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.

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.

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.

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.

Design and Evaluation of Advanced Smart Needles for Brain Biopsy

Biopsy involves removing a piece of tissues for further medical examination. Brain biopsy is generally performed using different techniques, such as open biopsy, stereotactic core biopsy, and needle biopsy. Open biopsy is the most common and the most invasive form of the brain biopsy. During the procedure, a piece of the skull is removed and the brain is exposed. Stereotactic core and needle biopsies are minimally invasive. In these procedures, a hole is usually drilled into the skull and a needle is inserted through the hole to extract the tissue. Brain biopsy has its risks and complications due to the vulnerability of the brain tissue. Although using needle or stereotactic biopsies reduce the risks, brain biopsy may cause swelling or bleeding in the brain, and in some cases, can result in infection, stroke, seizure or even coma. A needle biopsy with conventional needles involves pulling or pushing the cutting stylet inside the needle hollow body (cannula). The manual pulling and pushing procedure induces lateral movement of the needle, which increases the damage in brain tissue. The goal here is to completely remove the needle harmful lateral movement. In this work, design of smart biopsy needles is proposed and demonstrated by incorporating nitinol wires and springs to control the lateral movement of the cutting stylet. The first design comprises of two parts. The first part of the needle is a 360° tissue cutting stylet, and the second part is the cannula. The cutting stylet can slide inside the cannula and a nitinol wire is embedded at the end of the stylet and the end of the cannula. As the electric current is applied on the nitinol wire, it shrinks and pulls the cutting stylet. The second design is almost similar to the first design, but it has a 180° tissue cutting stylet with a similar actuating mechanism. The last design uses a nitinol torsion spring that is attached to the cutting stylet. It cuts tissue samples by activating the nitinol spring to rotate the cutting stylet.

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.