On the Diagnostic Accuracy of Stereotactic Vacuum-Assisted Biopsy of Nonpalpable Breast Abnormalities. Results in a Consecutive Series of 769 Procedures Performed at the Trento Department of Breast Diagnosis

Abstract

Aims and Background

To assess the diagnostic accuracy of stereotactic vacuum-assisted biopsy of nonpalpable breast lesions.

Methods and Study Design

769 consecutive vacuum-assisted biopsy procedures were retrospectively reviewed. Positive predictive value for carcinoma (B5) at vacuum-assisted biopsy was assessed on the overall series and by age, lesion morphology and size, degree of suspicion and calendar period. The accuracy of vacuum-assisted biopsy was based on surgical histology or follow-up (no change at 12 months was assumed as negative).

Results

Lesions were depicted as isolated microcalcifications, opacity + microcalcifications, or opacity in 716 (93.1%), 28 (3.6%), or 25 (3.2%) cases, respectively. Vacuum-assisted biopsy was negative (B1 = 63; B2 = 319) in 382 (49.7%), borderline (B3) in 142 (18.5%), suspicious (B4) in 2 (0.3%), and positive (B5) in 243 (31.6%) cases (in situ = 185, 24.1%), invasive = 58 (7.5%)), respectively. Age (χ²_df3 = 19.50; P <0.002), size (χ²_df4 = 51.02; P = 10^-6) and degree of suspicion (χ²_df2 = 146.68; P = 10^-6) were associated with a B5 outcome, no significant association was evident for morphology (χ²_df2 = 0,47; P <0.78), whereas calendar period had a moderate but significant inverse association (χ²_df2 = 6.12; P <0.04). The positive predictive value for surgically confirmed carcinoma (in situ or invasive) was 0% for B1, 0.7% for B2, 12.3% for B3, 100% for B4, 92.7% for in situ B5, and 94.6% for invasive B5. Conversion from in situ B5 to invasive was 12.3% and was insignificantly associated with size (χ²_df2 = 0.95; P = 0.62) and histology grade (χ²_df2 = 3.64; P = 0.16). Down-grading of vacuum-assisted biopsy lesions to a less severe histology occurred in 13 (7.2%) in situ and in 16 (28.6%) invasive carcinomas. B3 cases upgrading to more severe lesions was 0%, 4.5% or 16.0% in the presence of no, mild, or severe atypia.

Conclusions

The study confirmed a good performance of vacuum-assisted biopsy, possibly influenced by the local scenario (e.g., radiologist's and pathologist's interobserver variability and sampling modality). Conflicting results with the literature may have local explanations rather than being due to inadequate performance.

Keywords

breast cancer core biopsy diagnosis vacuum-assisted biopsy

Get full access to this article

View all access options for this article.

References

Parker

S.H.

, Burbank

, Jackman

R.J.

, Aucreman

C.J.

, Cardenosa

, Cink

T.M.

, Coscia

J.L.

Jr. , Eklund

G.W.

, Evans

3rd , Garver

P.R.

: Percutaneous large-core breast biopsy: a multi-institutional study. Radiology, 193: 359–364, 1994.

Burbank

: Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with a directional, vacuum-assisted biopsy instrument. Radiology, 202: 843–847, 1997.

Ciatto

, Houssami

, Ambrogetti

: Accuracy and underestimation of malignancy of breast core needle biopsy: the Florence experience of over 4,000 consecutive biopsies. Breast Cancer Res Treat, 101: 291–297, 2006.

Liberman

: Clinical management issues in percutaneous core breast biopsy. Radiol Clin North Am, 38: 791–807, 2000.

Houssami

, Cuzick

, Dixon

J.M.

: The prevention, detection and management of breast cancer. Med J Aust, 184: 230–234, 2006.

Ciatto

, Rosselli Del Turco

, Ambrogetti

, Bravetti

, Catarzi

, Morrone

, Cariaggi

M.P.

: Solid nonpalpable lesions - success and failure of guided fine-needle aspiration cytology in a consecutive series of 2444 cases. Acta Radiologica, 38: 815–820, 1997.

Houssami

, Ciatto

, Ellis

, Ambrogetti

: Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer, 109: 487–495, 2007.

Jackman

R.J.

, Burbank

, Parker

S.H.

, Evans

3rd , Lechner

M.C.

, Richardson

T.R.

, Smid

A.A.

, Borofsky

H.B.

, Lee

C.H.

, Goldstein

H.M.

, Schilling

K.J.

, Wray

A.B.

, Brem

R.F.

, Helbich

T.H.

, Lehrer

D.E.

, Adler

S.J.

: Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology, 218: 497–502, 2001.

Perry

, Broeders

, de Wolf

, Tornberg

, Holland

, von Karsa

, Putaar

(eds): European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis 4th edn, Europe Against Cancer, European Commission, Luxembourg, 2006.

10.

Houssami

, Irwig

: Likelihood ratios for clinical examination, mammography, ultrasound and fine needle biopsy in women with breast problems. Breast, 7: 85–89, 1998.

11.

NHS Non-operative Diagnosis Subgroup of the National Coordination Group for Breast Screening Pathology: Guidelines for Non-operative Diagnostic Procedures and Reporting in Breast Cancer Screening (NHSBSP publication no. 50). NHS Cancer Screening Programmes: Sheffield. 2001.

12.

Houssami

, Ciatto

, Bilous

, Vezzosi

, Bianchi

: Borderline breast core needle histology: predictive values for malignancy in lesions of uncertain malignant potential (B3). Br J Cancer, 96: 1253–1257, 2007.

13.

Tonegutti

, Girardi

, Ciatto

, Manfrin

, Bonetti

: B3 breast lesions determined by vacuum-assisted biopsy: how to reduce the frequency of benign excision biopsies. Radiol Med, 115: 1246–1257, 2010.

14.

Ancona

, Capodieci

, Galiano

, Mangieri

, Lorusso

, Gatta

: Vacuum-assisted biopsy diagnosis of atypical ductal hyperplasia and patient management. Radiol Med, 116: 276–291, 2011.

15.

Houssami

, Ambrogetti

, Marinovich

M.L.

, Bianchi

, Macaskill

, Vezzosi

, Mamounas

E.P.

, Ciatto

: Accuracy of a preoperative model for predicting invasive breast cancer in women with ductal carcinoma in-situ on vacuum-assisted core needle biopsy. Ann Surg Oncol, 18: 1364–1371, 2011.