Needle Localization Breast Biopsy Research Articles

Clinical Analyses of Clustered Microcalcifications after Autologous Fat Injection for Breast Augmentation

Background: Autologous fat injection for breast augmentation has been disputed with regard to its complications for many years, especially regarding calcifications, most of which present with benign features. In previous studies, clustered microcalcifications were not observed after fat injection for breast augmentation, which are usually regarded as malignant calcifications. Methods: From July of 1999 to December of 2009, autologous fat injection for breast augmentation was performed for both breasts in 48 patients. Eight patients with clustered microcalcifications found by mammography after surgery were analyzed retrospectively. For the nonpalpable breast lesions in three patients, the clustered microcalcifications were resected with the help of needle localized breast biopsy. The palpable lump, including clustered microcalcifications, was resected 1 cm away from its border in the other patients. All of the specimens were submitted to pathologic examination. Results: The digitized mammographic films of eight of 48 patients (16.7 percent) showed clustered microcalcifications after autologous fat injection, which were highly suspected of being breast carcinoma microcalcifications, whereas all pathologic examinations indicated fat necroses. Conclusions: Clustered microcalcifications can be found after autologous fat injection for breast augmentation, which cannot be distinguished from malignancy. The mammographic confusion constitutes the problem rather than the success of the procedure itself, and the method should continue to be prohibited.

Clinical Analyses of Clustered Microcalcifications after Autologous Fat Injection for Breast Augmentation

Autologous fat injection for breast augmentation has been disputed with regard to its complications for many years, especially regarding calcifications, most of which present with benign features. In previous studies, clustered microcalcifications were not observed after fat injection for breast augmentation, which are usually regarded as malignant calcifications. From July of 1999 to December of 2009, autologous fat injection for breast augmentation was performed for both breasts in 48 patients. Eight patients with clustered microcalcifications found by mammography after surgery were analyzed retrospectively. For the nonpalpable breast lesions in three patients, the clustered microcalcifications were resected with the help of needle localized breast biopsy. The palpable lump, including clustered microcalcifications, was resected 1 cm away from its border in the other patients. All of the specimens were submitted to pathologic examination. The digitized mammographic films of eight of 48 patients (16.7 percent) showed clustered microcalcifications after autologous fat injection, which were highly suspected of being breast carcinoma microcalcifications, whereas all pathologic examinations indicated fat necroses. Clustered microcalcifications can be found after autologous fat injection for breast augmentation, which cannot be distinguished from malignancy. The mammographic confusion constitutes the problem rather than the success of the procedure itself, and the method should continue to be prohibited.

Migration of Guidewire After Surgical Breast Biopsy: An Unusual Case Report

Needle localization of breast lesions is commonly performed for surgical guidance when excising nonpalpable lesions. A few reports have specifically addressed complications associated with needle-localized surgical breast biopsy. We present the first reported case of delayed cardiac injury resulting from migration of a guidewire from a needle-localized breast biopsy that occurred 2 years after the procedure. The patient presented with chest pain and cardiac tamponade. It was found that a hook-wire had penetrated the pericardium and left ventricular myocardium through the aortic valve into the ascending aorta. The diagnosis was made by echocardiogram and computed axial tomography scan and subsequent surgical removal was undertaken successfully.

Nine Years’ Experience of Needle Localized Breast Biopsy in a University Hospital: Results and Evaluation of the Role of the Surgeon in Decision Making

Background: Needle localized breast biopsy is an effective means of detecting breast cancer in its early stages. We analysed the indications for needle localized biopsies, evaluated the results, and determined the surgeon’s role in the decision-making process.Methods: The needle localized open biopsy results of 350 patients were assessed.Results: Malignancy was encountered in 7 of 56 patients in whom the radiologist suggested follow-up due to mammo-graphical images, although a surgeon performed a biopsy with the assessment of the patient’s historical and clinical findings (12.5%). Biopsy failure rates were higher for office-based ambulatory patients (9.1%) than for those patients who underwent biopsies in an operating theatre (1.9%; P < .05). Patients undergoing operating theatre biopsies under local anaesthesia showed statistically significant failure rates compared with those under general anaesthesia (p = .04). The rate of malignancy of micro-calcification was highest in patients younger than 40 years of age (64.3%), while spicular lesions were commonly malignant in patients over 50 years of age.Conclusions: From our experience, we suggest that needle localized biopsies should be performed in the operating theatre with the patient under general anaesthesia. Although both micro-calcifications and spicular lesions have a high rate of malignancy in all decades, micro-calcifications are more prevalent in younger patients while spicular lesions prevail in older patients. The final decision, to follow-up or biopsy, should be based on a patient’s clinical and historical perspective and not only on the guidance of the mammography report.

Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

Needle localization breast biopsy (NLBB) is presently the primary means of localizing non-palpable lesions. Disadvantages of NLBB include vasovagal episodes, patient discomfort, and miss rates. Because hematomas naturally fill the cavity after vacuum-assisted breast biopsies (VABB), we hypothesized that ultrasound (US) could be used to find and accurately excise the actual biopsy site of non-palpable breast lesions without a needle. This is a retrospective study from January 2000 to July 2005. Electronic chart review identified patients with non-palpable breast lesions detected by means of mammogram who then underwent lumpectomy via NLBB or the hematoma-directed ultrasound-guided technique (HUG). HUG involved localizing the hematoma with a 7.5-MHz US probe and using the "line of sight" technique straight down toward the chest wall. A block of tissue encompassing the hematoma was then excised. Localization procedures were performed in 186 patients-63 (34%) via needle localization and 123 (66%) via HUG. The previous VABB site in 100% of patients was successfully excised using HUG, 65 of 123 (53%) were benign and 58 of 123 (47%) were malignant; margins were positive in 13 of these 58 (22%). NLBB was successful in 100% of patients, 44 of 63 (70%) were benign and 19 of 63 (30%) were malignant; margins were positive in 14 of these 19 (73%). Margin positivity was significantly higher for NLBB than HUG (P = 0.0001, Fisher Exact). This study suggests that HUG is more accurate in localizing non-palpable lesions than NLBB. By eliminating the additional procedure needed for NLBB, HUG may also be more time- and cost efficient. HUG makes VABB not only a less invasive diagnostic procedure, but also a localization procedure.

Surgical benefits conveyed by biopsy site marking system using ultrasound localization

Background With vacuum-assisted biopsy technology all, or most, of a breast lesion may be removed during the initial biopsy; in such cases a metallic marker is often inserted at the site of the biopsy for future localization. The aim of this study was to evaluate the efficacy and impact of the Gel Mark Ultra biopsy site marking system (SenoRx, Aliso Viejo, CA) on the practice of needle localization breast biopsy. Methods We retrospectively analyzed the experience of 45 general surgeons across the United States in a variety of practice settings using the Gel Mark Ultra clip. Imaging-guided biopsy technique, localization quality, surgeon confidence, and margin status were assessed and compared against the broad data reported in the literature. Results A total of 432 records of patients who underwent imaging-guided breast biopsy with placement of Gel Mark Ultra clip were reviewed. Of these, 63 (15%) patients required definitive surgical intervention, for which 41 cases were localized with ultrasound and assessed for margin clearance. Clear margins were achieved in 37 (90%) of the 41 cases. These results are statistically superior ( P < .01) to positive margins rates reported in the literature. Conclusions The Gel Mark Ultra biopsy site marking system is a new localization device that provides a safe and effective alternative to traditional localization methods with a significant reduction in the percentage of positive margins, as well as advantages in terms of surgical approach, time, and patient comfort.

Tissue compression is not necessary for needle-localized lesion identification

Background Tissue compression to enhance lesion visibility on radiography of needle-localized breast biopsy specimens is widely used. We hypothesized that compression is not necessary for detection of lesions on specimen radiography. Methods Forty-nine consecutive patients underwent needle-localization biopsies of 59 mammographic targets. All specimens were radiographed without and with compression. The films were later independently reviewed and compared with preoperative mammograms by 2 surgeons and a breast-imaging radiologist. The primary end point was identification of mammographic targets in noncompressed specimen radiographs. Results Twenty-nine targets were masses, 36 contained calcifications, and 14 contained previously placed clips. All mammographically localized lesions were identified on noncompressed views. Overall concordance for the 2 images was 100% for all 3 reviewers and 98% among reviewers. Conclusions Tissue compression before specimen radiography is not routinely necessary for target lesion identification.

P50 Ten year experience with needle-localized open breastbiopsy for non-palpable breast lesions: BIRADS classification and histopathologic correlation

P50 Ten year experience with needle-localized open breastbiopsy for non-palpable breast lesions: BIRADS classification and histopathologic correlation

Stereotactic histologic biopsy with patients prone: technical feasibility in 98% of mammographically detected lesions.

