Stereotactic core needle biopsy in non‐palpable breast lesions. what number is needed?
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Abstract:
To investigate whether three stereotactic core needle biopsies (S-CNB) in non-palpable breast lesion are enough for accurate preoperative diagnosis.Between September 1994 and December 2000, 523 patients with mammographically detected breast lesions and who proceeded to surgery were preoperatively stereotactically biopsied with an automated 14-gauge biopsy device. Three samples were taken from each lesion irrespective of whether the lesion presented as "microcalcifications only", "microcalcifications and a mass", or a "mass, architectural distorsion, or stellate lesion without microcalcifications". The histopathology was divided into three subgroups: diagnostic, atypia (ranging from atypical cells to probably cancer), and non-diagnostic material.Post-surgical histopathology diagnosed 454 (87%) malignant tumors and 69 (13%) benign lesions. Three S-CNB correctly diagnosed the malignant tumors in 84% in the subgroup "microcalcifications only". In the category "microcalcifications and a mass", the diagnostic accuracy was 97% and in the subgroup "mass, architectural distorsion, or stellate lesion without microcalcifications" 3 S-CNB resulted in 93% correct diagnostic material. In 19 of the 454 patients (4%) 1, 2 or all 3 preoperative S-CNB showed atypia. In 20 patients (4%), all 3 S-CNB were non-diagnostic. Thirteen of these 20 patients had "microcalcifications only" and 7 had a mass without microcalcifications.Three S-CNB were enough for correct diagnosis in "masses, architectural distorsions, or stellate lesions without microcalcifications" and in "microcalcifications and a mass", but were not sufficient in "microcalcifications only".Keywords:
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CT-guided stereotactic biopsy is now an accepted method of tissue sampling in intracranial mass lesions but many surgeons still practise freehand burrhole biopsy. This study compares two groups of patients who had either stereotactically guided (n = 153) or freehand (n = 217) biopsy. Stereotactic biopsy has a lower incidence of both mortality (2.6%) and morbidity (1.3%) than freehand (7.8 and 7.8%) while diagnostic accuracy is 92.1 and 64.9%, respectively. The success rate for stereotactic biopsy is independent of the size and depth of the lesion while freehand biopsy is most successful for large, superficial lesions but its success never exceeds 88%. The stereotactic technique is superior to the freehand for all intracranial biopsies regardless of size or site.
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Stereotactic Histologic Biopsy with Patients Prone: Technical Feasibility in 98% of Mammographically Detected LesionsRoger J. Jackman1 and Francis A. Marzoni, Jr.2Audio Available | Share
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A 49-year-old woman underwent 11-gauge vacuum-assisted stereotactic biopsy of a cluster of indeterminate calcifications in the left breast. A clip was deployed accurately at the biopsy site as confirmed on mammograms obtained immediately after biopsy. The patient returned 8 days later for additional stereotactic biopsies of the left breast. Repeat mammograms revealed that the clip deployed at the original biopsy site had migrated 5 cm inferiorly. © RSNA, 2003
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Purpose: To determine the value of mammography and ultrasonography in the detection of early breast cancer, and the usefulness of combining the two modalities for the diagnostic study of this condition. Materials and Methods: The mammographic and ultrasonographic features of 47 female patients aged 23-68 (average, 46) years with pathologically proven early breast cancer were analyzed retrospectively. Mammography was performed in 46 patients and ultrasonography in 38, and 37 underwent both mammography and ultrasonography. Analysis of the mammographic and/or ultrasonographic features focused on mass, microcalcification, mass with microcalcification, multiple nodules, duct dilatation, and architectural distortion. Results: Mammography revealed microcalcification in 29 (63%) patients, mass in 13 (28%) patients, mass with microcalcification in 8 (17%) patients, multiple nodules in 2 (4%) patients, architectural distortions in 1 (2%) patient, and negative finding in 9 (20%) patients. Ultrasonography revealed mass in 25 (66%) patients, microcalcifcation in 9 (24%) patients, mass with microcalcification in 8 (21%) patients, multiple nodules in 2 (5%) patients, duct dilatation in 3 (8%) patients, and negative finding in 7 (18%) patients. On combined study of mammography and ultrasonography of the 37 patients, mammography or ultrasonography revealed mass in 25 (68%) patients, microcalcification in 20 (54%) patients, multiple nodules in 2 (5%) patients, duct dilatation in 3 (8%) patients, and architectural distortion in 1 (3%) patient. In one (3%) patient among them, both mammography and ultrasonography revealed negative findings. The false negative rate of mammography, ultrasonography or both was 20%, 18%, and 3%, respectively, which was statistically significant difference (p
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One hundred two patients with mammographically suspicious, nonpalpable lesions underwent stereotactic breast biopsy with a biopsy gun and an automated 14-gauge cutting needle. After biopsy, a localization wire was placed and surgical biopsy performed. There was agreement of the histologic results from the gun biopsy and the surgical biopsy specimens in 98 cases (96%), including 22 of 23 carcinomas (96%) (kappa = 0.936). The gun biopsy yielded findings that led to the correct diagnosis in two cases involving lesions that were missed at surgical biopsy; two lesions found at surgery were missed at gun biopsy. The results of this study suggest that the use of 14-gauge needles improves agreement between surgical and needle core biopsy findings and that stereotactic biopsy with an automated needle and gun can be an acceptable alternative to surgical biopsy in women with mammographically suspicious breast lesions.
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In patients with mammographically detected breast lesions, stereotactic-guided core biopsy was studied as an alternative to surgical biopsy. Fifty-two patients with a total of 58 mammographically detected suspicious lesions underwent stereotactic-guided core biopsy (average 4.7 cores per lesion) with a 14-G biopsy gun. The results were correlated with subsequent needle-localized surgical biopsy that was performed immediately after the core specimens were obtained. The core biopsy results correlated with the surgical biopsy in 54 of the 58 lesions (93% agreement), including correct identification of 14 malignancies. No false negative or false positive results occurred using core biopsy to detect cancer. These findings suggest stereotactic-guided core biopsy is an accurate method and an acceptable alternative to needle localization in the diagnosis of mammographically suspicious nonpalpable breast lesions.
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Automated Stereotactic Core Needle Biopsy of Microcalcifications with Correlation to Surgical Biopsy
Purpose: To compare pathologic findings from stereotactic core and excisional biopsies in patients with microcalcifications in the breast. Material and Methods: Stereotactic core needle biopsies of 101 lesions with mammographic evidence of microcalcifications were performed with long-throw (2.2 cm) automated core biopsy devices fitted with 2.1-mm needles. The core specimens were placed on microscope slides and radiographed. The pathologic features of core and excisional specimens were compared. Results: In 100 of the 101 breast lesions, a correct choice for an additional diagnostic procedure or definitive treatment could have been made upon histo-pathologic findings of the core needle biopsy. Conclusion: Stereotactic core needle biopsy is a reliable alternative to surgical biopsy of breast lesions with microcalcifications provided that specimen radiography has been performed to ensure that appropriate tissue has been obtained. Excisional biopsy may be avoided if microcalcifications are visible in radiographs of core biopsy specimen with benign histology.
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