Of the 2182 vacuum-assisted biopsies,
53 yielded LN (2.4 %).
Of the 53 biopsies,
23 were ALH and 33 LCIS.
Forty-three of 53 LN were obtained under stereotactic guidance (81 %) and 10 under sonographic guidance (19 %).
Clinical Findings
The average patient age was 51 years (range,
35-73 years).
LN was found during the staging of a synchronous cancer in the contralateral breast in five patients and another four patients had a history of previous cancer in the other breast.
Thirteen patients had familial history of breast cancer.
One of the 53 lesions was palpable.
Imaging Findings
All 52 patients underwent a mammogram and 10 patients an ultrasound as well.
Mammography
Mammographic breast composition displayed a type 4 pattern (extremely dense) in one of 52 patients (2%),
a type 3 pattern (heterogeneously dense) in 26 patients (50%),
a type 2 pattern (scattered fibroglandular densities) in 20 patients (38%),
and a type 1pattern (fatty) in one patient (2%).
In four patients mammograms could not be reviewed because they were performed at another institution.
On mammography,
47 lobular neoplasia lesions were visible,
and 6 were occult.
Lobular neoplasia appeared as microcalcifications in 43 of the 53 lesions (81 %),
as a mass without calcifications in 2 lesions (4%),
as a distortion with calcifications in one lesion (2%) and as a asymmetry without calcifications in one lesion (2%).
Thirty-nine of the 43 cases of microcalcifications were BIRADS 4 (10 BIRADS a,
22 BIRADS b and 7 BIRADS c),
and one case was catalogued as BIRADS 5.
In three lesions BIRADS classification for microcalcifications groups could not be assigned because mammograms were performed at another institution.
For the remaining lesions also visible on mammography,
3 corresponded to BIRADS 4 (one BIRADS a,
one BIRADS b and one BIRADS c).
In one case BIRADS classification could not be assigned because mammogram was performed at another institution
The mean lesion size of the 47 lesions seen mammographically was 1.4 cm (range,
0.3-6.0 cm).
Sonography
Sonography was performed in 10 lesions: eight masses,
one group of microcalcifications and one asymmetry with microcalcifications.
Among these,
three masses and the group of microcalcifications had a mammographic correlation.
For the six lesions only visible on sonography,
three were classified as BIRADS 3 and the other three as BIRADS 4a.
The mean lesion size of the 10 lesions was 1.4 cm (range,
0.7-2.5 cm).
Imaging-guided Needle Biopsy
Of the 53 lesions biopsied,
44 (83%) were visible on mammogram only (all cases of microcalcifications and one case of distortion with microcalcifications) and all except one group of microcalcifications were biopsied under stereotactic guidance,
three (2 masses and one asymmetry with calcifications: 6% ) were seen on mammogram and ultrasound and biopsied under ultrasound guidance and six (11%) were seen only on ultrasound and biopsied under ultrasound guidance.
With respect to stereotactically VAB of microcalcifications,
complete removal was achived in 40% (17/42).
In another 19% (8/42),the percentage of microcalcifications removed was more than 75%.
Assesment After Imaging-Guided Biopsy
Surgical Excision
Thirty-two of 53 patients (60%) underwent surgical excision without a follow-up interval.
Surgical pathology confirmed the diagnosis of LN in twenty-two cases (69%)(Fig.3 y 4).
Atypical ductal hyperplasia (ADH) was found in one lesion (3%),
flat epithelial atypia (FEA) in two lesions (6%) and six cases proved to be benign at excision (19%).
Surgery revealed one case of 3 mm infiltrating lobular carcinoma (ILC) (3%) (Fig.5).
The case of ILC was a large (4.0 cm) group of microcalcifications BIRADS 4b biopsied under stereotactic guidance with a pathologic result of ALH.
The patient had history of previous cancer in the contralateral breast.
The percentage of microcalcifications removed was less than 75%.
Follow-up
In twenty-one lesions (40%),
an imaging follow-up was decided.
One of them,
a patient with familial history of breast cancer and a mass of 1.8 cm biopsied under sonographic guidance with the result of LCIS,
decided to undergo a prophylactic mastectomy two years later.
In this case,
the diagnosis of LCIS was confirmed.
The other twenty patients underwent a minimum 2 years´ imaging follow-up (24 -109 months),
with no significant changes documented.