Of the 1181 vacuum-assisted biopsies,
175 yielded a diagnosis of a high-risk lesion
(15 %).
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%).
Clinical Findings
The average patient age was 51 years (range,
34-73 years).
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 patients.
Another ten patients had a history of previous cancer (one in the same breast and nine in the other one).
Thirty-two patients had familial history of breast cancer.
One of the 175 lesions was palpable.
Findings at mammography
Mammographic breast composition displayed a type 4 pattern (extremely dense) in eight of 169 patients (5%),
a type 3 pattern (heterogeneously dense) in 79 patients (47%),
a type 2 pattern (scattered fibroglandular densities) in 70 patients (41%),
and a type 1 pattern (fatty) in five patients (3%).
In seven patients mammograms could not be reviewed because they were performed at another institution.
One hundred and sixty-three of the 176 cases of microcalcifications were BIRADS 4 (38 BIRADS a,
86 BIRADS b and 40 BIRADS c),
and four cases were catalogued as BIRADS 5.
In seven lesions BIRADS classification could not be assigned because mammograms were performed at another institution.
The mean lesion size of the 175 lesions seen mammographically was 1.4 cm (range,
0.3-9.0 cm).
Imaging-guided Needle Biopsy
Complete removal of microcalcifications was achieved in 38% (67/175).
In another 18% (32/175),the percentage of microcalcifications removed was more than 75%.
Assesment After Imaging-Guided Biopsy
Surgical Excision
One hundred and twenty two of the 175 lesions (70%) underwent surgical excision without a follow-up interval.
Surgical pathology results were as follows: ADH in thirty-two cases (26%),
LN in thirty-one lesions (26%),
FEA in sixteen cases (13%),
benign papilloma in one lesion (1%),
thirty-one cases proved to be benign at excision (26%) and 11 lesions yield malignancy at surgical excision (8.2%) (5 ductal carcinoma in situ,
5 infiltrating ductal carcinoma and one infiltrating lobular carcinoma).
The underestimated cases corresponded to six of the 74 cases (8%) of ADH that underwent surgical biopsy,
three of 19 cases (16%) of FEA,
one case of 26 LN (4%) and the only case of papilloma in which immediate surgical biopsy was indicated.
There were not cases of cancer in the group of mucocele-like lesions (n = 2).
No cases of radial scar underwent surgical biopsy.
Follow-up
In fifty-three lesions (30%),
an imaging follow-up was decided.
In this group,
two patients with three groups of microcalcifications underwent surgery due to changes at the site of the VAB biopsy.
The first case was a patient with two different groups of microcalcifications,
of 0.4 and 0.7 cm,
BIRADS 4 a and BIRADS 4c,
respectively,
located in the same breast,
both of them with a diagnosis of benign papilloma after the stereotactic VAB.
One of them was completely removed,
and in the other the percentage of removal was inferior to 75%.
Four years later,
a distortion with microcalcifications was seen at a screening mammogram at the site of VAB,
and an infiltrating ductal carcinoma was diagnosed.
The other case was a patient referred from another institution to perform a stereotactic VAB in a 3.0 cm group of microcalcifications,
BIRADS 4c.
The diagnosis was ADH.
The percentage of removal was inferior to 25%.
The patient did not undergo immediate surgery.
After eighteen months of follow-up,
surgical biopsy was indicated because an increase in the number of microcalcifications,
yielding a diagnosis of ductal carcinoma in situ.
The other fifty lesions underwent a minimum 2 years´ imaging follow-up (24 -109 months),
with no significant changes documented.