Korean J Radiol.  2003 Dec;4(4):217-223. 10.3348/kjr.2003.4.4.217.

Stereotactic Core-Needle Biopsy of Non-Mass Calcifications: Outcome and Accuracy at Long-Term Follow-Up

• Han BK
• Choe YH
• Ko YH
• Nam SJ
• Kim JH
• Yang JH

• KMID: 1111250
• DOI: http://doi.org/10.3348/kjr.2003.4.4.217

Abstract

OBJECTIVE
To determine, by means of long-term follow-up evaluation, the outcome and accuracy of stereotactic core-needle biopsy (SCNB) of non-mass calcifications observed at mammography, and to analyze the factors contributing to false-negative findings. MATERIALS AND METHODS: Using a 14-gauge needle, SCNB was performed in cases involving 271 non-mass calcified lesions observed at mammography in 267 patients aged 23 72 (mean, 47) years. We compared the SCNB results with those of long-term follow-up which included surgery, mammography performed for at least six months, and reference to Korean Cancer Registry listings. We investigated the retrieval rate for calcifications observed at specimen mammography and histologic evaluation, and determined the incidence rate of cancer, sensitivity, and the underestimation rate for SCNB. False-negative cases were evaluated in terms of their mammographic findings, the effect of the operators' experience, and the retrieval rate for calcifications. RESULTS: For specimen mammography and histologic evaluation of SCNB, the retrieval rate for calcifications was, respectively, 84% and 77%. At SCNB, 54 of 271 lesions (19.9%) were malignant [carcinoma in situ, 45/54 (83%) ], 16 were borderline, and 201 were benign. SCNB showed that the incidence of cancer was 5.0% (6/120) in the benign mammographic category and 31.8% (48/151) in the malignant category. The findings revealed by immediate surgery and by longterm follow-up showed, respectively, that the sensitivity of SCNB was 90% and 82%. For borderline lesions, the underestimation rate was 10%. For false-negative cases, which were more frequent among the first ten cases we studied (p = 0.01), the most frequent mammographic finding was clustered amorphous calcifications. For true-negative and false-negative cases, the retrieval rate for calcifications was similar at specimen mammography (83% and 67%, respectively; p = 0.14) and histologic evaluation (79% and 75%, respectively; p = 0.47). CONCLUSION: In this study group, most diagnosed cancers were in-situ lesions, and long-term follow-up showed that the sensitivity of SCNB was 82%. Falsenegative findings were frequent during the operators' learning period.

Keyword

Breast, biopsy; Breast neoplasms, diagnosis; Stereotaxis

MeSH Terms

Adult
Aged
Biopsy, Needle/*methods/standards/statistics & numerical data
Breast/*pathology/surgery
Breast Neoplasms/*diagnosis/epidemiology/surgery
Calcinosis/*diagnosis/epidemiology/surgery
Carcinoma in Situ/*diagnosis/epidemiology/surgery
Diagnosis, Differential
Disease Progression
False Negative Reactions
Female
Follow-Up Studies
Human
Incidence
Mammography/statistics & numerical data
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Time Factors
Treatment Outcome

Figure

• 

  Fig. 1 A 46-year-old woman with calcifications detected at screening mammography. A. Routine mammogram obtained at the time of SCNB depicts multiple amorphous round calcifications in a 7-mm cluster, but no mass (arrow). Ultrasonography also failed to identify a mass associated with these calcifications (not shown here). Mammography of the SCNB core tissue specimen revealed a calcified particle, and the histologic diagnosis was fibrocystic change, with calcifications. B. Mammogram obtained 13 months after SCNB, at which time the patient reported the presence of a lump, reveals a 2-cm-sized, irregular-shaped mass (arrowheads) at the same site, where a similar number of calcifications were present (arrows). Ultrasonography visualized two 2-cm sized masses above and below the nipple (not shown here). A modified radical mastectomy revealed the presence of a 4-cm-sized invasive ductal carcinoma, and single axillary lymph node metastasis.

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