Stereotactic core biopsy of calcifications highly suggestive of malignancy.
OBJECTIVE
To assess stereotactic core biopsy for evaluation of Breast Imaging Reporting and Data System (BI-RADS) category 5 calcifications (highly suggestive of malignancy).


METHODS
Retrospective review of mammograms revealed 31 women (aged 34-86 years) with BI-RADS category 5 calcifications who underwent 14-gauge stereotactic core biopsy with an automated gun. Records were reviewed to determine the frequency with which stereotactic core biopsy obviated a surgical procedure. Cost savings were based on Medicare estimates of $472 for stereotactic core biopsy and $1,335 for surgical biopsy.


RESULTS
Of 31 patients, stereotactic core biopsy revealed carcinoma in 19 (61%), atypical ductal hyperplasia (ADH) in eight (26%), and benign findings discordant with mammographic results in four (13%). Surgical biopsy was recommended for the 12 patients with ADH or benign but discordant core biopsy diagnoses. Of the 19 patients with carcinoma at stereotactic core biopsy, two chose to undergo a second biopsy surgically, two had small foci of ductal carcinoma in situ (DCIS) that would have been fully excised with surgical biopsy, one with DCIS at stereotactic core biopsy underwent axillary dissection after invasion was found at surgery, and one underwent excision but had tumor at lumpectomy margins. Thirteen (42%) of 31 patients were spared a surgical procedure, saving $100 per patient.


CONCLUSIONS
Stereotactic core biopsy with an automated gun obviated a surgical procedure in 42% of patients with BI-RADS category 5 calcifications, resulting in modest cost savings in this group.
Liberman
L
L
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
LaTrenta
L R
LR
Van Zee
K J
KJ
Morris
E A
EA
Abramson
A F
AF
Dershaw
D D
DD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001706:Biopsy / Q000191:economics; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017046:Cost Savings; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008197:Lymph Node Excision; D008327:Mammography; D015412:Mastectomy, Segmental; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000191:economics; D014481:United States