Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions.
OBJECTIVE
We evaluated the reliability of stereotactic vacuum-assisted breast biopsies (VAB) from our personal experience.


METHODS
Between January 2003 and December 2005, 268 patients underwent VAB with an 11-gauge probe at our institution. Inclusion criteria were nonpalpable lesions, undetectable by ultrasound and suspected at mammography (microcalcifications, circumscribed mass, architectural distortion), for which cytology and/or core biopsy could not provide a definite diagnosis. Lesion mammographic patterns were microcalcifications in 186 cases (77.5%), mostly localised clusters (130/186: 70%); circumscribed mass with or without microcalcifications in 36 cases (15%) and architectural distortion with or without microcalcifications in 18 cases (7.5%). On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification, 16 cases (7%) were graded as highly suspicious for malignancy (BI-RADS 5), 81 (34%) as suspicious for malignancy (BI-RADS 4b), 97 (40%) as indeterminate (BI-RADS 4a) and 46 (19%) as probably benign (BI-RADS 3). Lesion size was <or=10 mm in 161 cases (67%) and >20 mm in only 38 cases (16%), 30 of which appeared as microcalcifications.


RESULTS
In 28/268 lesions (10.5%) the biopsy could not be performed (nonidentification of the lesion; inaccessibility due to location or breast size). In 12/240 (5%) biopsies, the sample was not representative. Pathology revealed 100/240 (42%) malignant or borderline lesions and 140/240 (58%) benign lesions. Among the malignant lesions, 16/100 (16%) were invasive carcinoma [infiltrating ductal carcinoma (IDC) or infiltrating lobular carcinoma (ILC)], 13/100 (13%) were microinvasive (T1mic), 35/100 (35%) were ductal carcinoma in situ (DCIS), 9/100 (9%) were lobular carcinoma in situ (CLIS). Among the borderline lesions, 27/100 (27%) were atypical epithelial hyperplasia [atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)]. In 9/100 surgically treated lesions (9%), there was discordance between the microhistological findings of VAB and the pathological results of the surgical procedure: 8/9 were underestimated by VAB (four ADH vs. DCIS, three DCIS vs. IDC, one ADH vs. IDC), and 1/9 was overestimated (T1mic vs. DCIS). Complications following VAB occurred in 9/240 patients (3.7%).


CONCLUSIONS
In our experience, VAB showed fair reliability in the diagnosis of nonpalpable breast lesions despite a portion of failed (10.5%), nonsignificant (5%) procedures and underestimated lesions (9%).
Tonegutti
M
M
Servizio di Radiosenologia, Casa di Cura P. Pederzoli, Via Monte Baldo 19, 37019, Peschiera del Garda, Verona, Italy.
Girardi
V
V
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology; D002278:Carcinoma in Situ / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology; D018275:Carcinoma, Lobular / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia; D042361:Mammary Glands, Human / Q000473:pathology; D008327:Mammography; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015203:Reproducibility of Results; D013238:Stereotaxic Techniques / Q000009:adverse effects / Q000706:statistics & numerical data; D014618:Vacuum