Failure of Stereotactic Core Needle Biopsy in Women Recalled for Suspicious Calcifications at Screening Mammography: Frequency, Causes and Final Outcome in a Multi-institutional, Observational Follow-up Study

PurposeWe determined the failure rate of stereotactic core needle biopsy (SCNB) and its causes and final outcome in women recalled for calcifications at screening mammography.MethodsWe included a consecutive series of 624,039 screens obtained in a Dutch screening region between January 2009 and July 2019. Radiology reports and pathology results were obtained of all recalled women during two-year follow-up. ResultsA total of 3,495 women (19.6% of 17,809 recalls) were recalled for suspicious calcifications. SCNB was indicated in 2,818 women, of whom 12 had incomplete follow-up and another 12 women refused biopsy. DCIS or invasive cancer was diagnosed in 880 of the remaining 2,794 women (31.5%). SCNB failed in 62 women (2.2%, 36/2,794). These failures were mainly due to a too posterior (n=30) or too superficial location (n=17) of the calcifications or calcifications too faint for biopsy (n=13). Of these 62 women, 10 underwent surgical biopsy, yielding one DCIS (intermediate grade) and two invasive cancers (one intermediate grade and one high grade) and another two women were diagnosed with DCIS (both high grade) at follow-up. Thus, the malignancy rate after SCNB failure was 8.1% (5/62). Calcifications were neither depicted at SCNB specimen radiography nor at pathology in 16 women after (repeated) SCNB (0.6%, 31/2,732). None of them proved to have breast cancer at 2 year follow-up. ConclusionThe failure rate of SCNB for suspicious calcifications is low but close surveillance is warranted, as breast cancer may be present in up to 8% of these women.

Fine, Linear/Branching Calcifications

Of all of the calcifications identified on mammography, fine, linear/branching calcifications are the most suspicious for malignancy, most commonly ductal carcinoma in situ (DCIS). The risk of malignancy associated with fine, linear/branching calcifications is approximately 70%. A recent study evaluating the positive predictive value of suspicious calcifications based on the fifth edition of BI-RADS found the positive predictive value of fine pleomorphic/linear or segmental calcifications was 93.8%. This chapter, which appears in the section on calcifications, reviews the key imaging features, imaging protocols for evaluating calcifications, management, and potential pitfalls or mimics of fine, linear/branching calcifications. Topics discussed will include magnification views, stereotactic core needle biopsy, and radiology–pathology correlation.

Effectiveness of Multimodality Imaging in Differential Diagnostics of Nonpalpable Breast Architectural Distortion

Objective:the aim of the study was to estimate the informative value of multimodality imaging in differential diagnostics of nonpalpable breast architectural distortion of different origin.Matherials and methods.We analyzed the results of multimodality examination of 307 women with nonpalpable breast architectural distortion of different origin. They underwent mammography, handheld sonography (B-mode), compressive elastosonography, Doppler angiography, automated breast volume US-scanning, US-guided core needle biopsy (n = 115; 38%) and stereotactic core needle biopsy (n = 192; 62%), pathomorphologic analysis. Results.Breast cancer were diagnosed in 221 (72%) women, benign lesions – in 86 (28%) women. Surgical treatment was performed In 254 (83%) cases and 31 (10%) breast lesions were removed with vacuum-assisted aspiration biopsy.Conclusion.Multimodality imaging with the invasive procedures gave 92.5% sensitivity, 100% specificity, 100% showed positive prognosis, 72.5% negative prognosis, 93.1% accuracy index.

Does 8-guage stereotactic core needle biopsy improve the accuracy over 11-gauge devices? Evaluation of pure DCIS on stereotactic biopsy and the rate of upstaging.

