Aims and objectives
Stereotactic vacuum-assisted biopsy (VAB) is widely used in place of surgical biopsy for the diagnosis of mammographically detected lesions of the breast.
Although stereotactic VAB has been shown to be highly accurate in diagnosing benign and malignant breast disease,
and is considered a safe procedure comparable to surgical biopsy for characterization of microcalcifications (1,2),
with low false-negative results (3,4).
when a high-risk lesion is encountered VAB specimens,
the presence of an underlying malignancy within the lesion or in the nearby tissue can be underestimated....
Methods and materials
We reviewed our database of all stereotactically (n=1181) vacuum assisted biopsy procedures performed in our hospital between December 2003 and December 2010.
We included in the study 175 lesions (169 patients) in which the pathologic examination of 11G stereotactic VAB samples obtained after the biopsy of microcalcifications revealed a high risk lesion.
All 175 lesions underwent surgical excision (n=125) or a minimum of 2 years´ imaging follow-up (n=50).
The patient´s age,
personal history of breast cancer,
clinical presentation (if the lesion was palpable),...
Of the 1181 vacuum-assisted biopsies,
175 yielded a diagnosis of a high-risk lesion
Of the 175 biopsies,
79 were atypical ductal hyperplasia (45%),
42 lobular neoplasia (24%),
31 flat epithelial atypia (18%),
10 papillomas (6%),
11 radial scars (6%) and 2 mucocele-like lesions (1%).
The average patient age was 51 years (range,
The high-risk lesion was found during the staging of a synchronous cancer in the same breast in two patients and in the contralateral breast in other four...
In this study,
the global underestimation rate for high-risk lesions diagnosed after a stereotactic vacuum-assisted biopsy of suspicious microcalcifications was 8% (14/175).
Unless in mucocele-like lesions (0%) and radial scar (0%),
in the other lesions the underestimation rate (atypical ductal hyperplasia 8.9% [7/79],
lobular neoplasia 2.3% [1/42] ,
flat epithelial atypia 9.7% [3/31] and papilloma 30% [3/10] ) suggests that surgical biopsy is warranted.
Stereotactic11-gauge vacuum-assisted breast biopsy: a validation study.
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Vacuum-assisted large-core needle biopsy(VLNB) improves the management of patients with breast microcalcifications: analysis of 1009 cases.
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Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with a 14-gauge directional vacuum biopsy.
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