Open Breast Biopsy Research Articles

Open surgical breast biopsy

Background : open biopsy has been considered the gold standard in establishing or ruling out carcinoma of the breast. Women suspected of having breast cancer are usually referred for breast biopsy to determine whether the lesion is benign or malignant and whether further treatment is needed.Purpose: to analyse the results of open surgical breast biopsies of 2 years intervalMethods: Patients who underwent lumpectomy, wide local excision and incisional biopsy of a breast mass in Al- Karama Teaching Hospital / Wasit Governorate from January 2009 through December 2010 were included in the study.Results: A total of 70 patients with 70 open biopsies were identified and analysed. The mean age was 32.5 years. Within the malignant group the average age was 45.25 years. Out of the 70 biopsies included; 30 (42.85%) were malignant,13(18.62%) were fibroadenoma,11(15.70%) were fibrocystic disease, 7(10%) were of duct ectasia, 3(4.28%) were fibroploreferative disease and 6 (8.5%) were of another pathology. Conclusions: The rate of malignancy in open breast biopsies increases with age reaching a peak in forties. We recommend that all women above the age of 40 presenting with a palpable breast lump to have their lump excised even though the lump is suspected to be benign.

Improving Breast Conserving Surgery Using the Faxitron® OR Specimen Radiography System - A Complication Analysis, Cost Evaluation and Literature Review.

The combination of pre-surgical clip placement and hook-wire guided surgery is considered the gold standard for adequately locating non-palpable lesions during breast conserving surgery. After surgical removal of the segment, radiography is required to confirm clip removal, increasing surgical time, post-surgical complication rates, and cost. We performed a retrospective analysis, using the Faxitron® in-theater specimen radiography system, of the following primary endpoints: surgical time and complication rates. The secondary endpoints were cost effectiveness and clip-location rates. The Control cohort included breast conserving surgery patients prior to May 2019 (n=150) and the Validation cohort included breast conserving surgery patients after May 2019 (n=53). The analysis showed an improvement in surgical time when using the Faxitron® system, which is directly linked to a benefit in cost effectiveness. A numerical benefit in complication rates was also shown. A subgroup analysis showed a significant advantage in surgical time for breast conserving surgery plus sentinel node biopsy and open breast biopsies. Use of the Faxitron® system significantly reduces surgical time, which increases cost efficiency while maintaining a low complication rate.

Stereotactic vs open biopsy for non-palpable breast lesions. Their impact on short term quality of life

ABSTRACT Stereotactic biopsy and open biopsy represent useful diagnostic tools of breast lesions. However, both affect the Quality of Life (QoL) in various degrees. We conducted this prospective longitudinal comparative study in order, first to access the impact of these techniques on short-term QoL and second to compare and critically discuss our results with those of literature review. Group A (58 patients) underwent vacuum-assisted stereotactic biopsy and Group B (46 patients) underwent open biopsy. The Health-Related Quality of Life (HRQol) was estimated using the European Quality of Life scale (EuroQol) and the SF-36 (The 36-Item Short-Form Health Status Survey) questionnaires. The stereotactic breast biopsy seems to be more accepted from the patients as it affects quality of life to a lesser extent than open breast biopsy. This difference is mainly attributable to a reduction of physical discomfort and pain.

Comparison of two minimally invasive biopsy techniques - Breast Lesion Excision System and vacuum-assisted biopsy - for diagnosing and treating breast lesions.

The vacuum-assisted biopsy (VAB) and the Breast Lesion Excision System (BLES) are minimally invasive biopsy techniques, both used as diagnostic and therapeutic tools. The aim of the study is to compare these two methods and assess them in the context of discomfort, early and late complications and their diagnostic and therapeutic potential. The study involved 173 patients who underwent a VAB or a BLES breast biopsy in the period between 2009 and 2016. Approximately 3 months after the biopsy, the patients completed a questionnaire in which they assessed the procedure for discomfort associated with the procedure and the final cosmetic outcome. The cosmetic effect of the biopsy was also assessed by a surgeon. The BLES and the VAB breast biopsies did not differ in terms of pain, duration, and discomfort of the procedure, breast bruising, breast tenderness about 24 h after the procedure or pain lasting over 3 months after the biopsy. Subsequently, the biopsies were evaluated in terms of the cosmetic effect assessed by the patient and by a surgeon and no differences were observed. There were no significant differences between the VAB and the BLES breast biopsies in the course of the procedure, early and late complications and cosmetic effect. Since the BLES breast biopsy makes it possible to evaluate the margins, it is a good alternative to the open breast biopsy.

