Stereotactic Vacuum-assisted Biopsy Research Articles

Abstract P2-02-01: Randomised controlled trial of stereotactic 11g vacuum-assisted or core biopsy for diagnosis and management of malignant microcalcification

Abstract Background Vaccum-assisted biopsy (VAB) is claimed to improve diagnosis of malignant microcalcification (MM) and prevent underestimation of invasive component compared to stereotactic core biopsy (SCNB) 14g biopsies. VAB is also reported to reduce requirement for further surgical procedures versus SCNB. Methods In a randomised controlled trial, we compared both techniques in the firstline diagnosis of MM and subsequent surgical management in two UK Breast Screening Units. Patients with MM were identified and gave written informed consent to the study before randomisation 1:1 to SCNB or VAB. Exclusions included bleeding diathesis or significant comorbidity preventing surgery. SCNB was performed by advanced radiography practitioners and VAB by experienced radiologists under local anaesthesia. Quality of life was assessed using EORTC QLQ-BR23 questionnaire: Pre-biopsy, 2, 6, and 12 months post-randomisation. The primary objective compared the final pathological diagnosis with the initial biopsy (VAB or SCNB) and required 110 patients to be randomised to show a 25% improvement in diagnostic accuracy with VAB compared to SCNB with a 90% power. Results Three quarters of MM investigated was less than 15mm in size. Overall 787 women were investigated for eligibility. 476 did not meet the inclusion criteria, 82 declined to participate and 100 met exclusion criteria. In total, 129 women were randomised. Both groups were evenly matched for age 57.2 years (range 47-75) and lesion size but VAB took longer (p<0.001) and produced on average, 4 more cores (12 versus 8) (p<0.01). Three (4.7%) VAB developed bleeding causing procedure abandonment. The PPV for biopsy of MM was 30.2% and 1 patient withdrew before the procedure. There was an 84% diagnostic accuracy of SCNB which precluded any effect on surgical outcome. AnalysisVABCore SCNBPn6364 Accurate diagnosis54 (86%)54 (84%)1.0Subsequent therapeutic porcedures - 19 (56%)17 (71%)0.50Subsequent therapeutic procedures - 27 (44%)7 (29%)0.50DCIS upgrade to invasive12.5%8.7%0.86 Both groups had significant Quality of Life (QOL) falls in Global Health (p<0.001) and Social Functioning over time (p<0.04) but no overall difference between groups was seen. At 12 months, body image scores fell and fatigue increased in patients undergoing surgery. Conclusion SCNB has equal accuracy as VAB in the firstline diagnosis of malignant microcalcification. Devicor provided the equipment to Dr S.B. and Prof. N.B., to do this study. Citation Format: Sara M Bundred, Jin Zhou, Anthony Maxwell, Sigrid Whiteside, Julie Morris, Janicke Harake, Nigel J Bundred. Randomised controlled trial of stereotactic 11g vacuum-assisted or core biopsy for diagnosis and management of malignant microcalcification [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-02-01.

Diagnostic value of X-ray stereotactic vacuum-assisted biopsy for breast micro-calcification

Objective To compare the accuracy and clinical effect between X-ray stereotactic vacuum-assisted biopsy (SVAB) and metal wire guided lumpectomy. Methods From January 2010 to June 2014, 681 cases of breast micro-calcification biopsy were performed. Among them, 78 cases were performed with SVAB and 603 cases were performed with the method of stereotactic metal wire guided lumpectomy. All cases were non-palpable breast lesions (NPBLs) and breast imaging-reporting and data system (BI-RADS) assessment categories 4. The diagnostic accuracy and clinical effect were compared. Results The sensitivity of both methods was 100 % with no misdiagnosis. The underestimation rate of SVAB was 12.5 %. Compared with the method of metal wire guided lumpectomy, SVAB had many advantages, such as easy to use, quickly performed, low rate of local deformation and lower rate of operative complications. 77.5 % patients benefited from SVAB by avoiding open surgery of benign disease. Conclusions SVAB is an accurate, safe and convenient method of biopsy. It can be recommended as the preferred method of micro-calcification (BI-RADS 4). Additional operation should be performed on patients with the pathological diagnosis of middle and high grade of dysplasia and any kind of carcinoma. Key words: Breast micro-calcification; Vacuum-assisted biopsy; Diagnosis; Wire guided lumpectomy

Vacuum-assisted stereotactic biopsy for isolated BI-RADS 4 microcalcifications: evaluation with histopathology and midterm follow-up results.

