[Percutaneous stereotactic biopsy of non-palpable breast lesions using the Advanced Breast Biopsy Instrumentation (ABBI) system: critical evaluation of indication strategies].
OBJECTIVE
To compare the indications for biopsy with and without the use of the Breast Imaging Reporting and Data System.


METHODS
Biopsies using the ABBI were performed in 62 patients with 64 non-palpable evident mammographic lesions. The initial decision for biopsy was made by non-radiologists due to suspicious microcalcifications (n = 53) and masses (n = 11). The indication was retrospectively reassessed by adopting the BI-RADS classification by three radiologists in consensus. The positive predictive value (PPV) of both indication strategies was assessed and compared.


RESULTS
Biopsies adopting ABBI were performed without major side-effects and were diagnostic. Carcinoma was present in 14 lesions: nine specimens were diagnosed as DCIS and five as invasive carcinomas. For the 50 benign lesions histology revealed mastopathies (26/50) and fibroadenomas (8/50) as the most frequent diagnosis. The positive predictive value (PPV) for the initial indication was 22%, whereas PPV for BI-RADS based indications (categories 4 and 5) was 31%.


CONCLUSIONS
ABBI enables stereotactically-guided procedures that result in representative and diagnostic biopsies. Standardized criteria like BI-RADS improve the PPV and should be a mandatory part of mammographic evaluation. Radiologists should remain involved in the decision making.
Wedegärtner
U
U
Institut für Diagnostische Radiologie, Universität Basel, Schweiz. u.wedeg@gmx.de
Otto
U
U
Buitrago-Tellez
C
C
Bremerich
J
J
Oertli
D
D
Torhorst
J
J
Bongartz
G
G
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000295:instrumentation*; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010173:Palpation; D010212:Papilloma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D013997:Time Factors