The evaluation of national time trends, quality of care, and factors affecting the use of minimally invasive breast biopsy and open biopsy for diagnosis of breast lesions

BackgroundMinimally invasive breast biopsy is a recommended biopsy method for suspicious lesions. This study examines national trends and factors associated with the use of open breast biopsy (OBB). MethodsThe national inpatient sample database was used to examine trends and factors associated with the use of OBB. Factors associated with OBB were evaluated using chi-square test for univariate analysis and logistic regression for multivariate analysis. ResultsOBB rate was 34%. Patients below 50 years of age had OBB rates of 47%, while those above 50 had OBB rates of 29.1% (P < .001). Higher OBB rates were observed in Asian (39.8%) and Hispanic (40.6%) women compared with white women (34.1%, P < .001). Private insurance patients were more likely to have OBB compared with Medicaid/Medicare patients (40.9% vs 30.6%, P < .001). About 1.2% of women who underwent OBB required multiple biopsies for diagnosis compared with .5% for minimally invasive breast biopsy (P < .001). ConclusionsOBB is still performed in one third of women despite higher morbidity and less accuracy. Factors associated with higher OBB rate included younger age; Asian ethnicity; private insurance; small, rural, and nonteaching hospitals.

Accurate excision of nonpalpable breast lesions with the new device system.

e11557 Background: A histological diagnosis for nonpalpable breast lesions (NPBL) is required to determine suitable therapy. The open-breast biopsy (OBB) is the gold standard to determine the nature of NPBL. However, it is not easy to accurately remove whole breast lesions due to insufficient safe margin of lesions excised. To improve accuracy for removal of NPBL, we designed new tools to assist surgeons to accurately localize and remove NPBL during OBB. Methods: The new device system has two primary parts. First is a set of accurate-resection devices composed of a rotary cutter, a pair of inner and outer tubes, two pairs of concave and convex curved hooks, and a curved incision plate. The second part is the 12 o'clock localization method used to accurately position lesions three-dimensionally after the breast tissue is excised cylindrically. Thus, the exact location of breast lesions removed can be precisely traced back to the original breast tissue location. Results: 100 patients with a total of 149 OBB were studied using the new device system guided with needle localization under ultrasound. 112 out of 149 procedures were identified as nodule. Among 112 cases, 95 were breast fibroadenomas, 10 were mammary adenosis with a trend to form fibroadenoma, 5 were mammary adenosis, and 2 were adipomas. The remaining 37 cases possessed clusters of calcified lesions with small nodule. 32 were benign lesions with calcinosis, and the other 5 lesions were identified as breast cancer. Pathological examination demonstrated that 144 NPBL were accurately resected with accurate-resection devices. However, 19 out of 144 breast lesions were not completely removed the first time. Thus the second surgical procedure was performed for the 19 cases based on 12 o'clock localization method. The results demonstrated that the remaining lesions were accurately and completely eliminated with the second procedure. All patients were followed up with for 2 to 48 months post procedures. These patients treated with accurate resection devices were very satisfied with no breast deformation. Conclusions: The new device system is easy to use and has very low cost. It is very comfortable for the patient and is of great help in accurately localizing and resecting the lesions to the surgeon.

The Role of Fine-Wire Localization Breast Biopsy in the Management of BI-RADS Category 4-5 for Non-Palpable Breast Lesions: An Experience at King Abdulaziz University Hospital, Saudi Arabia

The aim of this study is to determine a positive predictive value for malignancy in patients initially categorized as having Breast Imaging Reporting and Data System categories 4 and 5 with non-palpable breast lesions that underwent fine wire-localized biopsy. 116 patients underwent this process at the Surgery Department, King Abdulaziz University Hospital, Saudi Arabia: from December 2007 through November 2009. By histopathology, out of 116 patients, 76 (65.52%) were benign and 44 (37.93%) malignant lesions. According to Breast Imaging Reporting and Data System categories: 89 (76.72%) were category 4 and 27 (23.28%) were category 5. In category 4, 70.80% (n=64) of cases were benign and 28.10% (n=25) were malignant given positive predictive value 28.09%. In category 5, 29.60% (n=8) of cases were benign and 70.10% (n=19) were malignant given positive predictive value 70.73% after fine wire-localized biopsy for non-palpable breast lesions. In conclusion, combination of Breast Imaging Reporting and Data System categories and fine wire-localized biopsy for non-palpable breast lesions is safe, but the positive predictable value of malignancy of Breast Imaging Reporting and Data System was low especially in category 4. Preoperative histological confirmation is very important for suspicious non-palpable breast lesions to avoid unnecessary open breast biopsy.

