Imaging-histologic Discordance Research Articles

Upgrade Rate and Predictive Factors for Breast Benign Intraductal Papilloma Diagnosed at Biopsy: A Meta-Analysis.

Current standard management for intraductal papilloma (IDP) diagnosed at biopsy indicates complete surgical resection, but there are increasing controversies over whether and when routine excision is indeed necessary. The aim of this study was to determine the carcinoma upgrade rate and identify the associated predictive factors for IDP diagnosed at biopsy by meta-analysis. We searched the PubMed and EMBASE databases for studies published from 2009 to 2020 that investigated the upgrade rate and predictive factors of IDP diagnosed at biopsy. A total of 7016 IDP cases diagnosed at biopsy and histologically examined after surgical excision were pooled from 44 original studies. The pooled prevalence of IDP in breast biopsy findings was 4.6% [95% confidence interval (CI) 4.4-4.7%] and the majority of IDP tumors were benign. The pooled upgrade rates to carcinoma for benign IDP and atypical IDP were 5.0% (95% CI 4.4-5.5%) and 36.0% (95% CI 32.7-39.2%), respectively. In addition, we identified 10 predictive upgrade factors for benign IDP, including Breast Imaging Reporting and Data System (BI-RADS) 5, BI-RADS 4C, mass and calcification in the mammographic finding, bloody nipple discharge, imaging-histological discordance, peripheral IDP, palpable mass, BI-RADS 4B, microcalcification, and lesion size ≥ 1cm. The upgrade rates associated with these predictive factors ranged from 7.3 to 31.1%. Surgical excision appears a reasonable recommendation for atypical IDP. Patients with benign IDP exhibiting one or more predictive factors might benefit from surgical excision, while patients with asymptomatic benign IDP without these predictive factors can be managed by imaging surveillance.

Abstract P4-03-03: Accuracy of stereotactic vacuum-assisted breast biopsy for investigating suspicious calcifications in 1,809 patients a public hospital in Brazil

Abstract Background: The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. Stereotactic vacuum assisted breast biopsy (VASB) can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VASB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up, especially when stereotactic VASB is used to investigate microcalcifications. This method is expensive but cost effective when used to investigate microcalcifications classified as BI-RADS 4 and 5. Objectives: To evaluate the accuracy of VASB in the investigation of suspicious calcifications. Methods: We’ve performed a retrospective study from July, 2012 to June, 2019, in which 1,809 women with suspicious calcifications detected on mammography (BI-RADS 4 and 5) had VASB performed at Hospital Estadual Pérola Byington, a public Hospital in São Paulo, Brazil. The device used was Surus Pearl (Hologic, Malbolrough, Massachusetts, USA), with probe gauge 9. Fragments were obtained and sent to anatomopathological study; a metal clip was placed on the biopsy site. Four groups were analyzed, based on the biopsy results: benign, precursor lesions, Ductal Carcinoma In Situ (DCIS) and malignant. Most patients with positive or discordant cases underwent surgical treatment and the previous biopsy results were compared to surgery results. Results: patients median age was 55y (49-63). Pathology results on VASB and surgery were classified respectively as benign n=1,179 (65.1%), precursor lesions n=97 (5.4%), DCIS n=414 (22.9%) and malignant n=119 (6.6%). Benign and lesion precursor lesions results were clustered to form a new group (lower risk lesions) and so DCIS and malignant lesions (higher risk lesions). ROC curve and AUC were calculated to compare the results of lower and higher risk lesions groups according to VASB and surgery results (AUC=0,642). The X2 test was performed between the groups (p<0,05). The sensitivity of the method was 84.4 %, specificity was 96.1%, false negative rate was 4.5%, positive predictive value (PPV) was 89.8%, negative predictive value (NPV) was 93.8%. Conclusion: the VASB method has a good accuracy to distinguish lower and higher risk lesions groups comparing to the gold standard. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. Keywords: Calcifications; Vacuum-assisted stereotactic biopsy; Breast cancer; Diagnosis Citation Format: Andressa Amorim, Marcellus N. M. Ramos, André Mattar, Maria Isabela B. A. C. Sawada, Jorge Y. Shida, Luiz H. Gebrim. Accuracy of stereotactic vacuum-assisted breast biopsy for investigating suspicious calcifications in 1,809 patients a public hospital in Brazil [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-03-03.

