Stereotaktische Vakuumbiopsie mammographisch detektierter Läsionen: Erfolg, histologische Sicherheit, Patientenakzeptanz und BI-RADS-korrelierte Indikationsoptimierung

Purpose: To evaluate success, histologic accuracy, patient acceptance and BI-RADS-correlated malignancy rate of stereotactic vacuum-assisted breast biopsies in order to optimize the indication. Materials and Methods: In 132 patients with mammographically detected breast lesions 166 stereotactic vacuum-assisted 11 gauge core biopsies were performed. All lesions were classified according to the BI-RADS categories of the ACR. Removal of the lesion was radiographically assessed as complete, representative or not representative. Patient acceptance was evaluated. Results: Of the 166 lesions, 54 (32.5%) lesions were judged completely removed, 110 (66.3%) representatively removed and 2 (1.2%) not representatively removed. Malignancy was found in 38 (22.9%) lesions. The rate of malignancy increased from 6.3% (2/32) for BI-RADS category 3 to 16.7% (19/114) for BI-RADS category 4 and increased further to 85% (17/20) for BI-RADS category 5 (p < 0.001). The histology of a sufficient vacuum-assisted biopsy was underestimated in 6 (15%) of the 40 lesions that were subsequently excised surgically. Most patients (98.5%; 130/132) stated they would undergo a vacuum-assisted biopsy again. Conclusion: Vacuum-assisted breast biopsy is accurate, has a justifiable rate of histologic underestimation and is well accepted by patients. Patients with BI-RADS category 4 microcalcification benefit the most. Lesions of BI-RADS category 3 and BI-RADS category 5 should be biopsied only under special circumstances (family risk of breast cancer; assessment of lesions extension).