Long term follow-up and risk of breast cancer after a radial scar or complex sclerosing lesion has been identified in a benign open breast biopsy

Aims Radial scars (RS)/complex sclerosing lesions (CSL) are rare, benign breast lesions of unknown aetiology. Associations with breast cancer have been suggested particularly with larger lesions. This study aims to identify the risk of developing subsequent breast cancer after excision of a benign RS/CSL with respect to lesion size and compared to expected rates in the normal UK population. Methods A prospective cohort analysis was performed on patients diagnosed with RS/CSL in benign, open breast biopsy specimens over a 20-year period. The rate of subsequent breast cancer development was compared to expected rates in the normal UK population. Subjects were divided into two groups according to lesion size and the rates of subsequent breast cancer compared. Results 149 women without proliferative breast disease were followed for an average of 68 months. Five women developed subsequent cancer, equating to a rate of 0.84% per year. This compares to 0.32% per year in the normal population (RR 2.6, 95% CI 0.86–6.0). There were two subsequent cancers in the RS group and three subsequent cancers in the CSL group, P = 0.64. Conclusions The study finds no evidence to suggest that lesions greater than 10 mm (CSL) have any greater risk of developing cancer after excision than those below 10 mm (RS). Women treated for RS/CSL do not need any additional follow-up beyond routine mammographic breast screening. Additional surveillance should only be performed if there is associated pathology indicating an increased risk of subsequent malignancy.

Utilization of minimally invasive breast biopsy for the evaluation of suspicious breast lesions

BackgroundPercutaneous needle biopsy, also known as minimally invasive breast biopsy (MIBB), has become the gold standard for the initial assessment of suspicious breast lesions. The purpose of this study is to determine modern rates of MIBB and open breast biopsy. MethodsThe Florida Agency for Health Care Administration outpatient surgery and procedure database was queried for patients undergoing open surgical biopsy and MIBB between 2003 and 2008. ResultsAlthough there was an increase in the use of MIBB, the overall rate of open surgical biopsy remained high (∼30%). A reduction in the open biopsy rate from 30% to 10% could be associated with a charge reduction of >$37.2 million per year. ConclusionsThe current rate of open surgical breast biopsy remains high. Interventions and quality initiatives are warranted, which could lead to a reduction in unnecessary operations for women, improved patient care, and a reduction in breast health care costs.

BI-RADS Descriptors for Mammographically Detected Microcalcifications Verified by Histopathology After Needle-Localized Open Breast Biopsy

The objective of our study was to retrospectively determine the positive predictive value of each descriptor and of combined descriptors for microcalcifications to predict the risk of malignancy as well as the appropriate final assessment category. A total of 308 needle-localized open breast biopsies for mammographically detected microcalcifications were performed in 295 women (age range, 33-71 years; mean age, 52 years) during 7 years. Thirteen patients had bilateral microcalcifications that were studied separately. Two breast radiologists retrospectively reviewed the microcalcifications with regard to their morphology, distribution, and extent and to associated findings and final assessment category, after which they categorized them into nine combined descriptors. Surgical pathology served as the reference standard for malignant lesions and follow-up of at least 12 months served as the reference for benign lesions. The Fisher's exact test, including odds ratios, was used for statistical analysis. Of the 308 needle-localized open breast biopsies, 144 (47%) were malignant and 164 (53%) were benign. For combined descriptors of morphology and distribution, the odds ratios of malignancy regarding the higher probability of malignancy and ductal distribution were as follows: 0 for typically benign morphology or scattered distribution, 93.00 for intermediate concern and regional, 33.53 for intermediate concern and clustered, 5.00 for intermediate concern and ductal, 24.00 for higher probability of malignancy and regional, and 1.13 for higher probability of malignancy and clustered. Each descriptor and combined descriptors for microcalcifications and the final assessment category could help to predict the risk of malignancy.