The purpose of this retrospective study was to determine which mammographically detected lesions in need of imaging-guided biopsy could undergo prone, stereotactic biopsy. 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. 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%). 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.

Advances in the Diagnosis and Excision of Breast Cancer

Until recently little advance in the diagnosis and excision of breast cancer has been made since the inception of needle localization breast biopsy (NLBB). Stereotactic core needle breast biopsy (SCNBB) can avoid most NLBB especially for calcifications. However, when open biopsy is necessary NLBB has been the standard of care. As many as 50 per cent of nonpalpable lesions can be seen by ultrasound (US) to avoid the unpleasantness and complications associated with NLBB. Further SCNBB leaves a blood-filled cavity that can be easily seen by US. Intraoperative US can be used to direct the excision while improving margin negativity. MRI has improved sensitivity in detecting suspicious breast lesions and techniques such as hematoma-directed US-guided breast biopsy can facilitate excision of such masses. Clearly new technologies have improved the ability to diagnosis and excise breast cancer. The onus on the surgeon is to incorporate them into standard practice to improve outcomes.

Clip migration in stereotactic biopsy

Background: Needle localization breast biopsy (NLBB) is the standard for removal of breast lesions after vacuum assisted core biopsy (VACB). Disadvantages include a miss rate of 0% to 22%, a positive margin rate of approximately 50%, and vasovagal reactions (approximately 20%). We hypothesized that clip migration after VACB is clinically significant and may contribute to the positive margin rates seen after NLBB. Methods: We performed a retrospective review of postbiopsy films in patients who had undergone VACB with stereotactic clip placement for abnormal mammograms. We measured the distance between the clip and the biopsy site in standard two view mammograms. The location of the biopsy air pocket was confirmed using the prebiopsy calcification site. The Pythagorean Theorem was used to calculate the distance the clip moved within the breast. Pathology reports on NLBB or intraoperative hematoma-directed ultrasound-guided breast biopsy (HUG, which localizes by US the VACB site) were reviewed to assess margin status. Results: In all, 165 postbiopsy mammograms on patients who had VACB with clip placement were reviewed. In 93 evaluable cases, the mean distance the clip moved was 13.5 mm ± 1.6 mm, SEM (95% CI = 10.3 mm to 16.7 mm). Range of migration was 0 to 78.3 mm. The median was 9.5 mm. In 21.5% of patients the clip was more than 20 mm from the targeted site. Migration of the clip did not change with the age of the patient, the size of the breast or location within the breast. In the subgroup of patients with cancer, margin positivity (including those with close margins) after NLBB was 60% versus 0% in the HUG group. Conclusions: Significant clip migration after VACB may contribute to the high positive margin status of standard NLBBs. Surgeons cannot rely on needle localization of the clip alone and must be cognizant of potential clip migration. HUG as an alternative biopsy technique after VACB eliminates operator dependency on clip location and may have superior results in margin status.

Intraoperative localization after stereotactic breast biopsy without a needle

Background: Needle localization breast biopsy (NLBB) is the standard for the removal of breast lesions after vacuum-assisted breast biopsy (VABB). Disadvantages include a miss rate of 0% to 22%, risk of vasovagal reactions, and scheduling difficulties. We hypothesized that the hematoma resulting from VABB could be used to localize the VABB site with intraoperative ultrasonography (US) for excision. Methods: Twenty patients had VABB followed by intraoperative US-guided excision. Results: The previous VABB site in 19 patients was successfully visualized with intraoperative US and excised at surgery. One patient had successful removal of the targeted area under US guidance, but failed to show removal of the clip on initial specimen mammogram. Conclusion: This study demonstrates the effectiveness of US in identifying hematomas after VABB for excision. This technique, which can be performed weeks after VABB, improves patient comfort and allows easier scheduling.

Magnetic resonance imaging-guided core needle biopsy and needle localized excision of occult breast lesions

Background: Breast magnetic resonance imaging (MRI) has been reported to be twice as sensitive and three times more specific in detecting breast cancer. We report a series of MRI-guided stereotactic breast biopsies (SCNBB) and needle localized breast biopsies (NLBB) to evaluate MRI as a localization tool. Methods: Forty-one breast lesions were identified in 39 patients who subsequently had SCNBB or NLBB. Suspicious areas of enhancement were stereotactically biopsied with 16-G core biopsy needles or localized with 22-G wires for excision under laser guidance. Results: Forty-one breast lesions were identified from 1,292 breast MRIs. SCNBB identified three malignancies and two areas of atypia. Two additional cancers were found after NLBB. In patients having NLBB alone, five cancers and two areas of atypia were identified. Conclusions: In this initial series, breast MRI-guided SCNBB and NLBB were valuable tools in the management of patients with suspicious abnormalities seen only on MRI.

