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Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions

Biopsia mammaria in stereotassi, vacuum-assisted, in 268 lesioni non palpabili

  • Breast Radiology Senologia
  • Published:
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Abstract

Purpose

We evaluated the reliability of stereotactic vacuum-assisted breast biopsies (VAB) from our personal experience.

Materials and 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 ≤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 releaved 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%).

Riassunto

Obiettivo

Valutare l’accuratezza del sistema di agobiopsia mammaria in stereotassi con metodica multidirezionale e dispositivo aspirante sotto vuoto (VAB) nell’esperienza personale, al fine di dimostrare la validità di questa metodica.

Materiali e metodi

Nel periodo compreso fra gennaio 2003 e dicembre 2005, 268 pazienti sono state sottoposte a manovra ago-bioptica con VAB utilizzando ago 11-gauge. Sono state avviate al VAB tutte le pazienti con alterazioni sospette alla mammografia, non riconoscibili con ecografia, non palpabili (focolai di microcalcificazioni, minuscole lesioni focali con o senza microcalcificazioni, aspetti di sovvertimento) in cui la tipizzazione non poteva essere ottenuta con metodiche alternative (citologia e/o core-biopsy) e non si riteneva opportuno il follow-up. L’aspetto radiologico delle lesioni è stato di microcalcificazioni in 186 casi (77,5%), per lo più distribuite in unico focolaio (130/186: 70%); opacità focale con o senza microcalcificazioni in 36 casi (15%), infine, in 18 casi (7,5%) distorsione, con o senza microcalcificazioni. Utilizzando la classificazione BIRADS il giudizio radiologico è stato “altamente sospetto” di malignità (BIRADS 5) in 16 casi (7%), “sospetto” di malignità (BI-RADS 4b) in 81 casi (34%), “indeterminato” (BI-RADS 4a) in 97 casi (40%) e “probabilmente benigno” (BI-RADS 3) in 46 casi (19%). Centosessantuno lesioni (67%) avevano diametro ≤10 mm; solo 38 lesioni (16%) erano >20 mm,la maggior parte di queste, 30 casi, si manifestavano alla mammografia sotto forma di microcalcificazioni.

Risultati

In 28/268 casi (10,5%) non è stato possibile procedure al prelievo (mancata visualizzazione della lesione, inaccessibilità al bersaglio per sede della lesione o ridotto spessore della mammella). Il campione è risultato non significativo in 12/240 procedure espletate (5%). Il riscontro di patologia francamente maligna o di lesioni border-line si è verificato nel 42% dei casi (100/240), nei restanti 140 casi (58%) si è rilevata patologia benigna. Fra le lesioni maligne, è stata posta diagnosi di carcinoma infiltrante (CDI e CLI) in 16 casi (16/100: 16%), di carcinoma microinfiltrante (T1mic) in 13 casi (13/100: 13%), di carcinoma duttale in situ (CDIS) in 35 casi (35/100: 35%); di carcinoma lobulare in situ (CLIS) in 9 casi (9/100: 9%) e di iperplasia epiteliale atipica (ADH e ALH) in 27 casi (27/100:27%). In 9/100 lesioni (9%) si è avuta discordanza fra i reperti microistologici del VAB e i risultati patologici delle procedure chirurgiche: 8/9 sono state sottostimate dal VAB (4 ADH vs CDIS, 3 CDIS vs CDI, 1 ADH vs CDI) e 1/9 è stata sovrastimata (T1mic vs CDIS). La comparsa di complicanze in seguito a manovra bioptica con VAB si è verificata in 9/240 pazienti (3,7%).

Conclusioni

Il prelievo con VAB è risultato essere nella esperienza personale metodica discretamente affidabile nella tipizzazione di lesioni mammarie non palpabili, seppur gravata da una quota di procedure mancate (10,5%), di campionamenti non significativi (5%), ed infine da lesioni sottostimate (9%).

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Authors and Affiliations

  1. Casa di Cura “P. Pederzoli”, Servizio di Radiosenologia, Via Monte Baldo 19, 37019, Peschiera del Garda, Verona, Italy

    M. Tonegutti

  2. Dipartimento Scienze Biomediche, Istituto di Radiologia, Policlinico Universitario G.B. Rossi, p.le L. Scuro, 37100, Verona, Italy

    V. Girardi

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  1. M. Tonegutti
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  2. V. Girardi
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Correspondence to V. Girardi.

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Tonegutti, M., Girardi, V. Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions. Radiol med 113, 65–75 (2008). https://doi.org/10.1007/s11547-008-0226-0

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  • DOI: https://doi.org/10.1007/s11547-008-0226-0

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