Are Percutaneous Biopsy Rates a Reasonable Quality Measure in Breast Cancer Management?

Utilization of percutaneous needle biopsy (PNB) has been proposed as a quality measure of breast cancer care. We evaluated rates and reasons for failure of patients undergoing PNB as the initial diagnostic procedure for evaluation of breast pathology. We performed a retrospective review of sequential patients undergoing image-guided PNB and open surgical excisional breast biopsies from January 2006 to July 2009 at our institution. Factors associated with failure to undergo a percutaneous approach were analyzed. During the study period, 1196 breast biopsies were performed; 87 (7.3%) were open surgical biopsies, and 1109 (92.7%) were PNB. Imaging used for percutaneous guidance or needle localization was ultrasound in 58.9%, mammogram in 40.0%, and magnetic resonance imaging (MRI) in 0.9%. Open surgical excisional biopsy was associated with mammographic guidance (P<.001), location in the central or lower inner quadrant of the breast (P=.002), BIRADS score of 1 or 6 (P<.001), or calcifications as target (P<.001). There were no differences in rates of PNB by age, size of lesion, or breast density. Reasons for failure of PNB were technical (calcifications not visualized, proximity to implant, etc.) in 86.2% of cases. No reason was documented in 10.3%, and 3.4% of patients refused a percutaneous approach. The majority of patients in this series underwent PNB as an initial diagnostic approach. Most percutaneous failures are due to technical reasons. PNB rates are a reasonable quality measure in breast cancer care. Documentation of failure to meet this benchmark should be stringently monitored.

Nonpalpable Breast Lesions in a Breast Care Unit: Prospective Analysis on 2708 Consecutive Cases.

Abstract Background: Breast cancer screening increases the detection of nonpalpable breast lesions, These lesions raise specific concerns, involving radiological imaging, biopsy techniques, and pathological analysis. The objective of the study is to evaluate the management of nonpalpable breast lesions in a breast disease unit.Material and Methods: From 2001 to 2007, 2708 nonpalpable breast lesions were prospectively evaluated by a multidisciplinary team. Radiologic lesions were detected by mammography alone (71,5%), ultrasonography (27,90%), MRI (0,20%). All lesions were classified according to the BI RADS classification. Three hundred and nine (309) core needle biopsies were performed, 807 vacuum assisted biopsies, and 521 open breast biopsies. The pathologic results were correlated with surgery, rebiopsy or long-term imaging follow up.Results: The pathologic results showed 33 % of malignant lesions (DCIS, invasive carcinoma), 9 % of high risk lesions (atypical ductal or lobular hyperplasia, lobular carcinoma in situ) and 58 % of benign lesions. The prevalence of cancer as a function of BI-RADS was: BI-RADS 0 : 2,6% (4/152), BI-RADS 2: 0% (0/55), BI-RADS 3: 2,3% (17/740), BI-RADS 4: 23,4% (352/1502) et BI-RADS 5 : 78,7% (185/235). Twelve of 152 (7,9 %) high risk lesions were upgraded to malignant lesions and 34/211 DCIS (16,1%) were upgraded to invasive carcinoma after surgery. Diagnostic performance rates exhibited the following results: agreement rate=96,6%, sensibility=96,2%, overall underestimation rate=12,6%, and false-negative rate=1,6%.Table 1: Diagnostic performance of core needle biopsy, vacuum assisted biopsy, open breast biopsy core needle biopsy%vacuum assisted biopsy%open breast biopsy%Totaln=309 807 521 1637Pathologic results benign21970,9%48960,6%23444,9%942 (57,5%)High risk82,6%728,9%6813,1%148 (9,0%)malignant8226,5%24630,5%21942,0%547 (33,4%)Diagnostic performance sensibility80/8297,6%228/24593,1%217/21999,1%525/546 (96,2%)agreement304/30998,4%762/80794,4%515/52198,8%1581/1637 (96,6%)high risk underestimate1/616,7%10/7713,0%1/691,4%12/152 (7,9%)DCIS underestimate3/650,0%27/12421,8%4/814,9%34/211 (16,1%)overall underestimate rate4/1330,8%37/20118,4%5/1503,3%46/364 (12,6%)false negative rate1/821,2%7/2462,8%1/2190,5%9/547 (1,6%) After vacuum assisted biopsy, one-step surgery was performed in 82,9% and after core needle biopsy in 68,4%.Conclusion: This kind of quality evaluation in community practice should be encouraged. Management of those lesions continuously evolves with the widespread of RMI and new biopsy techniques. Efforts should be made in exploring imaging-pathologic discrepancies, and in identifying predictive factors of invasion on biopsies. We currently perform a focused analysis on lesions that required two surgical steps despite a prior biopsy, in order to point out new ways to improve our practices. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6020.