Abstract P3-04-01: The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital

Abstract Background: The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Stereotactic vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up, especially when stereotactic VABB is used to investigate microcalcifications. This method is expensive but cost effective when used to investigate microcalcifications classified as BI-RADS 4 and 5. Methodology: We performed a review in 1,354 patients with suspicious mammography microcalcifications, classified as BI-RADS 4 or 5 that were seen in Perola Byington Hospital from July 2012 to July 2017 in São Paulo-Brazil. We have used aHologic Lorad Multicare Platinum Stereotactic Prone Breast Biopsy and a Surus Pearl (Hologic, Malbolrough, Massachusetts, USA), with gauge 9 probe. Four to eight fragments (median of 6) were obtained with the placement of a metal clip in the bed that the biopsy was performed, and histopathological analysis was made. Results:The histopathological study of the lesions revealed benign alterations in 956 (68%) of our patients. The findings were positive for malignancy in 358 patients (29%) and the precursor lesions were diagnosed in 40 (3%). In 81 cases (5.9%) the findings were discordant. The sensitivity of the method was 84.4%, specificity was 96.1%, false negative rate was 4.5%, positive predictive value (PPV) was 89.8%, negative predictive value (NPV) was 93.8%. In literature review the sensitivity varies 91.5-100%, specificity 81.9-110%, false negative rate 0-3.3%, PPV 92.2-100% and NPV 80.5-99.5%. All patients with positive or discordant cases underwent surgical treatment to increase the margin or complete removal of the lesion. Conclusions: The VABB is an outpatient procedure that avoids hospital admissions for diagnostic elucidation in most of cases suspected of malignancy. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. In addition to presenting the cost lower than the surgical biopsy it indirect increases the supply of hospital beds for cancer treatment. Citation Format: Mattar A, Amorim AG, Ramos MdNM, Shida JY, Fonseca GR, Hegg R, Gebrim LH. The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-04-01.

Breast lesions diagnosed by ultrasound-guided core needle biopsy: Can shearwave elastography predict histologic upgrade after surgery or vaccuum assisted excision?

PurposeTo compare breast stiffness based on shear-wave elastography (SWE) quantitative parameters with histopathologic results diagnosed by ultrasound (US)-guided core needle biopsy (CNB) to determine their association with upgrade rates after surgical excision or follow-up US as well as clinico-radiologic differences between upgrade and non-upgrade groups. Materials and methodsThis retrospective study enrolled 225 breast lesions from 225 patients, including 159 benign lesions, 38 high risk lesions and 28 ductal carcinoma in situ (DCIS) diagnosed by US-guided CNB. Quantitative SWE parameters of breast lesions were measured before CNB and compared according to histopathologic results (benign, high risk and DCIS) and lesion size (<20 mm and >20 mm). Clinico-radiologic and pathologic factors were compared between upgrade and non-upgrade groups after surgical excision or follow-up US. ResultsAfter surgical excision or follow-up US after more than one year, 29 lesions were upgraded for an overall upgrade rate of 12.9% (29/225). There were significant differences between upgrade and non-upgrade groups in age, mammographic category, US category, and sonographic features, including shape, margin, orientation, imaging-histologic correlation and E ratio. Patients with lesion upgrade were much older and had lesions characterized by significantly higher mammographic and US category (>4b), irregular shape, nonparallel orientation, microlobulated or angular margin, calcification in a mass, larger size on US (>20 mm) and greater imaging-histologic discordance. Multivariate analysis showed only mean and minimum elasticity values displayed a borderline association with histologic underestimation. ConclusionUpgrade of breast lesions diagnosed by US-guided CNB can be predicted using Emean and Emin among quantitative SWE parameters.

Histopathological and Immunohistochemical Studies of A Typical Case of Intraductal Papillary Carcinoma of A Male Breast

Intraductal papillary carcinoma is very uncommon breast disease, constituting 0.5% to 1% of all breast cancers. Intraductal and intracystic papillary carcinomas are the histological classification of papillary carcinomas. Here we report, a 61 year old man presented with a mass in the upper outer quadrant of the left breast, with associated nipple discharge and bleeding since 2 months. Histological examination revealed tumor cells arranged in multi-cell layered papillae mostly in dilated lumen with foci of cribriform, follicular and solid pattern. Occasional psammoma bodies are also noted. Surgical excision is usually recommended after core-needle biopsy if there is atypia, high risk lesion, imaging histological discordance or positivity for malignancy. Often biopsy excision is performed directly when papillary carcinoma is suggested by sonography or mammography. Indeed, the surgical excision allows the pathologist to classify the papillary by classically histological examination of the lesions especially with immunohistochemical study and to research invasion or DCIS in surrounding breast tissue, present in majority of cases. There are no evidence based guidelines for treatment of intraductal papillary carcinoma. Hence, it is recommended to go for conservative surgery without axillary dissection, which shows excellent prognosis.