Hematoma-directed ultrasound-guided breast biopsy.

The standard technique for removal of nonpalpable breast lesions is needle localization breast biopsy. Because traumatic hematomas can often be seen with ultrasound, the authors hypothesized that iatrogenically induced hematomas could be used to guide the excision of nonpalpable lesions using ultrasound. Twenty patients with nonpalpable breast lesions detected by magnetic resonance imaging only were enrolled in this single-institution trial, approved by the institutional review board. A hematoma consisting of 2 to 5 mL of the patient's own blood was injected into the breast to target the nonpalpable lesion. Intraoperative ultrasound of the hematoma was used to direct the excisional biopsy. The average age of women was 53.8 +/- 10 years. Ninety-five percent of lesions detected by magnetic resonance imaging were localized by hematoma injection. All the hematomas used to recognize targeted lesions were identified at surgery by ultrasound and removed without complication. Eight (40%) of the lesions were malignant, with an average tumor size of 12 +/- 6 mm (range 4-25). The remaining 12 lesions (60%) comprised papillomas, sclerosing adenosis, radial scar, fibroadenoma, and areas of atypical ductal hyperplasia. The results of this pilot study show the effectiveness of hematoma-directed ultrasound-guided breast biopsy for nonpalpable lesions seen by magnetic resonance imaging. This new procedure is potentially more comfortable for the patient because no wire or needle is left in the breast. It is technically faster and easier because ultrasound is used to visualize directly the location of the hematoma at surgery and to confirm lesion removal in the operating room by specimen ultrasound. The hematoma can be placed several days before biopsy, easing scheduling, and without fear of the migration that may occur with needle localization. This method may have ready application to mammographically detected lesions.

Impact of stereotactic large-core needle biopsy on diagnosis and surgical treatment of non-palpable breast cancer

Introduction Stereotactic large-core needle biopsy is increasingly replacing needle-localized breast biopsy for the diagnosis of nonpalpable breast disease. In this prospective study, the impact of the introduction of this technique on diagnosis and surgical treatment of nonpalpable breast cancer was assessed in two hospitals in The Netherlands. Patients and methods A total of 84 patients with nonpalpable breast cancer, diagnosed by means of stereotactic large-core needle biopsy (needle biopsy group) were compared with 80 patients diagnosed with nonpalpable breast cancer before the introduction of large-core needle biopsy. These patients were diagnosed by means of needle-localized open breast biopsy (control group). Clinical outcome measures evaluated included: duration of diagnostic and therapeutic intervals and number of surgical procedures required for complete surgical treatment. Subgroup analysis was performed for the category of microcalcifications without tissue distortion.Results For the needle biopsy group, the median interval between initial referral to the surgeon and the availability of histological diagnosis was 9 days and the interval between initial referral and complete surgical treatment was 31 days. These intervals were significantly longer for the control group (19 days and 44 days respectively); 75% of patients in the needle biopsy group were treated in a single step surgical procedure compared to 16% of the patients in the control group (67vs 25% respectively for the subgroup). The mean number of surgical procedures required to complete surgical treatment was 1.31 for needle biopsy group vs 1.91 for the open biopsy group (1.46 vs 1.84 for the subgroup).Conclusion Introduction of stereotactic large-core needle biopsy leads to a reduction of the time to diagnosis and the time to complete surgical treatment of nonpalpable breast cancer. It also reduces the number of surgical procedures required for complete surgical treatment of nonpalpable breast cancer. The benefits of large-core needle biopsy may also be anticipated for patients with microcalcifications without tissue distortion.

Intraoperative ultrasound-guided breast biopsy

Background: Biopsy of nonpalpable lesions has increased during the last decade. Commonly these lesions are excised using preoperative wire localization. We describe a technique of intraoperative ultrasound-guided breast biopsy that allows easier excision and aids in obtaining surgical margins in breast cancer. Methods: Intraoperative ultrasound was performed on 81 lesions. Ultrasound was used in an attempt to approximate a 1 cm margin on malignant lesions. Results: All attempts to localize lesions with ultrasound in surgery were successful (81 of 81). Ultrasound-guided surgery was accurate in predicting margins in 24 of 25 malignant lesions. No complications resulted. Conclusions: Ultrasound proved to be an effective technique for localizing and excising breast lesions. Benefits may include improving patient comfort, avoiding complications of needle localization breast biopsy, and simplifying the scheduling of surgical procedures. Additionally, this procedure may be used to obtain adequate surgical margins and thus reduce the recurrence rate of breast cancer.