Evaluation of the Tyrer-Cuzick Model in Women with Atypical Hyperplasia.

Abstract Background: Risk prediction models are important clinical tools for counseling and decision making for women with an elevated risk of breast cancer, such as women with atypical lobular or ductal hyperplasia (atypia). The Gail model has been shown to underestimate the risk of breast cancer in women with atypia. We sought to evaluate the performance of the Tyrer-Cuzick model in a well-defined cohort of women with atypia.Methods: The Mayo Benign Breast Disease (BBD) Cohort includes 9,376 women aged 18 to 85 who had an open breast biopsy with benign pathological findings between 1967 and 1991. The subset of women with atypia was identified by our study pathologists. Risk factor data required by the Tyrer-Cuzick model were collated for each woman, and the model was used to predict each woman's risk of developing invasive breast cancer within ten years. The predicted numbers of breast cancers were compared to the observed numbers to assess overall model calibration, and the concordance between breast cancer outcomes and predicted probabilities was used to measure the accuracy of the model on the individual level. Subset analysis of women with strong family history was performed. Strong family history was defined as: at least one first-degree relative with breast cancer before the age of 50 years or two or more relatives with breast cancer, at least one being a first degree relative.Results: Three hundred and thirty one women with atypia were identified. Over a mean follow up of 13.7 years, 62 (19%) women have developed invasive breast cancer. Thirty one women developed invasive cancer in the first ten years after biopsy. The Tyrer-Cuzick model predicted that 64.6 invasive breast cancers would occur in the first ten years after biopsy. Thus, the predicted to observed ratio was 2.08 [95% CI: 1.47 – 2.96], p &amp;lt; 0.001).The concordance statistic was 0.51, revealing that the Tyrer-Cuzick model did not accurately distinguish, on an individual level, between women who were diagnosed with invasive breast cancer within ten years of biopsy and those who were not.Performance was somewhat better in the subset of 68 women with a strong family history of breast cancer. The model predicted 12.3 invasive breast cancers, and 7 were observed, for a predicted to observed ratio of 1.76 [95% CI: 0.84 – 3.70]. The concordance statistic was 0.57.Conclusion: The Tyrer-Cuzick model significantly overestimated the risk of breast cancer in the first ten years after biopsy for this group of women with atypia. Individual risk estimates showed poor concordance. Performance was slightly improved in women with a strong family history of breast cancer. Physicians should be cautious when using the Tyrer-Cuzick model to predict ten-year risk in patients with atypia. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6063.

Vacuum-assisted breast biopsy in close proximity to the skin: a case report

IntroductionVacuum-assisted breast biopsy is a minimally invasive technique used increasingly for the assessment of mammographically detected, non-palpable breast lesions. The effectiveness of vacuum-assisted breast biopsy has been demonstrated on lesions both with and without microcalcifications. Given that the position of the lesion represents a major factor in stereotactic vacuum-assisted breast biopsy, targeting lesions in close proximity to the skin (superficial lesions) has been described as a problematic issue.Case presentationA 53-year-old woman presented with a newly developed, non-palpable lesion in her left breast. The lesion consisted of widely spread microcalcifications located approximately 5 mm from the skin. The lesion was isoechoic on ultrasound examination. Vacuum-assisted breast biopsy was scheduled (on the Fischer's table, using 11-gauge probes, under local anaesthesia). The vacuum-assisted breast biopsy probe was inserted antidiametrically into the breast, the probe reached the lesion and effort was made to excise the microcalcifications. As only a small proportion of the microcalcifications were excised an accurate diagnosis could not be expected. However, with the probe having entered the breast antidiametrically, the probe tip underlying the skin could be palpated. Following the palpation of the tip, the exact point was marked by a pen, the probe was removed and the patient was transferred to the surgery room to have the remaining lesion removed by a spindle-form excision under local anaesthesia. The mammogram of the removed specimen confirmed the total excision of the suspicious microcalcifications.ConclusionIsoechoic superficial lesions can be localized with a hook-wire and open breast biopsy under general or local anaesthesia can be performed. However, vacuum-assisted breast biopsy might offer an alternative solution and serve as an alternative approach to localize the lesion. The clinical significance of the present exploratory effort remains to be assessed in the future.