97 Background: Ductal carcinoma in situ (DCIS) accounts for 25% of newly diagnosed breast cancers. Core needle biopsy (CNB) has replaced open surgical biopsy for mammographic calcifications. We compare our experience with 8-gauge vs. 11-gauge vacuum assisted core needle biopsy in pure DCIS. We hypothesize that the diagnosis of DCIS with use of an 8-gauge vacuum-assisted core needle will lead to a lower rate of upstaging to invasive cancer at definitive surgical excision compared to 11-gauge vacuum-assisted core needle biopsy. Methods: A retrospective study was performed evaluating all patients who underwent a stereotactic core needle biopsy at our institution for DCIS during 2008-2012.We then compared the upstaging rates between patients biopsied using 8 or 11-gauge biopsy devices. Results: A total of 580 patients underwent STCNB during 2008-2012 at our institution, there were 461 patients excluded as they did not meet inclusion criteria and 119 patients were included. The most common mammographic finding was calcifications in 104/119 (87.4%) and a mammographic mass in 15/119 (12.60%). Biopsy with the 11 gauge needle was utilized in 60 patients and 59 patients with 8-G needle. Factors associated with upstaging were using a smaller 11 gauge needle and a mass on imaging, higher grade and more than four cores obtained on biopsy. There was an upstaging rate of 17/60 (28%) in patients who underwent stereotactic biopsy using a11-gauge needle versus upstaging rate of 7/59 (11.8%) in patients who underwent stereotactic biopsy using 8 gauge needle. We obtained a statistically significant p-value of 0.025. Conclusions: This is one of the few studies comparing upstaging rates from pure DCIS on STCNB using 8 and 11-gauge stereotactic vacuum assisted needles. Our results show that there is a statistically significant decrease in upstaging of pure DCIS to invasive malignancy at excision using the larger 8-gauge needle devices. The clinical implication is that SLNB need not be performed secondary to the low upstaging rate. We recommend that all stereotactic core needle biopsies be performed using the 8-gauge needle devices, and that SLNB generally be omitted for DCIS.

Lymphatic mapping of ductal carcinoma in situ diagnosed by stereotactic core needle biopsy

10507 Background: About 20% of ductal carcinoma in situ (DCIS) lesions diagnosed by stereotactic core needle biopsy (SCNB) are shown to be invasive on postoperative pathology examination. Sentinel lymph node biopsy (SLNB) is an accurate method of evaluating axillary lymph nodes in patients with invasive breast cancer. The aim of this study was to review our experience with lymphatic mapping in patients with a SCNB diagnosis of pure DCIS, to evaluate the DCIS underestimation rate and consequently the risk of lymph node metastases. Methods: Files from 160 patients diagnosed with pure DCIS by SCNB between July 1999 and March 2005 were retrieved from our database. Patients with DCIS were selected for SLNB if there was concern for presence of an invasive component on the basis of size, palpability or imaging. Results: The median age of the study group was 55 years (range 29–85 years) and median DCIS size on mammography was 25 mm (range 4–96 mm). Thirty-six (23%) out of the 160 women underwent a SLNB. Macrometastases in the sentinel node were detected in seven (19%) patients and one (3%) patient was found to have a micrometastasis. Twenty (56%) of these 36 patients had invasive lesions on final pathology. Of the 124 women who did not receive SLNB, 29 (24%) turned out to have invasive lesions on postoperative evaluation. In total, 49/160 (31%) patients with pure DCIS diagnosed by SCNB had invasive breast cancer (range pT1mic-pT2) on final pathology. Finally, 88 patients underwent lymphatic staging by SLNB, basal node sampling or complete axillary lymph node dissection. Nodal involvement was present in 14 (16%) out of these 88 patients with initially diagnosed DCIS: 36% in patients with invasive breast cancer and 2% with pure DCIS on final pathology. Conclusion: Postoperative pathology examination of the specimen demonstrates DCIS underestimation in nearly one third of SCNB diagnosed DCIS patients. SLNB is of benefit for these patients as in 19% of the patients who undergo a SLNB macrometastatic disease in the sentinel node can be found. No significant financial relationships to disclose.