of patients discontinuing AT therapy (p = .92 [discontinuing vs maintaining]). Breast bruise occurred in 2% of patients without AT use, 1% of patients discontinuing AT therapy, and 6% of patients maintaining AT therapy (p < .001 [discontinuing vs maintaining]). In multivariable analysis adjusting for age, biopsy imaging modality, needle gauge, number of biopsy samples, and pathologic result, discontinued AT therapy (using maintained AT therapy as reference) was not a significant independent predictor of imaging-apparent hematoma (p = .23) or palpable hematoma (p = .91) but independently predicted decreased risk of bruise (OR = 0.11, p < .001). No patient developed clinically significant postbiopsy hematoma. CONCLUSION. Frequencies of imaging-apparent and palpable hematoma were not significantly different between patients temporarily discontinuing versus maintaining AT therapy. CLINICAL IMPACT. The findings support the safety of continuing AT therapy during CNB. Patients who maintain AT therapy should be counseled regarding risk of bruise.

Results of Magnetic Resonance Imaging (MRI) Screening in Patients at High Risk for Breast Cancer.

Screening MRI as an adjunct to mammography is recommended by the ACS for patients with a lifetime risk for breast cancer > 20%. While the benefits are clear, MRI screening is associated with an increase in false-positive results. The purpose of this study was to analyze our institutional database of high-risk patients and assess the uptake of screening MRI examinations and the results of those screenings. Our institutional review board-approved High-Risk Breast Cancer Database was queried for patients enrolled from January 2017 to January 2023 who were at high risk for breast cancer in a comparative analysis between those who were screened versus not screened with MRIs. Variables of interest included risk factor, background, MRI screening uptake, and frequency and results of image-guided breast biopsies. A total of 254 of 1106 high-risk patients (23%) had MRI screening. Forty-six of 852 (5.3%) patients in the non-MRI-screened cohort and nine of 254 (3.5%) patients in the MRI-screened cohort were diagnosed with a malignant lesion after image-guided biopsy (p = 0.6). There was no significant difference between MRI and non-MRI guided biopsies in detecting breast cancer. All malignant lesions were T1 or in situ disease. The 254 patients in the MRI-screened group underwent 185 biopsies. Fifty-seven percent of MRI-guided biopsies yielded benign results. Although the addition of MRI screening in our high-risk cohort did not produce a significant number of additional cancer diagnoses, patients monitored in our high-risk cohort who developed breast cancer were diagnosed at very early stages of disease, underscoring the benefit of participation in the program.

Atypical hyperplasia of the breast: Clinical cases and management strategies.

Atypical hyperplasia of the breast is a histopathologic lesion identified incidentally on image-guided breast biopsy. It is associated with a substantial increase in lifetime risk for breast cancer. Clinicians should counsel women with atypical hyperplasia regarding risk-reducing strategies, which include preventive endocrine therapy options, enhanced surveillance imaging, and lifestyle modifications. In this review, we describe 5 different but common clinical case scenarios for atypical hyperplasia of the breast and review management strategies for each scenario.

Sixteen-Year Institutional Review of Magnetic Resonance Imaging-Guided Breast Biopsies: Trends in Histologic Diagnoses With Radiologic Correlation.

Breast magnetic resonance imaging (MRI) is an important imaging tool for the management of breast cancer patients and for screening women at high risk for breast cancer. To examine long-term trends in the distribution of histologic diagnoses obtained from MRI-guided breast biopsies. Retrospective analysis. We retrospectively reviewed the distribution of histologic diagnoses of MRI-guided breast biopsies from 2004 to 2019. All cases underwent central pathology review and lesions were classified based on the most prominent histologic finding present. Magnetic resonance imaging features were extracted from radiology reports when available and correlated with pathology diagnoses. Four hundred ninety-four MRI-guided biopsies were performed on 440 patients; overall, 73% of biopsies were benign and 27% were malignant. The annual percentages of benign and malignant diagnoses remained similar throughout the 16-year period. Of the benign entities commonly identified, the percentage of benign papillary and sclerosing lesions detected in the benign biopsies increased significantly (13% in 2004-2011 vs 31% in 2012-2019, P = .03). The mean size of malignant lesions was larger than benign lesions (30.1 mm compared with 14.2 mm, P = .045); otherwise, there were no distinguishing radiologic features between benign and malignant lesions. The specificity of breast MRI remained constant over a 16-year period; however, there was a shift in the distribution of benign diagnoses with increased detection and biopsy of benign papillary and sclerosing lesions. Monitoring the distribution of breast MRI biopsy diagnoses over time with radiology-pathology correlation might improve the suboptimal specificity of breast MRI.