The aim of this study was to evaluate the 10-gauge vacuum-assisted stereotactic biopsy (VASB) of isolated Breast Imaging Reporting and Data System (BI-RADS) 4 microcalcifications, using histology and follow-up results. From January 2011 to June 2013, VASB was performed on 132 lesions, and 66 microcalcification-only lesions of BI-RADS 4 were included into our study. VASB was performed using lateral decubitis stereotaxy for all patients. Pathologic results of VASB and further surgical biopsies were reviewed retrospectively. Patients who were diagnosed to have benign lesions by VASB were referred for follow-up. VASB and surgical histopathology results were compared to determine the underestimation ratios. Fifteen out of 66 lesions from 63 patients (median age, 47 years; range, 34-88 years) were identified as malignant by VASB. Pathological results after surgery revealed three cases of invasive ductal carcinoma among the 12 VASB-diagnosed ductal carcinoma in situ (DCIS) lesions, for a DCIS underestimation rate of 25%. The atypical ductal hyperplasia underestimation rate was 0% for the three lesions. The follow-up period was at least 10 months, with an average of 22.7 months for all patients and 21.2 months for patients with VASB-diagnosed benign lesions. None of the patients had malignancy during the follow-ups. The false-negative rate was 0% in the follow-up of 48 patients. VASB should be the standard method of choice for BI-RADS 4 microcalcifications. This method obviates the need for a surgical procedure in 73% of BI-RADS 4 microcalcification-only patients.

Diagnostic Accuracy of Stereotactic Vacuum―assisted Biopsy of Breast Tissues

Diagnostic Accuracy of Stereotactic Vacuum―assisted Biopsy of Breast Tissues

PB.9. Randomised controlled trial of stereotactic 11G vacuum-assisted core biopsy for diagnosis and management of malignant microcalcification

Vacuum-assisted biopsy (VAB) may improve accuracy of diagnosis of malignant microcalcification (MM) compared with 14G core biopsy (SCNB), thus reducing requirements for further surgical procedures.

Stereotactic vacuum-assisted core biopsy results for non-palpable breast lesions.

The increase in breast cancer awareness and widespread use of mammographic screening has led to an increased detection of (non-palpable) breast cancers that cannot be discovered through physical examination. One of the methods used in the diagnosis of these cancers is vacuum-assisted core biopsy, which prevents a considerable number of patients from undergoing surgical procedures. The aim of this study was to present the results of stereotactic vacuum-assisted core biopsy for suspicious breast lesions. Files were retrospectively scanned and data on demographic, radiological and pathological findings were recorded for patients who underwent stereotactic vacuum-assisted core biopsy due to suspicious mammographic findings at the Interventional Radiology Centre of the Florence Nightingale Hospital between January 2010, and April 2013. Statistical analysis was carried out using Pearson's Chi-square, continuity correction, and Fisher's exact tests. The mean age of the patients was 47 years (range: 36-70). Biopsies were performed due to BIRADS 3 lesions in 8 patients, BIRADS 4 lesions in 77 patients, and BIRADS 5 lesions in 3 patients. Mammography elucidated clusters of microcalcifications in 73 patients (83%) and focal lesions (asymmetrical density, distortion) in 15 patients (17%). In terms of complications, 1 patient had a hematoma, and 2 patients had ecchymoses (3/88; 3.3%). The histopathologic results revealed benign lesions in 63 patients (71.6%) and malignant lesions in 25 patients (28.4%). The mean duration of the procedure was 37 minutes (range: 18-55). Although all of the BIRADS 3 lesions were benign, 22 (28.6%) of the BIRADS 4 lesions and all of the BIRADS 5 lesions were malignant. Among the malignant cases, 80% were in situ, and 20% were invasive carcinomas. These patients underwent surgery. In cases where non-palpable breast lesions are considered to be suspicious in mammography scans, the vacuum-assisted core biopsy method provides an accurate histopathologic diagnosis thus preventing a significant number of patients undergoing unnecessary surgical procedures.

Sentinel lymph node biopsy is not necessary in patients diagnosed with ductal carcinoma in situ of the breast by stereotactic vacuum-assisted biopsy.

This study evaluated the role and need of a sentinel lymph node biopsy (SLNB) in patients with an initial diagnosis of ductal carcinoma in situ (DCIS) made by stereotactic vacuum-assisted biopsy (VAB). A retrospective analysis was performed of 1,458 patients who underwent stereotactic VAB between January 1999 and December 2012 at Aichi Cancer Center Hospital. The rates of axillary node metastasis and the underestimation of invasive ductal carcinoma (IDC) were examined. Of the 1,458 patients who underwent stereotactic VAB, 199 had a preoperative diagnosis of DCIS and underwent surgery. In these patients, 20 % (39/199) were upstaged to IDC or at least microinvasion in final pathology. Axillary lymph node status was investigated in 81 % (161/199) of initially diagnosed DCIS patients, and resulted in finding lymph node metastasis in 0.62 % (1/161) patients. To assess the potential preoperative predictors of invasiveness, the value of DCIS histological grade on biopsy samples, the distribution of calcifications on mammograms, and the combination of these factors were studied. The underestimation rate was higher (30 %) in the combination of high DCIS histological grade and extensive calcification although there was no significant association (p = 0.23). The rate of lymph node metastasis was extremely low (0.62 %), even when invasive carcinoma was identified on excision in patients initially diagnosed with DCIS by stereotactic VAB. Because of the low prevalence of metastatic involvement, the cessation of SLNB is a reasonable consideration in patients initially diagnosed with DCIS by stereotactic VAB.

Evaluation of the Role of Dynamic Contrast-Enhanced MR Imaging for Patients with BI-RADS 3–4 Microcalcifications

ObjectiveThe purpose of study was to prospectively evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging in the differentiation of malignant lesions from benign ones in patients with BI-RADS 3–4 microcalcifications detected by mammography.Materials and Methods93 women with 100 microcalcifications had undergone breast MRI from June 2010 to July 2013. Subsequently, 91 received open biopsy and 2 received stereotactic vacuum-assisted biopsy. All results were compared with histological findings. The PPV, NPV and area under curve (AUC) of the mammography and breast MRI were calculated.ResultsThere were 31 (31.0%) BI-RADS 3 microcalcifications and 69 (69.0%) BI-RADS 4. The PPV and NPV of mammography is 65.2% (45/69) and 90.3% (28/31). The PPV and NPV of breast MRI was 90.2% (46/51) and 95.9% (47/49). Among 31 BI-RADS 3 microcalcifications, the PPV and NPV of breast MRI was 100% (3/3) and 100% (28/28). Among 69 BI-RADS 4 microcalcifications, the PPV and NPV of breast MRI was 89.6% (43/48) and 90.5% (19/21). The AUC of mammography and breast MRI assessment were 0.738 (95% CI, 0.639–0.837) and 0.931 (95% CI, 0.874–0.988) (p<0.05).ConclusionDynamic contrast-enhanced MR imaging of breast is able to be applied to predict the risk of malignance before follow-up for BI-RADS 3 microcalcifications and biopsy for BI-RADS 4 microcalcifications.

Values of pathological analysis of lost tissue fragments in the vacuum canister during a vacuum-assisted stereotactic biopsy of the breast

Determine values of pathological analysis of the canister content during a vacuum-assisted breast biopsy (VABB). Approval was obtained from the ethical committee. Prospective radiological and pathological analyses of the canister content collected during 231 VABBs performed on 231 patients were carried out. χ(2) test was used to determine predictors on canister pathology. The canister pathology was reported separately in 212 cases. It showed only blood in 78/212 (37%) cases and benign (including high-risk lesions) and malignant results in, respectively, 113/212 (53%) and 21/212 (10%) cases. Respective specimen analysis was benign, including high-risk lesions in 162/212 cases (76%) and malignant in 50/212 (24%) cases. Microcalcifications were documented on canister X-ray in 70/231 (30%) cases. There was significant association between the canister and the specimen pathology (p<0.0001). In none of the cases was microcalcifications seen exclusively in the canister content or pathological upgrading found in the canister content compared with the specimen. Small tissue fragments and microcalcifications may be lost in the canister during a VABB. Nevertheless, our results did not show any significant value for systematic analysis of the canister content. There is no added diagnostic value to retrieval and analysis of tissue lost in the canister during a VABB.

Breast Microcalcification: Diagnostic Value of Calcified and Non-calcified Cores on Specimen Radiographs

To determine if the specimen without calcification, as depicted on specimen radiography, made any contribution to the final histopathological diagnosis in comparison to the specimen with calcification. The records of 1312 stereotactic vacuum-assisted biopsies for breast microcalcifications between February 2000 and December 2010 were reviewed retrospectively. Following specimen x-ray the biopsy tissues with and without microcalcifications were sent in two separate pots (pot 1 and pot 2 respectively). The number of cores in each pot and the number of calcium specks within the cores were recorded. In 1135 of the 1312 (86%) cases the histopathological findings were similar for pot 1 and pot 2. In 165 cases (13%) the diagnosis was made solely on pot 1 while cores in pot 2 did not reveal any additional pathology. In 12 biopsies (1%) the significant pathology was only present in the specimen without any calcification. For "microcalcification only" breast lesions the specimen containing calcium will yield a correct diagnosis in 99% of cases. Cores containing no calcification rarely contribute to the diagnosis on their own, but in 87% of cases an accurate diagnosis would still have been made even if the targeted calcification had been missed.

Stereotactic Vacuum-Assisted Biopsies on a Digital Breast 3D-Tomosynthesis System

The purpose of this study was to describe our operating process and to report results of 118 stereotactic vacuum-assisted biopsies performed on a digital breast 3D-tomosynthesis system. From October 2009 to December 2010, 118 stereotactic vacuum assisted biopsies have been performed on a digital breast 3D-tomosynthesis system. Informed consent was obtained for all patients. A total of 106 patients had a lesion, six had two lesions. Sixty-one lesions were clusters of micro-calcifications, 54 were masses and three were architectural distortions. Patients were in lateral decubitus position to allow shortest skin-target approach (or sitting). Specific compression paddle, adapted on the system, performed, and graduated, allowing localization in X-Y. Tomosynthesis views define the depth of lesion. Graduated Coaxial localization kit determines the beginning of the biopsy window. Biopsies were performed with an ATEC-Suros, 9 Gauge handpiece. All biopsies, except one, have reached the lesions. Five hemorrhages were incurred in the process, but no interruption was needed. Eight breast hematomas, were all spontaneously resolved. One was an infection. About 40% of patients had a skin ecchymosis. Processing is fast, easy, and requires lower irradiation dose than with classical stereotactic biopsies. Histology analysis reported 45 benign clusters of micro-calcifications, 16 malignant clusters of micro-calcifications, 24 benign masses, and 33 malignant masses. Of 13 malignant lesions, digital 2D-mammography failed to detect eight lesions and underestimated the classification of five lesions. Digital breast 3D-tomosynthesis depicts malignant lesions not visualized on digital 2D-mammography. Development of tomosynthesis biopsy unit integrated to stereotactic system will permit histology analysis for suspicious lesions.

Morphological parameters of flat epithelial atypia (FEA) in stereotactic vacuum-assisted needle core biopsies do not predict the presence of malignancy on subsequent surgical excision

Flat epithelial atypia (FEA) may represent the earliest precursor of low-grade breast cancer and often coexists with more advanced atypical proliferative breast lesions such as atypical ductal hyperplasia (ADH) and lobular intraepithelial neoplasia (LIN). The present study aims to investigate the association between morphological parameters of FEA and presence of malignancy at surgical excision (SE) and the clinical significance of the association of FEA with ADH and/or LIN. This study included 589 cases of stereotactic 11-gauge vacuum-assisted needle core biopsy (VANCB), reporting a diagnosis of FEA, ADH or LIN with subsequent SE from 14 pathology departments in Italy. Available slides were reviewed, with 114 (19.4%) showing a malignant outcome at SE. Among the 190 cases of pure FEA, no statistically significant association emerged between clinical-pathological parameters of FEA and risk of malignancy. Logistic regression analyses showed an increased risk of malignancy according to the extension of ADH among the 275 cases of FEA associated with ADH (p = 0.004) and among the 34 cases of FEA associated with ADH and LIN (p = 0.02). In the whole series, a statistically significant increased malignancy risk emerged according to mammographic R1-R3/R4-R5 categories (OR = 1.56; p = 0.04), extension (OR = 1.24; p = 0.04) and grade (OR = 1.94; p = 0.004) of cytological atypia of FEA. The presence of ADH was associated with an increased malignancy risk (OR = 2.85; p < 0.0001). Our data confirm the frequent association of FEA with ADH and/or LIN. A diagnosis of pure FEA on VANCB carries a 9.5% risk of concurrent malignancy and thus warrants follow-up excision because none of the clinical-pathological parameters predicts which cases will present carcinoma on SE.

Biopsia mamaria asistida por vacío y guiada por estereotaxia. Correlación con la biopsia quirúrgica

ObjectiveTo evaluate the efficiency of stereotactic vacuum-assisted core breast biopsy as an alternative to diagnostic surgical biopsy. Material and methodsA retrospective study based on 250 stereotactic vacuum-assisted percutaneous biopsies was conducted from March 2006 to August 2010. The false-negative rate and underestimation of disease at percutaneous biopsy were determined in comparison with diagnostic surgical biopsy. ResultsThe false-negative rate was 2% (1/63) and the positive predictive value was 100%. Surgical excision revealed carcinoma in 30% (3/10) of the patients with atypical ductal hyperplasia at core biopsy and in 33.3% (2/6) of those with lobular carcinoma in situ. Among 40 lesions diagnosed as ductal carcinoma in situ at vacuum-assisted biopsy, surgery revealed invasive carcinoma in four (10%). ConclusionsStereotactic core breast biopsy can be considered a valid alternative to diagnostic surgical biopsy, although diagnostic underestimation still occurs.

Factors that impact the upgrading of atypical ductal hyperplasia

The purpose of this study was to identify the factors that may have an impact on upgrading atypical ductal hyperplasia (ADH) lesions to malignancy. Between February 1999 and December 2010, the records of 150 ADH lesions that had been biopsied were retrospectively reviewed. The biopsy types included 11-gauge stereotactic vacuum-assisted biopsy (SVAB) (n=102) and ultrasonography (US)-guided 14-gauge automated biopsy (n=48). The patients were divided into two groups: those who had cancer in the final pathology and those who did not. Variables associated with underestimation of ADH lesions were compared between the groups. The underestimation rates according to the biopsy types were 41.7% (20/48) for the US-guided 14-gauge automated biopsy and 20.6% (21/102) for the 11-gauge SVAB (P = 0.007). The rate of underestimation was significantly higher in lesions greater than 7 mm than it was in smaller lesions, with both US-guided 14-gauge automated biopsy and 11-gauge SVAB (P = 0.024 and P = 0.042, respectively). The rate of underestimation was significantly higher with the 11-gauge SVAB (P = 0.025) in lesions that were suspicious (R4) and highly suggestive of malignancy (R5) than in those that were probably benign (R3). The underestimation rate in ADH lesions was significantly higher with US-guided 14-gauge automated biopsy compared to the 11-gauge SVAB. The underestimation rate was also significantly higher in lesions greater than 7 mm regardless of the biopsy type, and in lesions biopsied using SVAB that were regarded as suspicious (R4) or highly suggestive of malignancy (R5) on imaging.

On the Diagnostic Accuracy of Stereotactic Vacuum-Assisted Biopsy of Nonpalpable Breast Abnormalities. Results in a Consecutive Series of 769 Procedures Performed at the Trento Department of Breast Diagnosis

To assess the diagnostic accuracy of stereotactic vacuum-assisted biopsy of nonpalpable breast lesions. 769 consecutive vacuum-assisted biopsy procedures were retrospectively reviewed. Positive predictive value for carcinoma (B5) at vacuum-assisted biopsy was assessed on the overall series and by age, lesion morphology and size, degree of suspicion and calendar period. The accuracy of vacuum-assisted biopsy was based on surgical histology or follow-up (no change at 12 months was assumed as negative). Lesions were depicted as isolated microcalcifications, opacity + microcalcifications, or opacity in 716 (93.1%), 28 (3.6%), or 25 (3.2%) cases, respectively. Vacuum-assisted biopsy was negative (B1 = 63; B2 = 319) in 382 (49.7%), borderline (B3) in 142 (18.5%), suspicious (B4) in 2 (0.3%), and positive (B5) in 243 (31.6%) cases (in situ = 185, 24.1%), invasive = 58 (7.5%)), respectively. Age (χ²df3 = 19.50; P <0.002), size (χ²df4 = 51.02; P = 10⁻⁶) and degree of suspicion (χ²df2 = 146.68; P = 10⁻⁶) were associated with a B5 outcome, no significant association was evident for morphology (χ²df2 = 0,47; P <0.78), whereas calendar period had a moderate but significant inverse association (χ²df2 = 6.12; P <0.04). The positive predictive value for surgically confirmed carcinoma (in situ or invasive) was 0% for B1, 0.7% for B2, 12.3% for B3, 100% for B4, 92.7% for in situ B5, and 94.6% for invasive B5. Conversion from in situ B5 to invasive was 12.3% and was insignificantly associated with size (χ²df2 = 0.95; P = 0.62) and histology grade (χ²df2 = 3.64; P = 0.16). Down-grading of vacuum-assisted biopsy lesions to a less severe histology occurred in 13 (7.2%) in situ and in 16 (28.6%) invasive carcinomas. B3 cases upgrading to more severe lesions was 0%, 4.5% or 16.0% in the presence of no, mild, or severe atypia. The study confirmed a good performance of vacuum-assisted biopsy, possibly influenced by the local scenario (e.g., radiologist's and pathologist's interobserver variability and sampling modality). Conflicting results with the literature may have local explanations rather than being due to inadequate performance.

Accuracy and upgrade rates of stereotactic vacuum-assisted breast biopsy: Impact of number of core samples taken on malignancy underestimation rates.

20 Background: There are multiple options for the diagnostic evaluation of mammographic suspicious breast abnormalities. The therapeutic strategy is often based on lesion histopathological information obtained from stereotactic vacuum-assisted biopsy (VAB). Therefore, accurate information obtained by VAB is very important. This study was performed to evaluate the impact of the number of core samples obtain during VAB on malignancy underestimation rates for mammographically detected breast lesions. Methods: The pathologic results of 128 consecutive stereotactic biopsies (January 2010-December 2010) were retrospectively reviewed. All biopsies were performed using a 9-gauge needle. Pathologic results of core biopsies and surgical excision were compared. Underestimation rates of malignancy were calculated and correlation was made with the number of core samples obtained. Results: Surgical excision was performed on 41% (52/128) lesions; 4 benign, 19 indeterminate and 29 malignant. Overall malignancy underestimation rate was 19%. There were 8 cases of ductal carcinoma in situ (DCIS) on core biopsy that were proven to be invasive ductal carcinoma (IDC) on surgical excision. There was one case of benign microcalcifications that was proven to be lobular neoplasia (LN). There was one case of an atypical papillary lesion that was proven to be DCIS. There was a significant difference (p=0.02) between the mean number of core samples taken in the underdiagnosed lesions (8, range 6-12) and the concordant lesions (10, range 6-20). Conclusions: In the case of stereotactic VAB diagnosis of breast lesions, the underestimation rate of malignancy is more likely with a lower number of core samples obtained.

Accuracy of stereotactic vacuum-assisted biopsies in a community population.

106 Background: Stereotactic core biopsy in mammographically detected lesions permits histologic confirmation previous to surgery planning. We evaluated the use of stereotactic vacuum-assisted biopsy (VAB) for diagnosing suspicious, mammographically detected breast lesions in a community population. Furthermore, we determined the level of agreement between the pathology findings of VAB and the final surgical excisional biopsy. Methods: We retrospectively evaluated the results of 128 consecutive stereotactic VAB with 9-gauge needles performed over a period of 1 year in our community population. The imaging histologic concordance was ascertained for each lesion. We also evaluated concordance between VAB results and surgical excision results. Results: For the 128 patients included Breast Imaging Reporting and Data System (BI-RADS) staging showed BI-RADS 3: 4%; BI-RADS 4: 91%; and BI-RADS 5: 5%. VAB demonstrated 65 (51%) benign lesions, 31(24%) indeterminate lesions and 32 (25%) malignant lesions. The 31 indeterminate lesions included atypical ductal hyperplasia (n=13), lobular neoplasia (n=4), papillary lesions (n=12), radial sclerosing lesions (n=5), and flat epithelial atypia (n=13). Surgical excision was performed on 52 patients, and pathology demonstrated; 4 benign, 19 indeterminate, and 29 malignant lesions. There was one (3%) underestimation of an indeterminate lesion and there were 8 (25%) underestimations of malignant lesions after surgical excision. We did not observe any post-biopsy complications. Conclusions: Stereotactic VAB with a 9-gauge needle is a reliable method for diagnosing mammographically detected breast lesions in a community population.