Commentary

The management of a palpable breast mass starts with identification of the lesion and a suspicion of malignancy. While seemingly simple, the initial evaluation can significantly impact upon treatment options and outcomes. The management of two patients recently referred to this Institution highlights common pitfalls and technical considerations in the diagnosis and treatment of palpable breast masses.The case histories of two patients referred after open breast biopsy were examined. The English language medical literature was searched manually and by Medline for publications related to the evaluation of palpable breast masses. Imaging, diagnostic techniques and technical considerations in the management of palpable lesions were reviewed.The initial use of carefully selected diagnostic and therapeutic measures is critical in optimizing outcomes measured in improved quality of life and survival. Inappropriate choices at this first stage can have extremely negative consequences. The early evaluation of two patients highlighted these considerations. Management pitfalls included serial examination of a suspicious lesion, failure to obtain a mammogram prior to excisional biopsy and unnecessary testing. Technical problems included piecemeal excision of the tumor with positive margins, use of a drain, closure of deep tissues with dimpling of the breast, and incision placement in a location that subsequently necessitated mastectomy.Careful adherence to the clinical and operative principles of breast cancer management optimizes outcomes in the evaluation of palpable breast masses.

Audit of open breast biopsies in a Nigerian teaching hospital

11091 Background: Open biopsy is an accurate method for diagnosis of breast tumors especially where facilities for needle biopsies like tru cut needle biopsy or aspiration cytology method are not readily available. We report a 10-year retrospective study of the clinical and pathological characteristics of excised breast masses in our centre. Methods: Clinical records and pathological results of all breast biopsies of consecutive patients referred to the Breast Clinic of the Abia State University Teaching Hospital, Aba, Nigeria were studied from January 1994 to December 2003. We present the outcome of the histology reports from breast biopsy for a period of 10 years (1994- 2003) in Abia State University Teaching Hospital. Results: A total of 421 patients had open biopsies for breast masses. The age ranged from 12 years to 80 years with the median age of 34 years. The commonest symptom was painless breast lump in 90% of patients; breast pain was present in less than 5% of cases. Malignancies were discovered in 24% of the cases and the predominant histological type was infiltrating ductal carcinoma (NOS) which was found in 78% of cases, lobular carcinoma was found in 2% of cases. 79% of the breast cancers occur in pre menopausal women and the majorities (85%) were late stages. 79% of the patients with cancer of the breast were 50 years old or younger and the youngest patient was 14 years. The benign lesions in order of frequency were fibroadenoma (45%), fibroadenosis (41%), granulomas (5%), breast cyst (3%), and galactocele (2%).Other less common pathologies include lipoma, chronic abscesses and parasitic cysts. Conclusions: Majority of breast masses in Nigerian women are benign. The preponderance of late staged tumors and pre menopausal patients call for early detection, public awareness and improved screening methods No significant financial relationships to disclose.

Korrelation zwischen histologischem Befund und einem Computer-assistierten Detektionssystem (CAD) für die Mammografie

PURPOSE: To assess the sensitivity and specificity of a wavelet transformation-based computer-assisted detection system (CAD) for mammography after film digitizing and data compression. MATERIALS AND METHODS: 128 one-sided mammograms of 128 patients with 135 histological proven lesions were evaluated by the CAD System (66 malignant lesions, 69 benign lesions). Two groups were enrolled and analysed: one group with calcifications only and one group with masses and calcifications. None of the lesions were palpable. After stereotactic wire placement the histological specimens were obtained by open breast biopsy. The mammograms were digitized and afterwards analysed by the CAD system integrated in the mammography system. RESULTS: CAD correctly detected 95.4 % of the malignant lesions with microcalcifications only and 81.8 % of the malignant lesions with mammographic masses and calcifications. Overall, 90.9 % of malignant lesions were detected. With respect to all benign lesions CAD correctly did not mark 50 % of lesions with microcalcifications only and 44 % of masses with calcifications. The specificity was 50.7 %. CONCLUSION: With regard to its high sensitivity the evaluated CAD system is useful as a supporting method in mammographies. Because of its low specificity every CAD mark must be cross-checked by a skilled mammography examiner.

