Cancelled stereotactic biopsy of calcifications not seen using the stereotactic technique: do we still need to biopsy?
OBJECTIVE
To determine the frequency of cancelled stereotactic biopsy due to non-visualisation of calcifications, and assess associated features and outcome data.


METHODS
A retrospective review was performed on 1,874 patients scheduled for stereotactic-guided breast biopsy from 2009 to 2011. Medical records and imaging studies were reviewed.


RESULTS
Of 1,874 stereotactic biopsies, 76 (4 %) were cancelled because of non-visualisation of calcifications. Prompt histological confirmation was obtained in 42/76 (55 %). In 28/76 (37 %) follow-up mammography was performed, and 7/28 subsequently underwent biopsy. Of 27 without biopsy, 21 (78 %) had follow-up. Nine cancers (9/49, 18 %) were found: 6 ductal carcinoma in situ (DCIS), 3 infiltrating ductal carcinoma (IDC). Of 54 patients with either biopsy or at least 2 years' follow-up, 9 (17 %) had cancer (95 % CI 8-29). Cancer was present in 7/42 (17 %, 95 % CI 7-31 %) lesions that had prompt histological confirmation (DCIS = 5, IDC = 2) and in 2/28 (7 %, 95 % CI 0.8-24 %) lesions referred for follow-up (DCIS = 1, IDC = 1). Neither calcification morphology (P = 0.2), patient age (P = 0.7), breast density (P = 1.0), personal history (P = 1.0) nor family history of breast cancer (P = 0.5) had a significant association with cancer.


CONCLUSIONS
Calcifications not visualised on the stereotactic unit are not definitely benign and require surgical biopsy or follow-up. No patient or morphological features were predictive of cancer.


CONCLUSIONS
• Half of cancelled stereotactic biopsies were due to non-visualisation of calcified foci. • This reflects the improved detection of calcifications by digital mammography. • Calcifications too faint for the stereotactic technique require alternative biopsy or follow-up • 17 % of patients with biopsy or at least 2 years' follow-up had cancer. • No patient/morphological features were found to aid selection for re-biopsy vs. follow-up.
Departments of Radiology, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street, # 731, New York, NY, 10065, USA, brennans@mskcc.org.
Sandra B
SB
Brennan
Donna
D
D'Alessio
Laura
L
Liberman
Dilip
D
Giri
Edi
E
Brogi
Elizabeth A
EA
Morris
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D013238:Stereotaxic Techniques