EVALUATION OF CLUSTERED MICROCALCIFICATIONS, INITIALLY GRADED AS LIKELY MALIGNANT ON BASELINE MAMMOGRAPHY, WITH STEREOTACTIC BIOPSY: A RAD-PATH CORRELATION

Background: Stereotactic-guided breast biopsy is an invincible tool to sample abnormalities visible only on mammography with subtle or occult ultrasound findings. Common mammographic abnormalities which require stereotactic core biopsy include calcifications, architectural distortion and satellite lesions. With advancement in techniques for adequate localisation of lesions, the use of stereotactic needle breast biopsy is exponentially increasing. A study was performed to look for frequency of benignancy or malignancy of microcalcifications and architectural distortions in patients initially falling in malignant category of Breast Imaging-Reporting and Data System of American College of Radiology (BI-RADS®) Assessment Categories.Materials and Methods: Patient presenting in outpatient (OPD) clinic who underwent stereotactic biopsies for labelled malignant on mammograms from May 2015 to May 2018 was included in retrospective study. Age, technique used, baseline mammogram and histopathology were reviewed.Results: A total of 91 patients underwent stereotactic biopsy. Age range varied between 28 and 81 years. Stereotacticguided biopsies were taken using a standard 14-gauge core needle with long throw of 22 mm excursion. None of the biopsy was inconclusive. In comparison with baseline mammograms and histopathology, 40% of the clusters of microcalcification which were initially labelled as malignant turned out to be malignant on histopathology as well, whereas 60% were reported as benign breast parenchyma.Conclusion: Agreement between the diagnostic accuracy of microcalcifications on mammogram and histopathology of same lesions after stereotactic biopsy was comparable to international figures with probability of being benign surpassing malignant on routine screening.Key words: Breast cancer, mammography, microcalcifications, stereotactic biopsy

Stereotactic Core Biopsy

Stereotactic biopsy systems utilize angled mammography images and parallax shift to localize and sample a target. The most common indication for stereotactic core biopsy is to sample suspicious/indeterminate calcifications, but it can be used to biopsy any mammographic finding (mass, developing asymmetry, architectural distortion). In benign cases, core biopsy may avoid unnecessary surgery. In malignant cases, core biopsy allows for a pathological diagnosis prior to lumpectomy, and better surgical planning. This chapter, appearing in the section on interventions and surgical procedures, provides a practical guide to stereotactic core biopsy. Topics discussed include stereotactic core biopsy equipment, procedure protocols and pitfalls, clinical management, and imaging follow-up.

Post–Vacuum-Assisted Stereotactic Core Biopsy Clip Displacement: A Comparison between Commercially Available Clips and Surgical Clip

Purpose The placement of localization clips following percutaneous biopsy is a standard practice for a variety of situations. Subsequent clip displacement creates challenges for imaging surveillance and surgical planning, and may cause confusion amongst radiologists and between surgeons and radiologists. Many causes have been attributed for this phenomenon including the commonly accepted “accordion effect.” Herein, we investigate the performance of a low cost surgical clip system against 4 commercially available clips. Methods We retrospectively reviewed 2112 patients who underwent stereotactic vacuum-assisted core biopsy followed by clip placement between January 2013 and June 2016. The primary performance parameter compared was displacement >10 mm following vacuum-assisted stereotactic core biopsy. Within the group of clips that had displaced, the magnitude of displacement was compared. Results There was a significant difference in displacement among the clip types ( P < .0001) with significant pairwise comparisons between pediatric surgical clips and SecureMark (38% vs 28%; P = .001) and SenoMark (38% vs 27%; P = .0001) in the proportion displaced. The surgical clips showed a significant magnitude of displacement of approximately 25% greater average distance displaced. Conclusions As a whole, the commercial clips performed better than the surgical clip after stereotactic vacuum-assisted core biopsy suggesting the surrounding outer component acts to anchor the central clip and minimizes clip displacement. The same should apply to tomosynthesis-guided biopsy.