Korean J Radiol.  2014 Dec;15(6):697-703. 10.3348/kjr.2014.15.6.697.

Percutaneous Ultrasound-Guided Vacuum-Assisted Removal versus Surgery for Breast Lesions Showing Imaging-Histology Discordance after Ultrasound-Guided Core-Needle Biopsy

• Sohn YM
• Yoon JH
• Kim EK
• Moon HJ
• Kim MJ

• KMID: 1794640
• DOI: http://doi.org/10.3348/kjr.2014.15.6.697

Abstract

OBJECTIVE
To evaluate the upgrade rate and delayed false-negative results of percutaneous vacuum-assisted removal (VAR) and surgical excision in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy (CNB) of the breast and to validate the role of VAR as a rebiopsy method for these discordant lesions.
MATERIALS AND METHODS
Percutaneous US-guided 14-gauge CNB was performed on 7470 patients between August 2005 and December 2010. Our study population included 161 lesions in 152 patients who underwent subsequent rebiopsy due to imaging-histologic discordance. Rebiopsy was performed using VAR (n = 88) or surgical excision (n = 73). We investigated the upgrade rate immediately after rebiopsy and delayed false-negative results during at least 24 months of follow-up after rebiopsy. We also evaluated the clinicoradiological differences between VAR and surgical excision.
RESULTS
Total upgrade to malignancy occurred in 13.7% (22/161) of lesions at rebiopsy including both VAR and surgical excision: 4.6% (4/88) of VAR cases (4/88) and 24.7% (18/73) of surgical excision cases (p < 0.001). Surgical excision was performed significantly more frequently in older patients and for larger-sized lesions than that of VAR, and a significant difference was detected between VAR and surgical excision in the Breast Imaging and Reporting and Data System category (p < 0.007). No delayed false-negative results were observed after VAR or surgical excision during the follow-up period.
CONCLUSION
Long-term follow-up data showed no delayed cancer diagnoses after US-guided VAR in imaging-histologic discordant lesions of the breast, suggesting that VAR might be a rebiopsy method for these lesions.

Keyword

Imaging-histologic discordance; Core needle biopsy; Vacuum-assisted removal; Surgical excision

MeSH Terms

Adult
Age Factors
Aged
Biopsy, Needle
Breast/*pathology/surgery
Breast Neoplasms/pathology/surgery
False Negative Reactions
Female
Follow-Up Studies
Humans
*Mammography
Middle Aged
Ultrasonography, Interventional
Vacuum
Young Adult

Figure

• 

  Fig. 1 Diagram of our study population. F/U = follow-up

• 

  Fig. 2 51-year-old woman with mammographic abnormality. A. Left mediolateral oblique mammography view shows partially obscured hyperdense mass. B. Transverse sonogram corresponding to mammographic abnormality shows microlobulated hypoechoic mass (arrows) classified as Breast Imaging and Reporting and Data System category 4a. Ultrasound-guided core needle biopsy reveals fibrocystic change; however, this result was regarded as discordant benign. C. Eleven-gauge vacuum-assisted removal (arrowheads) was performed, and histological results indicated invasive ductal carcinoma.

• 

  Fig. 3 77-year-old woman with palpable mass in her left breast. A. Left mediolateral oblique mammography view shows irregular shaped hyperdense mass. B, C. Transverse (B) and longitudinal (C) sonogram corresponding to palpable site shows irregular and hypoechoic mass (arrows) classified as Breast Imaging and Reporting and Data System category 5. Ultrasound-guided core needle biopsy revealed intraductal papilloma; however, this result was regarded as discordant benign. Surgical excision was performed, and histological results revealed ductal carcinoma in situ.

Reference

1. Son EJ, Kim EK, Youk JH, Kim MJ, Kwak JY, Choi SH. Imaging-histologic discordance after sonographically guided percutaneous breast biopsy: a prospective observational study. Ultrasound Med Biol. 2011; 37:1771–1778.

2. Jang M, Cho N, Moon WK, Park JS, Seong MH, Park IA. Underestimation of atypical ductal hyperplasia at sonographically guided core biopsy of the breast. AJR Am J Roentgenol. 2008; 191:1347–1351.

3. Suh YJ, Kim MJ, Kim EK, Moon HJ, Kwak JY, Koo HR, et al. Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy. Br J Radiol. 2012; 85:e349–e356.