Interpretation of Image-Guided Biopsy Results and Assessment

The success of image-guided breast biopsy depends on the biopsy method, needle selection, and appropriate technique based on the accurate judgment by the radiologist at biopsy. However, insufficient or inappropriate sampling of specimens may result in false-negative results or pathologic underestimation. Therefore, image-pathology concordance assessments after biopsy are essential for appropriate patient management. Particularly, the assessment of image-pathology concordance can avoid false-negative reports of breast cancer as a benign pathology. Therefore, this study aimed to discuss factors that impact the accurate interpretation of image-guided breast biopsy along with the appropriate assessments.

High-risk breast lesions: role of multi-parametric DCE-MRI in detection and histopathological upgrade prediction

BackgroundHigh-risk breast lesions represent 3–21% of all breast lesions and are non-obligate precursors of malignancy. Various studies have evaluated the value of DCE-MRI including DWI and ADC mapping in the detection of high-risk breast lesions, differentiating them from malignant lesions and predicting upgrade risk after surgical excision reducing misdiagnosis and overtreatment. This study is a retrospective review of all image-guided breast biopsy procedures performed in 2021 at our institution, identified 68 patients with histopathologically proven high-risk breast and available MRI examinations with no concurrent ipsilateral malignancy. Image analysis of MRI examinations included morphological criteria, enhancement pattern, dynamic curves, DWI and ADC mapping assessment. Since our knowledge of high-risk breast lesions is still growing, this study is important to evaluate the merits of DCE-MRI in the assessment of high-risk breast lesions, to allow optimization of treatment, better limit it to those women at risk, and avoid overtreatment in women at low risk.ResultsThe mean ADC value of high-risk breast lesions was not significantly different from that of malignant breast lesions (p value = 0.015). Non-mass enhancement and type III enhancing curve proved to be significant indicators of high-risk breast lesions upgrade in surgical pathology. Cut-off average ADC value for differentiating upgraded high-risk lesions from non-upgraded high-risk lesions proved 1.24 mm2/sec with sensitivity and specificity of 94 & 100%, respectively.DiscussionManagement of high-risk breast lesions is important in the screening setting, as they are non-obligate precursors of malignancy, and also function as risk indicators. Frequency and upgrade rates of high-risk lesions detected by MRI provide a reference for clinical management. DCE-MRI has a high negative predictive value in predicting the upgrade risk of high-risk lesions. In this study, non-mass enhancement and type III curve were proven to be indicators of high-risk lesion upgrade. Limitations of the study included small number of patients and limited follow-up period.ConclusionsThe use of multi-parametric DCE-MRI including DWI and ADC mapping provides complementary information to detect high-risk breast lesions and predict their upgrade rate.