215. Imaging-histologic discordance following image-guided core-needle or vacuum assisted breast biopsy – Analysis of 340 lesions of BIRADS category 4C

Background: Subsequent surgical excision after hook wire/skin marking localisation is the preferred option in our institution when imaging-histologic discordance (IHD) is found following stereotactic or ultrasound-guided breast biopsy of BIRADS 4C lesion. The aim of this study was the analysis of IHD cases after core-needle and vacuum-assisted biopsy.

207. Non-pleomorphic LCIS without imaging-histologic discordance and residual lesion may be referred to a close follow-up instead of surgical excision

Background: There is still no consensus on the optimal management of lobular carcinoma in situ (LCIS) found on minimal-invasive breast biopsy. Particularly the need of surgical excision remains a subject of debate. The aim of this study was to assess the correlation between preoperative findings and risk of invasive cancer in postoperative specimen in patients with LCIS detected on image-guided biopsy.

Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study.

Background & objectives:Biopsy of palpable breast masses can be performed manually by palpation guidance or under imaging guidance. Based on retrospective studies, image guided biopsy is considered more accurate than palpation guided breast biopsy; however, these techniques have not been compared prospectively. We conducted this prospective study to verify the superiority and determine the size of beneficial effect of image guided biopsy over palpation guided biopsy.Methods:Over a period of 18 months, 36 patients each with palpable breast masses were randomized into palpation guided and image guided breast biopsy arms. Ultrasound was used for image guidance in 33 patients and mammographic (stereotactic) guidance in three patients. All biopsies were performed using 14 gauge automated core biopsy needles. Inconclusive, suspicious or imaging-histologic discordant biopsies were repeated.Results:Malignancy was found in 30 of 36 women in palpation guided biopsy arm and 27 of 36 women in image guided biopsy arm. Palpation guided biopsy had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 46.7, 100, 100, 27.3 per cent, respectively, for diagnosing breast cancer. Nineteen of 36 women (52.8%) required repeat biopsy because of inadequate samples (7 of 19), suspicious findings (2 of 19) or imaging-histologic discordance (10 of 19). On repeat biopsy, malignancy was found in all cases of imaging-histologic discordance. Image guided biopsy had 96.3 per cent sensitivity and 100 per cent specificity. There was no case of inadequate sample or imaging-histologic discordance with image guided biopsy.Interpretation & conclusions:Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.

Imaging–Histologic Discordance at Percutaneous Biopsy of the Lung

The purpose of this study was to quantify the degree of imaging-histologic discordance in a cohort of patients undergoing computed tomography (CT)-guided lung biopsy for focal lung disease. A retrospective review was performed of 186 patients who underwent percutaneous lung biopsy of a parenchymal lesion at our institution between January and December 2009. Diagnostic radiology reports of CT or positron emission tomography-CTs performed before biopsy were used to classify the lesion as malignant or benign by five readers. Pathology reports of the biopsied lesions were classified by three readers. Inter-reader agreement and imaging-histologic concordance were quantified using kappa statistics. Discordant benign cases were then revisited to determine downstream effects. Inter-reader agreement on report content was substantial or almost perfect with kappas >0.783. Kappas for concordance were as follows: malignant (0.448), primary lung cancer (0.517), metastatic disease to lung (0.449), benign (0.510), and overall agreement (0.381). Of the twelve discordant benign cases that were revisited, four were found to be false negatives, resulting in a delay in diagnosis. Our study of imaging-histologic discordance in percutaneous biopsy of lung lesions supports the need for imaging report standardization and improved integration and communication between the fields of radiology and pathology.

Percutaneous ultrasound-guided vacuum-assisted removal versus surgery for breast lesions showing imaging-histology discordance after ultrasound-guided core-needle biopsy.

