US-Guided Vacuum-Assisted Biopsy of Microcalcifications in Breast Lesions and Long-Term Follow-Up Results

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Abstract

Objective

To evaluate the diagnostic accuracy of the use of an ultrasonography (US)-guided vacuum-assisted biopsy for microcalcifications of breast lesions and to evaluate the efficacy of the use of US-guided vacuum-assisted biopsy with long-term follow-up results.

Materials and Methods

US-guided vacuum-assisted biopsy cases of breast lesions that were performed between 2002 and 2006 for microcalcifications were retrospectively reviewed. A total of 62 breast lesions were identified where further pathological confirmation was obtained or where at least two years of mammography follow-up was obtained. These lesions were divided into the benign and malignant lesions (benign and malignant group) and were divided into underestimated group and not-underestimated lesions (underestimated and not-underestimated group) according to the diagnosis after a vacuum-assisted biopsy. The total number of specimens that contained microcalcifications was analyzed and the total number of microcalcification flecks as depicted on specimen mammography was analyzed to determine if there was any statistical difference between the groups.

Results

There were no false negative cases after more than two years of follow-up. Twenty-nine lesions were diagnosed as malignant (two invasive carcinomas and 27 carcinoma in situ lesions). Two of the 27 carcinoma in situ lesions were upgraded to invasive cancers after surgery. Among three patients diagnosed with atypical ductal hyperplasia, the diagnosis was upgraded to a ductal carcinoma in situ after surgery in one patient. There was no statistically significant difference in the number of specimens with microcalcifications and the total number of microcalcification flecks between the benign group and malignant group of patients and between the underestimated group and not-underestimated group of patients.

Conclusion

US-guided vacuum-assisted biopsy can be an effective alternative to stereotactic-guided vacuum-assisted biopsy in cases where microcalcifications are visible with the use of high-resolution US.

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Most cited references 24

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Percutaneous large-core breast biopsy: a multi-institutional study.

Carmine Coscia, Todd R. Jackman, P Garver … (1994)

To assess the reliability and reproducibility of automated large-core breast biopsy. A consortium of 20 institutions reported, in a standardized fashion, their core breast biopsy data. All biopsies were performed with "long-throw" (2.3-cm) automated core biopsy devices fitted with 14-gauge needles. Needle guidance was accomplished by means of either a dedicated, stereotaxic device, in which the patient lies in the prone position, or high-frequency electronically focused ultrasound equipment. The data in 6,152 lesions were gathered. Clinical or surgical follow-up was available in 3,765 lesions; 1,363 of these lesions were subsequently surgically excised, and the core histologic study showed cancer in 910 lesions, mammary intraepithelial neoplasia in 173 lesions, and benign disease in 280 lesions. In these 280 lesions, there were 15 false-negative core biopsies. The data show that percutaneous large-core breast biopsy is a reproducible and reliable alternative to surgical biopsy.

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Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ.

R Holland, J H Hendriks, A L Vebeek … (1990)

To assess the potential of breast-conserving treatment for ductal carcinoma in situ (DCIS), 82 mastectomy specimens were studied by Egan's serial subgross method. 42 (51%) of the tumours were larger than 50 mm and only 12 (15%) were smaller than 20 mm; the size distribution was not affected by the mode of detection (mammography 52 cases, clinical examination 30). All but 1 case showed only 1 region of tumour. 66% of tumours involved one breast quadrant, 23% extended over more than one quadrant, and 11% were centrally located. Mammographic estimates, based on the extent of microcalcifications, frequently underestimated the histological size of tumours, the extent of the discrepancy being related to the histological type--8/50 predominantly micropapillary/cribriform. In view of the frequently large size, adequate excision of many DCIS will require a wide excision involving up to a whole quadrant.

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Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study.

K Rotter, Rüdiger Schulz, Daniela Peter … (2004)

Vacuum-assisted breast biopsy (VAB) can replace surgical biopsy for the diagnosis of breast carcinoma. The authors evaluated the accuracy and clinical utility of VAB in a multicenter setting using a strict quality assurance protocol. In the current study, VABs were performed successfully for 2874 patients at 5 sites. Benign lesions were verified by follow-up. Surgery was recommended for malignant and borderline lesions. VAB was performed on patients with lesions rated as highly suspicious (6%), intermediate to suspicious (85%), or probably benign (9%). Fifty-eight percent of the lesions were < 10 mm and 70% had microcalcifications. The authors identified 7% of patients with invasive carcinomas, 15% with ductal carcinomas in situ (DCIS), 5% with atypical ductal hyperplasias (ADH), and 0.6% with lobular carcinomas in situ. The results of the VAB necessitated an upgrade of 24% of patients with ADH to DCIS or DCIS and invasive carcinoma. Twelve percent of patients with DCIS proved to have invasive carcinoma. Seventy-three percent of the patients had benign lesions. Only 1 false-negative result was encountered (negative predictive value, 99.95%). Minor side effects were reported to occur in 1.4% of patients and 0.1% of patients required a subsequent intervention. Scarring relevant for mammography was rare among patients (i.e., 0.3% of patients had relevant scarring). Quality-assured VAB was found to be highly reliable. VAB effectively identified patients with benign lesions and assisted therapeutic decisions. Most important, only a single case of malignancy was missed. A close interdisciplinary approach assured optimal results. Copyright 2003 American Cancer Society.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Radiol

Journal ID (publisher-id): KJR

Title: Korean Journal of Radiology

Publisher: The Korean Society of Radiology

ISSN (Print): 1229-6929

ISSN (Electronic): 2005-8330

Publication date (Print): Nov-Dec 2008

Publication date (Electronic): 22 December 2008

Volume: 9

Issue: 6

Pages: 503-509

Affiliations

[1 ]Department of Radiology and Institution of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.

[2 ]Department of Diagnostic Radiology, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea.

Author notes

Address reprint requests to: Min Jung Kim, MD, Department of Diagnostic Radiology, Severance Hospital, Seodaemun-gu, Shinchon-dong, 134, Seoul 120-752, Korea. Tel. (822) 2228-7400, Fax. (822) 393-3035, mines@ 123456yuhs.ac

Article

DOI: 10.3348/kjr.2008.9.6.503

PMC ID: 2627239

PubMed ID: 19039266

SO-VID: e8828cbd-9700-443b-9bbb-a65e0c24d7fd

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

US-Guided Vacuum-Assisted Biopsy of Microcalcifications in Breast Lesions and Long-Term Follow-Up Results

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Abstract

Objective

Materials and Methods

Results

Conclusion

Related collections

Probing cerebral hemodynamics with BOLD fMRI

Most cited references 24

Percutaneous large-core breast biopsy: a multi-institutional study.

Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ.

Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study.

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