Robust Deflected Path Planning Method for Superelastic Nitinol Coaxial Biopsy Needle: Application to an Automated Magnetic Resonance Image-Guided Breast Biopsy Robot

The authors have developed magnetic resonance imaging-guided breast biopsy robot (MRSON), which is an automated magnetic resonance (MR) guided breast needle biopsy robot that works in an intragantry space with (3+1) degrees of freedom. This robot utilizes a bendable superelastic Nitinol biopsy needle. The MRSON’s needle path is normally parallel to the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">X</i> -axis of the Cartesian coordinates. However, in some cases, parallel biopsy needle paths are not feasible based on obstacles that are present in front of the target tumor (i.e., compressor grid walls, visible blood vessels, or nontarget tumors). Therefore, a deflected needle path planning method for MRSON was developed in this article to avoid obstacles and accurately perform biopsies. The novelty of the proposed method lies in using a grid with 20×12 holes, through which the robot introduces the biopsy needle and actively deflects the needle against the grid to generate a deflected needle path leading to the target lesion without requiring additional actuators. To calculate the deflection amount and needle insertion depth, the deflected needle is modeled by an <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$\epsilon$</tex-math></inline-formula> -second-order polynomial, and feasible needle paths are determined through geometry-based analysis. A path-ranking algorithm is then applied to select the best path among all feasible needle paths. Furthermore, to handle with any target lesion movement and coordinate misalignment between the robot and MR image coordinates, a Jacobian-based needle path adjustment method is proposed and verified through numerical simulations. The proposed deflected needle path planning method was verified through 28 in vitro accuracy test and four in vitro validation tests with a linear obstacle, which revealed a root-mean-square targeting error of 2.3 mm.

Ductal Carcinoma in situ Diagnosedby Magnetic Resonance Imaging-Guided Breast Biopsy

Ductal Carcinoma in situ Diagnosedby Magnetic Resonance Imaging-Guided Breast Biopsy

Upgrading Rate and Associated Factors of High-Risk Breast Lesions from Imaging Guided Breast Biopsy in King Chulalongkorn Memorial Hospital

Objective: To determine the underestimate rate of high-risk lesions from imaging guided breast biopsy to be malignancy from subsequent surgical excision in King Chulalongkorn Memorial Hospital and to determine the factor associated to imaging characteristics and geographic data. Materials and Methods: A retrospective review of 79 high-risk breast lesions of 78 patients who underwent imaging guided breast biopsy studies between January 1, 2010, and August 31, 2020, on women, aged 30 years or older in King Chulalongkorn Memorial Hospital. The upgrading rate of the high-risk lesions were calculated. Radiologic findings were analyzed by SPSS version 26. Results: Seventy-nine lesions were divided into three groups with 24 lesions of atypical ductal hyperplasia (ADH), 50 lesions of the papillary lesion, and five lesions of the complex sclerosing lesion. The authors found that the upgrade rate was about 58% in the ADH group, 28% in the papillary lesion group, and 20% in the complex sclerosing lesion group. Moreover, the authors found an increased upgrade rate among patient 50 years or older (43%) as compared with fourteen patients age under 50 years (32%). However, there was no statistically significant difference in radiologic findings or factors associated with upgrading rate to malignancy under subsequent surgical excision. Conclusion: Upgrading rate of high-risk lesions including ADH, papillary lesions, and complex sclerosing lesion were high in each lesion and the upgrade rate increased slightly in patient 50 years or older. However, there was no demonstrable radiologic manifestation or factor associated with upgrading to malignancy at subsequent surgical excision. Hence, radiologic-pathologic correlation or multidisciplinary discussion will be important roles in management of high-risk lesions. Keywords: Breast; High risk lesion; Atypical ductal hyperplasia (ADH); Papillary lesions; Radial scar; Complex sclerosing lesion

Tackling Health Disparities in Radiology: A Practical Conceptual Framework.

Tackling Health Disparities in Radiology: A Practical Conceptual Framework.