4. Shah VI, Raju U, Chitale D, Deshpande V, Gregory N, Strand V. False-negative core needle biopsies of the breast: an analysis of clinical, radiologic, and pathologic findings in 27 concecutive cases of missed breast cancer. Cancer. 2003; 97:1824–1831.

5. Youk JH, Kim EK, Kim MJ, Kwak JY, Son EJ. Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy. Eur Radiol. 2010; 20:782–789.

6. Kim MJ, Kim EK, Park SY, Jung HK, Park BW, Kim H, et al. Imaging-histologic discordance at sonographically guided percutaneous biopsy of breast lesions. Eur J Radiol. 2008; 65:163–169.

7. Youk JH, Kim EK, Kim MJ, Lee JY, Oh KK. Missed breast cancers at US-guided core needle biopsy: how to reduce them. Radiographics. 2007; 27:79–94.

8. Meyer JE, Smith DN, Lester SC, DiPiro PJ, Denison CM, Harvey SC, et al. Large-needle core biopsy: nonmalignant breast abnormalities evaluated with surgical excision or repeat core biopsy. Radiology. 1998; 206:717–720.

9. Philpotts LE, Shaheen NA, Carter D, Lange RC, Lee CH. Comparison of rebiopsy rates after stereotactic core needle biopsy of the breast with 11-gauge vacuum suction probe versus 14-gauge needle and automatic gun. AJR Am J Roentgenol. 1999; 172:683–687.

10. Liberman L, Drotman M, Morris EA, LaTrenta LR, Abramson AF, Zakowski MF, et al. Imaging-histologic discordance at percutaneous breast biopsy. Cancer. 2000; 89:2538–2546.

11. Liberman L, Feng TL, Dershaw DD, Morris EA, Abramson AF. US-guided core breast biopsy: use and cost-effectiveness. Radiology. 1998; 208:717–723.

12. Kim MJ, Kim EK, Lee JY, Youk JH, Park BW, Kim SI, et al. Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings. Eur Radiol. 2007; 17:2376–2238.

13. Li JL, Wang ZL, Su L, Liu XJ, Tang J. Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy: can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis? Breast. 2010; 19:446–449.

14. Mihalik JE, Krupka L, Davenport R, Tucker L, Toevs C, Smith RS. The rate of imaging-histologic discordance of benign breast disease: a multidisciplinary approach to the management of discordance at a large university-based hospital. Am J Surg. 2010; 199:319–323. discussion 323.

15. Wang ZL, Liu G, Li JL, Su L, Liu XJ, Wang W, et al. Breast lesions with imaging-histologic discordance during 16-gauge core needle biopsy system: would vacuum-assisted removal get significantly more definitive histologic diagnosis than vacuum-assisted biopsy? Breast J. 2011; 17:456–461.

16. American college of radiology. Breast imaging reporting and data system (BI-RADS) ultrasound. 4th ed. Reston, VA: American College of Radiology;2003.

17. Cassano E, Urban LA, Pizzamiglio M, Abbate F, Maisonneuve P, Renne G, et al. Ultrasound-guided vacuum-assisted core breast biopsy: experience with 406 cases. Breast Cancer Res Treat. 2007; 102:103–110.

18. Rajan S, Shaaban AM, Dall BJ, Sharma N. New patient pathway using vacuum-assisted biopsy reduces diagnostic surgery for B3 lesions. Clin Radiol. 2012; 67:244–249.

19. Dershaw DD, Morris EA, Liberman L, Abramson AF. Nondiagnostic stereotaxic core breast biopsy: results of rebiopsy. Radiology. 1996; 198:323–325.

20. Perez-Fuentes JA, Longobardi IR, Acosta VF, Marin CE, Liberman L. Sonographically guided directional vacuum-assisted breast biopsy: preliminary experience in Venezuela. AJR Am J Roentgenol. 2001; 177:1459–1463.

21. Peter D, Grünhagen J, Wenke R, Schäfer FK, Schreer I. False-negative results after stereotactically guided vacuum biopsy. Eur Radiol. 2008; 18:177–182.

22. Kim MJ, Park BW, Kim SI, Youk JH, Kwak JY, Moon HJ, et al. Long-term follow-up results for ultrasound-guided vacuum-assisted removal of benign palpable breast mass. Am J Surg. 2010; 199:1–7.

23. Li S, Wu J, Chen K, Jia W, Jin L, Xiao Q, et al. Clinical outcomes of 1,578 Chinese patients with breast benign diseases after ultrasound-guided vacuum-assisted excision: recurrence and the risk factors. Am J Surg. 2013; 205:39–44.