Is specimen mammography beneficial?

Specimen mammography is not beneficial in the management or outcome of patients undergoing image-guided needle-localized breast biopsies. A retrospective study of consecutive patients who underwent needle/dye-localized breast biopsies between January 1, 1993, and December 31, 1995. National Cancer Institute (Bethesda, Md)-designated comprehensive cancer center. One hundred sixty-four patients underwent 165 needle/dye-localized breast biopsies for suspicious mammographic abnormalities. In only 3 (1.8%) of 165 patients did the patient clearly benefit from specimen mammography. In no patient was a malignant neoplasm missed. The mean time for the specimen mammogram was 20 minutes, adding an additional 55 hours of operating room time. Specimen mammography cost an additional $60,522 and was incorrect in 41 (24.8%) of 165 patients. Specimen mammography added little to patient care, as only 3 (1.8%) of 165 patients benefited from the information.

The Role of Needle Localization Breast Biopsy for the Diagnosis of Nonpalpable Breast Cancer

The Role of Needle Localization Breast Biopsy for the Diagnosis of Nonpalpable Breast Cancer

The Advanced Breast Biopsy Instrumentation (ABBI) Experience at a Community Hospital

The Advanced Breast Biopsy Instrumentation (ABBI; U.S. Surgical Corp., Norwalk, CT) system is the newest technology available for the evaluation and diagnosis of nonpalpable breast lesions. It requires the breast imaging specialist, often a radiologist, to localize the suspicious lesion to x, y, and z coordinates in a digital mammogram unit. The coordinates are then used by the surgeon to operate and direct the ABBI biopsy device around the lesion to obtain an excisional biopsy. Mammographic confirmation of the specimen is then immediately obtained. First introduced in the United States in April 1996, the ABBI system is aimed at rivaling the previously relied upon methods of needle-localized and core needle breast biopsies. In this study, we analyzed the first 15 months of use of the ABBI system in a community hospital to evaluate its applicability and efficacy in the diagnosis of nonpalpable breast lesions. Eighteen surgeons and three radiologists performed a total of 230 cases on 223 patients (seven patients had bilateral breast biopsies). The lesions biopsied included 114 clustered microcalcifications, 115 masses, and 1 retained guidewire from a previous needle-localized breast biopsy. The average time for the complete procedure was 65 minutes. Breast cancer was identified in 36 patients (36 of 230, 15.7%) and 1 additional patient had an incidental finding of lobular carcinoma in situ. The malignancies included 20 cases of invasive ductal carcinoma, 12 cases of ductal carcinoma in situ, and four cases of invasive lobular carcinoma. Overall, 84 per cent of the patients had a definitive benign diagnosis and required no further surgical treatment of their mammographic finding. There have been no known missed lesions after use of the ABBI procedure. In conclusion, our experience has shown the ABBI system to be a valuable option in the management of selected patients with nonpalpable breast lesions.

Needle-localized Breast Biopsy for Mammographic Abnormalities: A Community Hospital Experience

Increased awareness of benefits of early detection of breast cancer has resulted in increased numbers of screening mammographies and breast biopsies for nonpalpable lesions. Tertiary hospital studies have demonstrated positive biopsy rates from abnormal mammographic findings at 18 to 32 per cent. We examined the effectiveness of needle biopsy for nonpalpable radiographic abnormalities in our community hospital. We reviewed 167 records of patients biopsied over a 2-year period. Mammographic assessment, biopsy, and pathological assessment were performed using accepted methods. Malignancy was detected in 34 of 167 biopsies (20%). The biopsy yield rate was highest for mammographic findings of spiculated or stellate masses (75%, P < 0.01). Most biopsies (83%) were performed because of mammographic findings of microcalcifications or circumscribed enlarging masses/nodular developing densities for a positive biopsy yield rate of 16 per cent. Rates were higher in patients with personal (44%) or family history (30%) of breast cancer and in postmenopausal women (30%). These results demonstrate that 1) factors such as age, personal or family history of breast cancer, and certain mammographic features of breast lesions are associated with high biopsy yield rates, and 2) the biopsy yield rate in our community setting is comparable to tertiary hospital experience.