Vacuum-assisted biopsy in diagnosis and treatment of breast nodules: a multi-center study

Objective To explore the clinical value of vacuum-assisted biospy in the diagnosis and treatment of breast nodules (clinically non-palpable solid mass with low-level echo in ultrasound, regarded as benign lesions). Methods From January 2008 to December 2009, 2 468 patients with breast nodules from Women and Children’s Hospital of Guangdong Province, Women and Children’s Hospital of Foshan City, Women and Children’s Hospital of Liuzhou City, Women and Children’s Hospital of Ili Kazak Autonomous Prefecture, Women and Children’s Hospital Women of Xiamen City underwent vacuum-assisted biopsy. According to the inclusion and exclusion criteria, 892 cases of breast nodules were enrolled in this retrospective study. The relationship of patient age, lesion diameter, ultrasound BI-RADS grade, breast X-ray findings with detection rate of breast cancer was analyzed to evaluate the application of vacuum-assisted biopsy in the diagnosis and treatment of breast nodules. The relationship between lesion diameter/patient age and the pathological results, between mass diameter/ ultrasonic BI-RADS grade/patient age and detection rate of breast cancer were analyzed by χ2 test and Fisher’s exact probability test. Paired χ2 test (McNemar test) was used to analyze the detection rate of breast cancer by breast ultrasound combined with X-ray scanning in patients with breast nodules at different BI-RADS grades. Results A total of 1 626 breast masses were removed from 892 patients, including 16 cases of breast cancer (1.8%, 16/892). The detection rate of breast cancer in patients with lesion diameter≥1.5 cm was significantly higher than that in patients with lesion diameter <1.5 cm [6.0% (5/84) vs 1.4% (11/808), χ2 =6.685, P=0.010]. The subgroup analysis showed that among the patients with lesion diameter <1.5 cm, the detection rate of breast cancer in patients≥40 years was significantly higher than that in patients <40 years [2.4% (9/370) vs 0.5% (2/438), χ2 =5.831, P=0.016]. No breast cancer was detected in the patients with BI-RADS grade 2 nodules. Among the patients with ultrasound BI-RADS grade 3 nodules, the detection rate of breast cancer in patients with lesion diameter ≥1.5 cm was significantly higher than that in patients with lesion diameter <1.5 cm [5.4% (3/56) vs 1.1% (6/565), χ2 =3.917, P=0.039]. Among the patients with breast nodule at ultrasound BI-RADS grade 3 and the diameter <1.5 cm, the detection rate of breast cancer in patients≥40 years was significantly higher than that in patients <40 years [2.3% (6/256) vs 0 (0/309), χ2 =5.259, P=0.022]. The detection rate of breast cancer in patients with breast nodules at ultrasound BI-RADS grade 4A was not related to patient age and nodule size (χ2 <0.001, P=1.000; P=0.162). In patients with breast nodules, based on the findings by breast ultrasound combined with X-ray scanning, the detection rate of breast cancer in BI-RADS grade 4A was significantly higher than that in grade 2 or 3 [12.3%(9/73)vs 0.5%(1/212), P<0.001]. Conclusion The size of breast nodule and patient age are influencing factors on the detection rate of breast cancer. Minimally invasive biopsy is considered for the patients with breast nodules at BI-RADS grade 3 and the diameter≥1.5 cm or the patients with nodule diameter<1.5 cm and the age ≥40 years. Patients with breast nodules at ultrasound BI-RADS grade 4A should undergo the biopsy. Breast ultrasound combined with X-ray scanning may increase the detection rate of breast cancer. Key words: Breast; Biopsy; Breast neoplasms