Breast Microcalcifications: Diagnostic Outcomes According to Image-Guided Biopsy Method.
Author(s): Bae S, Yoon JH, Moon HJ, Kim MJ, Kim EK
Publication: Korean J Radiol, 2015, Vol. 16, Page 996-1005
PubMed ID: 26357494 PubMed Review Paper? No
Purpose of Paper
The purpose of this paper was to compare diagnostic accuracy among breast specimens obtained by ultrasonography-guided core needle biopsy (US-CNB), ultrasonography -guided vacuum-assisted biopsy (US-VAB), and stereotactic-guided vacuum-assisted biopsy (S-VAB).
Conclusion of Paper
Biopsy failures, false negatives, and a diagnosis of malignancy occurred most frequently in specimens obtained by US-CNB, followed by those obtained by S-VAB then US-VAB. Further, tumors that were sampled by US-CNB were the more likely to receive an upgraded tumor status after surgical resection. Importantly, the method of biopsy depended on the sonographic visibility of calcifications and the presence of a mass; thus, the differences observed between biopsy methods may be attributable to the properties of the tumors sampled.
Studies
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Study Purpose
The purpose of this paper was to compare diagnostic accuracy among breast specimens collected by US-CNB, US-VAB, and S-VAB. US-CNB specimens were obtained with a 14-gauge needle from the breasts of 28 women with a sonographically-visible calcification and an associated mass. US-VAB specimens were obtained with a 8 or 11-gauge vacuum probe from 59 women with sonographically-visible calcification without an associated mass. S-VAB specimens were obtained (unspecified gauge) from 249 women with lesions only visible by mammogram. Proper sampling was confirmed by mammography. A false negative was diagnosed when malignancy was found at a 6, 12 or 24 month follow-up. The mean number of biopsies per lesion was 6.6 with US-CNB, but 12 with US-VAB and 12.6 with S-VAB.
Summary of Findings:
Biopsy failure and false negatives for malignancy occurred most frequently in biopsy specimens obtained by US-CNB (2/28 and 3/20 cases, respectively), followed by those obtained by S-VAB (7/249 and 2/46 cases, respectively) and US-VAB (0/59 and 0/31 cases, respectively). After surgical resection, the diagnosis of ductal carcinoma in situ (DCIS) was changed to invasive carcinoma in 5 of 12 (41.7%) US-CNB specimens, but this diagnostic change only occurred in 3 of 35 (8.6%) and 4 of 31 (12.9%) specimens obtained by S-VAB and US-VAB, respectively. Only one diagnosis of atypical ductal hyperplasia (ADH) was changed after surgical resection of a tumor originally biopsied by S-VAB. Importantly, malignancy rates were higher among specimens obtained by US-CNB (83.3%) than by US-VAB (58.5%) or S-VAB (23.7%), but this likely is an artifact of tumor properties influencing guidance method, as biopsies with a sonographically-visible calcification with an associated mass are more likely to be malignant than those without a mass or those only visible by mammography. In addition, malignant tumors sampled by US-CNB were more likely to be classified as invasive carcinomas (9 of 20 cases, respectively), than those sampled by S-VAB (8 of 46 cases, respectively) or US-VAB (5 of 31 cases, respectively).
Biospecimens
Preservative Types
- Formalin
Diagnoses:
- Neoplastic - Benign
- Neoplastic - Carcinoma
- Normal
Platform:
Analyte Technology Platform Morphology Light microscopy Morphology X-ray Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition Core needle biopsy
Vacuum assisted biopsy
Ultrasound-guided biopsy
Sterotactic-guided biopsy
Preaquisition Prognostic factor Ultrasound visible calcification and associated mass
Ultrasound visible calcification and no associated mass
No ultrasound visible calcification