Managing the Lesion and Counseling Patient Post–Breast Biopsy

AbstractBreast cancer is the leading cause of cancer deaths worldwide among women. Early diagnosis and prompt treatment offers a chance for cure and long-term survival among afflicted women. Triple assessment which includes clinical examination, radiological imaging and histopathological evaluation has become a standard of care in the evaluation of breast cancer. Radiological imaging involves mammography, ultrasound, and magnetic resonance imaging while pathological evaluation can be done on fine needle, core-needle, and surgical excision biopsy specimens with core needle biopsy being the workhorse for diagnosis. While triple assessment has increased the diagnostic yield and helps in the identification of early lesions, an increasing subset of patients present with a situation where the imaging and pathological characteristics of a lesion do not correlate with each other thereby causing diagnostic and therapeutic dilemma. Imaging and pathology concordance and discordance present distinctly under differing circumstances in the care of the patient. While those with concordant findings proceed to treatment or follow up directly and hence benefit from the early treatment, those with discordant findings are beset with a delay in the diagnosis and should be subjected to further evaluations for confirming or refuting a diagnosis. This article reviews the salient features of image-guided breast biopsy and the outcomes and management options in imaging and pathology concordance and discordance. We also discuss the role of a radiologist in the counselling of the patient before and after receiving the pathological report after biopsy.

Impact of multidisciplinary radiologic-pathologic correlation conference for benign image-guided breast biopsies on discordance rates and patient outcomes in a community teaching hospital

As the assessment for radiologic-pathologic concordance, particularly for benign image-guided breast biopsies, is crucial in the management of patients with imaging abnormalities, many health institutions now conduct multidisciplinary conferences to assess the imaging and pathology findings in patients who had image-guided needle biopsy. We aimed to identify the radiologic-pathologic discordance rates and changes in patient outcomes resulting from the implementation of radiologic-pathologic correlation conferences in a community teaching hospital. Twenty-two (5.6%) out of 393 cases presented were deemed discordant given that the imaging characteristics of the lesions were far too suspicious radiologically to correlate with the benign pathology. Six cases were recommended for further imaging (four had stable lesion on follow- up, one was lost to follow-up and one case eventually had surgical excision which showed atypia); 14 cases for repeat core needle/excisional biopsy (seven had surgical excision with benign histology, five did not have surgery but showed stable lesion on imaging, two were lost to follow-up); one case for close imaging follow-up (lesion ultimately disappeared); the remaining case for second opinion (no follow-up data). The rad-path correlation conference led to a higher level of patient care with significant change in practice across our hospital network.

Mammary collagen architecture and its association with mammographic density and lesion severity among women undergoing image-guided breast biopsy

BackgroundElevated mammographic breast density is a strong breast cancer risk factor with poorly understood etiology. Increased deposition of collagen, one of the main fibrous proteins present in breast stroma, has been associated with increased mammographic density. Collagen fiber architecture has been linked to poor outcomes in breast cancer. However, relationships of quantitative collagen fiber features assessed in diagnostic biopsies with mammographic density and lesion severity are not well-established.MethodsClinically indicated breast biopsies from 65 in situ or invasive breast cancer cases and 73 frequency matched-controls with a benign biopsy result were used to measure collagen fiber features (length, straightness, width, alignment, orientation and density (fibers/µm2)) using second harmonic generation microscopy in up to three regions of interest (ROIs) per biopsy: normal, benign breast disease, and cancer. Local and global mammographic density volumes were quantified in the ipsilateral breast in pre-biopsy full-field digital mammograms. Associations of fibrillar collagen features with mammographic density and severity of biopsy diagnosis were evaluated using generalized estimating equation models with an independent correlation structure to account for multiple ROIs within each biopsy section.ResultsCollagen fiber density was positively associated with the proportion of stroma on the biopsy slide (p < 0.001) and with local percent mammographic density volume at both the biopsy target (p = 0.035) and within a 2 mm perilesional ring (p = 0.02), but not with global mammographic density measures. As severity of the breast biopsy diagnosis increased at the ROI level, collagen fibers tended to be less dense, shorter, straighter, thinner, and more aligned with one another (p < 0.05).ConclusionsCollagen fiber density was positively associated with local, but not global, mammographic density, suggesting that collagen microarchitecture may not translate into macroscopic mammographic features. However, collagen fiber features may be markers of cancer risk and/or progression among women referred for biopsy based on abnormal breast imaging.