ObjectiveTo evaluate the upgrade rate and delayed false-negative results of percutaneous vacuum-assisted removal (VAR) and surgical excision in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy (CNB) of the breast and to validate the role of VAR as a rebiopsy method for these discordant lesions.Materials and MethodsPercutaneous US-guided 14-gauge CNB was performed on 7470 patients between August 2005 and December 2010. Our study population included 161 lesions in 152 patients who underwent subsequent rebiopsy due to imaging-histologic discordance. Rebiopsy was performed using VAR (n = 88) or surgical excision (n = 73). We investigated the upgrade rate immediately after rebiopsy and delayed false-negative results during at least 24 months of follow-up after rebiopsy. We also evaluated the clinicoradiological differences between VAR and surgical excision.ResultsTotal upgrade to malignancy occurred in 13.7% (22/161) of lesions at rebiopsy including both VAR and surgical excision: 4.6% (4/88) of VAR cases (4/88) and 24.7% (18/73) of surgical excision cases (p < 0.001). Surgical excision was performed significantly more frequently in older patients and for larger-sized lesions than that of VAR, and a significant difference was detected between VAR and surgical excision in the Breast Imaging and Reporting and Data System category (p < 0.007). No delayed false-negative results were observed after VAR or surgical excision during the follow-up period.ConclusionLong-term follow-up data showed no delayed cancer diagnoses after US-guided VAR in imaging-histologic discordant lesions of the breast, suggesting that VAR might be a rebiopsy method for these lesions.

Factors Associated with Imaging-Histologic Discordance in 102 Patients with Endometrial Cancer

Factors Associated with Imaging-Histologic Discordance in 102 Patients with Endometrial Cancer

Imaging-Histologic Discordance After Sonographically Guided Percutaneous Breast Biopsy: A Prospective Observational Study

The objective of this study was to determine the frequency of imaging-histologic discordance and to compare the frequency of carcinoma between concordant and discordant lesions in sonographically (US)-guided 14-gauge core needle biopsies (CNBs). From January 2005 to December 2006, we performed US-guided 14-gauge automated CNB on 3339 breast lesions and obtained benign results in 2194 cases. Five radiologists prospectively reviewed the pathologic reports in conjunction with the imaging. We included a total of 1588 lesions that were either excised ( n = 658) or followed up for at least 2 years ( n = 930) after CNB. We evaluated the rate of discordance and the clinical findings for both discordant and concordant lesions. We also analyzed the clinical and imaging differences between the upgrade and non-upgrade groups. Imaging-histologic discordance was present in 103 of 1588 (6.5%) lesions. The upgrade rate was 6.8% (7/103) in discordant lesions and 0.4% (6/1485) in concordant lesions ( p < 0.01). Lesion size, Breast Imaging, Reporting and Data System (BI-RADS) category and the presence or absence of symptoms was statistically significant between the upgrade and non-upgrade groups in discordant cases ( p < .05). Imaging-histologic discordance is an indication for excision because it has a higher upgrade rate than concordant lesions.

Breast Lesions with Imaging-Histologic Discordance During 16-Gauge Core Needle Biopsy System: would Vacuum-Assisted Removal get Significantly More Definitive Histologic Diagnosis Than Vacuum-Assisted Biopsy?

The aim of this study was to determine the role of vacuum-assisted biopsy (VAB) in patients with ultrasound imaging-histologic discordance during 16-gauge core needle biopsy (CNB) and to compare VAB with vacuum-assisted removal (VAR) in diagnostic accuracy in patients with ultrasound imaging-histologic discordance. From January 2006 to October 2008, a consecutive biopsy was performed on 1532 lesions with ultrasound-guided 16-gauge CNB. Sixty two lesions were considered to be ultrasound imaging-histologic discordant. Among the 62 lesions, 55 lesions underwent subsequent VAB or VAR, which made up our study population. Among the 55 cases, 22 underwent subsequent US-guided VAR, and the other 33 lesions underwent subsequent US-guided VAB. All malignant lesions at VAB and VAR got subsequent surgery, and all benign lesions at VAR or VAB were followed up for at least 1 year. Five lesions of the VAR group were diagnosed as having carcinoma (5/22, 22.7% of pathologic changing rate). Seven lesions of the VAB group were diagnosed as having carcinoma (7/33, 21.2% of pathologic changing rate). Subsequent surgery further demonstrated the diagnosis of VAB for all the lesions with pathologic change. There was no significant difference in pathologic changing rate between these two groups (p < 0.05). A US-guided VAB was a valuable alternative to VAR or surgery excision to obtain definitive diagnosis in patients with breast lesions showing imaging-histologic discordance during 16-gauge CNB.

