Directional, Vacuum-Assisted Stereotactic Biopsy of Nonpalpable Breast Lesions with Surgical Correlation

Lim, Sung Chul; Kim, Young Sook; Nour, Sneige

Abstract

BACKGROUND: The vacuum suction probe is an alternative to the 14-gauge needle and automatic gun for performing stereotactic core needle biopsies. This study assesses the accuracy of the directional, vacuum-assisted stereotactic biopsy (DVAB) of nonpalpable breast lesions. Materials and
METHODS
Four hundred and thirty DVABs were performed on 412 patients between January 1998 and December 2000. Using 11-gauge or 14-gauge needles, six to 22 core samples (mean=13) per lesion were obtained. One hundred and fifty-five lesions were subsequently excised, and 223 patients with benign diagnoses had mammographic follow-ups. The results of the DVABs and surgeries were reviewed and correlated.
RESULTS
The results of the DVABs and surgeries were concordant in 98 of 113 cases and discordant in 15 cases, including 15 cases for which DVAB results indicated ductal carcinoma in situ (DCIS) but surgery yielded invasive carcinoma. The overall sensitivity, specificity, and positive and negative predictive values of the DVABs were 99.3%, 100%, 100%, and 99.7%, respectively. The positive predictive value for the presence of invasion was 100% and the negative predictive value was 81%. Histologic comparison was performed in 19 of 31 atypical ductal hyperplasias (ADHs) diagnosed with DVAB. Of the 19 ADHs, histologic findings showed DCIS in one, ADH in 9, atypical lobular hyperplasia in one, and no residual lesions in 8. Cases with less than 3 lobules were involved with ADH, or cases with more than 50% of microcalcification retrieved were all adequately diagnosed. Only 17 of 240 benign lesions diagnosed with DVAB were subsequently excised. These were confirmed to be ADH in three of the cases, and other benign diagnoses were confirmed in 14 of the cases. The others were confirmed to be benign lesions upon mammographic follow-up. Lesions less than 1.0 cm in maximal diameter can be removed completely by DVAB.
CONCLUSION
DVAB reduced the number of underestimated infiltrating tumors, but still, significant cases were found to be invasive. ADH diagnosed with DVAB does not require subsequent surgery for a rule-out diagnosis of carcinoma, if the sampling is adequate and less than 3 lobules are involved with ADH. Lesions less than 1.0 cm in maximal diameter can be removed completely by DVAB. Benign lesions diagnosed with DVAB did not require subsequent surgery, so DVAB can reduce the probability of unnecessary surgery for benign lesions and/or small lesions.