4–19 Lesion Miss Rates and False-Negative Rates for 1115 Consecutive Cases of Stereotactically Guided Needle-localized Open Breast Biopsy With Long-term Follow-up

4–19 Lesion Miss Rates and False-Negative Rates for 1115 Consecutive Cases of Stereotactically Guided Needle-localized Open Breast Biopsy With Long-term Follow-up

Lesion Miss Rates and False-Negative Rates for 1115 Consecutive Cases of Stereotactically Guided Needle-localized Open Breast Biopsy with Long-term Follow-up

To retrospectively determine the lesion miss rate and false-negative rate of needle-localized open breast biopsy (NLOBB) with stereotactic guidance in a large study population. The ethical review board approved the study; the need for informed consent was waived. A total of 1115 stereotactic NLOBBs performed in 1068 women aged 22-90 years (mean age, 54 years) were tracked to determine outcomes. In cases of malignancy, NLOBB was considered to be diagnostically successful. The mammographic outcomes in all patients with benign results at NLOBB were tracked for at least 2 years. Cases without such mammographic follow-up were cross-referenced with a tumor registry after at least 54 months. The lesion miss rate was based on all malignant lesions and all lesions with long-term mammographic follow-up. Results from all 1115 NLOBBs were used to report the false-negative rate. Of 1115 NLOBBs, 472 (42%) had malignant results. Mammographic follow-up data were available for 535 (83%) of 643 NLOBBs with benign results. Mammographic follow-up revealed 11 lesions that were missed with NLOBB, of which five were malignant and six benign. Thus, the lesion miss rate with NLOBB was 1.1% (11/[472 + 535]). Among the 643 cases, in 108 of them without mammographic follow-up (17%), cross-referencing with a tumor registry did not reveal missed cases of breast carcinoma. The false-negative rate was therefore 1.0% (5/[472 + 5]). On the basis of the results of long-term follow-up, the authors noted a lesion miss rate of 1.1% and a false-negative rate of 1.0%, which indicate that NLOBB with stereotactic guidance is an accurate method for diagnosing breast lesions.

The Use of Stereotactic Excisional Biopsy in the Management of Invasive Breast Cancer

Stereotactic breast biopsy techniques minimize the surgical trauma associated with conventional wire-guided open breast biopsy for non-palpable breast lesions (NPBLs). Advanced breast biopsy instrumentation (ABBI) allows for a 2-cm core of breast tissue to be excised under stereotactic guidance in an outpatient setting. We report our initial experience with ABBI. Hospital charts from 89 ABBI procedures between 10/1996 and 07/2002 were retrospectively reviewed for patient characteristics, ABBI parameters, radiographic appearance, pathology, complications, and clinical follow-up. Data are presented as percentage/median (range). Median age was 59 years (range: 39-80 years), mammographic lesions were classified as calcifications 49% (44/89), soft tissue 39% (35/89), or mixed 11% (10/89). Median radiographic size was 7 mm (1-60 mm). Final pathology revealed ductal carcinoma in situ (DCIS) in 7% (6/89) and invasive cancer in 22% (20/89). Microscopically clear margins were obtained in 55% (11/20) of patients with invasive cancer. Of these, 82% (9/11) chose not to undergo further local surgical therapy. Eight patients remain disease free at 56 months (range: 41-95 months) follow-up. The ninth patient was deceased at 6 months from an unrelated cause. The overall complication rate was 3% (3/89). A definitive diagnosis was obtained in 100% of malignant and 87% of benign cases. Median waiting time was 19 days (range: 0-90 days). Our experience demonstrates that ABBI is an effective diagnostic tool for NPBLs. It is associated with minimal complications, and provides negative margins in over half of malignant cases. In selected patients with invasive cancer and negative margins, ABBI may obviate the need for further local surgical treatment. ABBI merits additional investigation as a therapeutic modality for early breast cancer.