The Current Role of Vacuum Assisted Breast Biopsy System in Breast Disease

The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up. In recent years, with the advancement of VABB instruments and techniques, many outcome studies have reported on the use of VABB for resecting benign breast lesions with a curative intent. VABB is highly accurate for diagnosing suspicious breast lesions and is highly successful at treating presumed benign breast lesions. Thus, in the near future, VABB will be routinely offered to all appropriately selected patients.

Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy: Can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis?

The aim of this study was to evaluate if re-biopsy with 10-gauge vacuum-assisted biopsy (VAB) could get definitive diagnosis for breast lesions with ultrasound (US) imaging-histologic discordance at 16-gauge core needle biopsy (CNB). From January 2007 to June 2008, a consecutive biopsy was performed on 1069 lesions with US-guided 16-gauge CNB. A total of 28 lesions were considered to be US imaging-histologic discordant and all of them underwent subsequent 10-gauge VAB. All malignant lesions located at VAB were treated with subsequent surgery and all benign lesions at VAB were followed up for at least 1 year. Six of the 28 lesions (21.4%) had pathologic upgrade after VAB. In them, one case upgraded from adenosis to ductal carcinoma in situ (DCIS); one case upgraded from adenosis to infiltrating ductal carcinoma (IDC); one case upgraded from atypical ductal hyperplasia to IDC; two cases upgraded from intraductal papilloma to DCIS; and one case upgraded from sclerosing adenosis to invasive lobular carcinoma (ILC). The subsequent surgery further demonstrated the diagnosis of VAB for all the lesions with histologic upgrade. Re-biopsy could improve diagnostic accuracy in patients with breast lesions showing imaging-histologic discordance during CNB, and 10-gauge VAB was a valuable method to deal with re-biopsy.

The rate of imaging-histologic discordance of benign breast disease: a multidisciplinary approach to the management of discordance at a large university-based hospital

Background Suspicious abnormalities seen on screening mammography require further imaging and histologic analysis. Any imaging-histologic discordance necessitates further imaging or surgical excision. Methods A retrospective review of all patients with evidence of benign breast lesions having imaging-histologic discordance from January 2005 to December 2007 was compared with the results of a previous study from January 2002 to September 2004. Results Of 1,264 benign cases, 25 patients had discordance (2%). Surgical intervention was required in 14 of 25 of all discordant cases (56%). One discordant case was found to be malignant after open excision, giving a false-negative rate of 4%. Previous data reported an 8.8% discordance rate, with 65.2% requiring surgical intervention and a false-negative rate of 29.3%. On comparison, the rate of discordance and false-negative image-directed core biopsies were decreased ( P < .05). Conclusions An organized multidisciplinary approach to imaging-histologic discordance in benign breast disease decreases the rate of discordance and unnecessary surgical interventions.

Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy

To determine the false-negative rate and to evaluate the clinical, radiologic or histologic features of false-negative results at ultrasound (US)-guided 14-gauge core needle biopsy (CNB). A total of 3,724 masses from 3,308 women who had undergone US-guided 14-gauge CNB and who had a rebiopsy or at least 2 years' follow-up were included. The histology of CNB was correlated with the rebiopsy or long-term imaging follow-up. In cases of missed cancer, the time interval between CNB and rebiopsy, the reasons for rebiopsy, and the procedural or lesion characteristics were analysed. Of 1,706 benign CNBs, 50 additional malignancies were found at excision (false-negative rate, 2.5% of 1,982 with a final diagnosis of malignancy). Of 50 false negatives, 41 were found immediately of which 28 had rebiopsy because of imaging-histological discordance. Regarding the frequency of malignancy according to the reasons for rebiopsy, suspicious imaging finding (24%) showed significantly higher frequency than suspicious clinical findings or request (1%). Regarding the characteristics except invasiveness, no significant differences in false-negative rates were found. Most false negatives were found immediately and imaging-histological discordance was the most important clue. Careful correlation of clinical, radiological and histological results as well as appropriate follow-up is essential.

Imaging–Histologic Discordance at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

Imaging–Histologic Discordance at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

Imaging-histologic discordance at sonographically guided percutaneous biopsy of breast lesions

Imaging-histologic discordance at sonographically guided percutaneous biopsy of breast lesions

Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings

Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings