Stereotactic Vacuum-assisted Core Biopsy Research Articles

Post–Vacuum-Assisted Stereotactic Core Biopsy Clip Displacement: A Comparison Between Commercially Available Clips and Surgical Clip

PurposeThe placement of localization clips following percutaneous biopsy is a standard practice for a variety of situations. Subsequent clip displacement creates challenges for imaging surveillance and surgical planning, and may cause confusion amongst radiologists and between surgeons and radiologists. Many causes have been attributed for this phenomenon including the commonly accepted “accordion effect.” Herein, we investigate the performance of a low cost surgical clip system against 4 commercially available clips. MethodsWe retrospectively reviewed 2112 patients who underwent stereotactic vacuum-assisted core biopsy followed by clip placement between January 2013 and June 2016. The primary performance parameter compared was displacement >10 mm following vacuum-assisted stereotactic core biopsy. Within the group of clips that had displaced, the magnitude of displacement was compared. ResultsThere was a significant difference in displacement among the clip types (P < .0001) with significant pairwise comparisons between pediatric surgical clips and SecureMark (38% vs 28%; P = .001) and SenoMark (38% vs 27%; P = .0001) in the proportion displaced. The surgical clips showed a significant magnitude of displacement of approximately 25% greater average distance displaced. ConclusionsAs a whole, the commercial clips performed better than the surgical clip after stereotactic vacuum-assisted core biopsy suggesting the surrounding outer component acts to anchor the central clip and minimizes clip displacement. The same should apply to tomosynthesis-guided biopsy.

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.

Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions

Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions

Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions

AIM To evaluate scar formation of impalpable breast lesions with benign histological outcome using stereotactic 11-gauge vacuum-assisted core biopsy (VACB). MATERIALS AND METHODS Two hundred and ten lesions with benign histology for which follow-up mammograms were available, were assessed for scar formation at the biopsy site. All biopsies were performed using stereotactic VACB with 11-gauge needle. The incidence of post-biopsy scar formation and the number of specimens removed were determined. RESULTS In 4.3% (9/210) of the lesions for which a biopsy was performed with 11-gauge directional vacuum-assisted technique, the follow-up mammogram revealed a scar formation. Of these, six were minimal scars, two were moderate scars and one was a marked scar. Minimal and moderate scars were diagnosed on imaging only. However, the case with marked scar formation required tissue diagnosis to rule out malignancy. CONCLUSION Although uncommon, scar formation can be seen in the follow-up mammograms after percutaneous breast biopsies. It is important that the radiologist interpreting follow-up mammograms is aware of the features of this lesion and its relationship to the biopsy procedure.

Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions

To evaluate scar formation of impalpable breast lesions with benign histological outcome using stereotactic 11-gauge vacuum-assisted core biopsy (VACB). Two hundred and ten lesions with benign histology for which follow-up mammograms were available, were assessed for scar formation at the biopsy site. All biopsies were performed using stereotactic VACB with 11-gauge needle. The incidence of post-biopsy scar formation and the number of specimens removed were determined. In 4.3% (9/210) of the lesions for which a biopsy was performed with 11-gauge directional vacuum-assisted technique, the follow-up mammogram revealed a scar formation. Of these, six were minimal scars, two were moderate scars and one was a marked scar. Minimal and moderate scars were diagnosed on imaging only. However, the case with marked scar formation required tissue diagnosis to rule out malignancy. Although uncommon, scar formation can be seen in the follow-up mammograms after percutaneous breast biopsies. It is important that the radiologist interpreting follow-up mammograms is aware of the features of this lesion and its relationship to the biopsy procedure.

S100P calcium-binding protein expression is associated with high-risk proliferative lesions of the breast

Benign breast diseases represent the vast majority of diagnosis in breast pathology. However, the limited capability in identifying lesions at high risk of breast cancer evolution is an increasing problem in clinical practice. In the present study, we tested the hypothesis that the overexpression of S100P calcium-binding protein, previously identified in the very early stages of breast carcinogenesis, could be used as a marker to differentiate lesions at high risk of malignant evolution. In addition to S100P, the well-known proliferative marker, Ki-67, and estrogen receptor (ER) status were also assessed by immunohistochemistry in 155 samples from patients who submitted to stereotactic vacuum-assisted core biopsy due to breast microcalcifications. Results showed a positive association between ER and S100P overexpression, as well as a clear positive association between S100P overexpression and high-risk lesions. The strong association between S100P and ER expression highlights the hypothesis about the possible role played by S100P in the very early stages of breast carcinogenesis.

The significance of mammotome core biopsy specimens without radiographically identifiable microcalcification and their influence on surgical management—A retrospective review with histological correlation

The aim of this study is to assess core specimens which do not contain radiographically visible calcification at stereotactic vacuum assisted core biopsy (SVACB) of indeterminate microcalcification, to determine what influence they may have on the surgical management of patients with breast disease. Review was made of the core biopsy and surgical histology results of 104 SVACB biopsies of indeterminate microcalcification over a 26 month period. Cores were placed in separate pots; POT A for cores containing microcalcification and POT B for cores without radiographically visible microcalcification before being sent to histology. Of 104 biopsies, 25% contained B3-B5 pathology in POT B and at surgery this correlated with a higher grade of ductal carcinoma in situ (DCIS) and an increased likelihood of invasive disease. The presence of B3-B5 pathology in POT B itself however did not act as a strong indicator of radiological-histological size discrepancy in this study.

Retrieval of lost microcalcifications during stereotactic vacuum-assisted core biopsy.

The purpose of our report was to describe patients in whom calcifications in the breast that were unequivocally removed during stereotactic core biopsy using the Mammotome device were not detected on the initial specimen radiograph. The lost calcifications in each instance were subsequently found when the tubing and contents of the debris canister were strained through a nonadhering dressing and radiographed. Additional situations in which calcifications are not seen on the initial specimen radiograph are described and recommendations are made. When vacuum-assisted core biopsy procedures are performed, it is important to be aware of the possibility that calcifications may be aspirated into the debris canister, thus compromising the accuracy of the histopathologic diagnosis. We recommend changing the tubing and the debris canister after each procedure and, in certain situations, sending the strained canister contents to pathology for evaluation.