3–5 BI-RADs Microcalcifications: Correlation between MRI and Histological Findings

Purpose. To evaluate the correlation between MRI and histopathological findings in patients with mammographically detected 3–5 BI-RAD (Breast Imaging Reporting And Data Systems) microcalcifications and to allow a better surgical planning. Materials and Method. 62 female Patients (age 50 ± 12) with screening detected 3–5 BI-RAD microcalcifications underwent dynamic 3 T contrast-enhanced breast MRI. After 30-day (range 24–36 days) period, 55 Patients underwent biopsy using stereotactic vacuum-assisted biopsy (VAB), 5 Patients underwent stereotactic mammographically guided biopsy, and 2 Patients underwent MRI-guided VAB. Results. Microhistology examination demonstrated 36 malignant lesions and 26 benign lesions. The analysis of MRI findings identified 8 cases of MRI BI-RADS 5, 23 cases of MRI BI-RADS 4, 11 cases of MRI BI-RADS 3, 4 cases type A and 7 cases type B, and 20 cases of MRI BI-RADS 1-2. MRI sensitivity, specificity, positive predictive value, and negative predictive value were 88.8%, 76.9%, 84.2%, and 83.3%, respectively.

Clip placement after an 11-gauge vacuum-assisted stereotactic breast biopsy: correlation between breast thickness and clip movement

To retrospectively evaluate the accuracy of clip placement on the basis of measurements obtained on pre- and post-vacuum-assisted 11-gauge stereotactic biopsy mammograms and to analyze the factors that can predict which patients will experience a significant movement of the clip. The pre- and post-vacuum-assisted 11-guage stereotactic biopsy mammographic findings in 204 cases undergoing clip placement were reviewed. The clip-to-lesion distance was measured. The correlations between the clinical-mammographic findings and the likelihood of clip movement were evaluated. Target mammographic lesion types of the 204 cases were characterized as calcification in all but one case, which was a distortion lesion. The clip-to-lesion distance was within 5 mm on both the craniocaudal and mediolateral oblique projections in 119 (58%) cases, within 6-10 mm in 28 (14%), within 11-19 mm in 25 (12%), and was > 20 mm in 32 (16%). The variability of the clip-to-lesion distance was greatest in the plane orthogonal to the compression plane used for stereotactic biopsy. Breast thickness was the only factor that was predictive of a significant movement of the clip, and thin breasts tended to exhibit greater clip movement. Breast thickness may be a useful factor for predicting the degree of clip movement after 11-gauge vacuum-assisted stereotactic biopsy.

Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): A large multi-institutional study in Italy

Percutaneous core biopsy (CB) has been introduced to increase the ability of accurately diagnosing breast malignancies without the need of resorting to surgery. Compared to conventional automated 14 gauge needle core biopsy (NCB), vacuum-assisted needle core biopsy (VANCB) allows obtaining larger specimens and has recognized advantages particularly when the radiological pattern is represented by microcalcifications. Regardless of technical improvements, a small percentage of percutaneous CBs performed to detect breast lesions are still classified, according to European and UK guidelines, in the borderline B3 category, including a group of heterogeneous lesions with uncertain malignant potential. We aimed to assess the prevalence and positive predictive values (PPV) on surgical excision (SE) of B3 category (overall and by sub-categories) in a large series of non-palpable breast lesions assessed through VANCB, also comparison with published data on CB. Overall, 26,165 consecutive stereotactic VANCB were identified in 22 Italian centres: 3107 (11.9%) were classified as B3, of which 1644 (54.2%) proceeded to SE to establish a definitive histological diagnosis of breast pathology. Due to a high proportion of microcalcifications as main radiological pattern, the overall PPV was 21.2% (range 10.6%–27.3% for different B3 subtypes), somewhat lower than the average value (24.5%) from published studies (range 9.9%–35.1%). Our study, to date the largest series of B3 with definitive histological assessment on SE, suggests that B3 lesions should be referred for SE even if VANCB is more accurate than NCB in the diagnostic process of non-palpable, sonographically invisible breast lesions.