Stereotactic Vacuum Biopsy of Calcifications with a Handheld Portable Biopsy System: a Validation Study

Overview

Journal Eur Radiol

Specialty Radiology

Date 2008 Mar 21

PMID 18351352

Authors

P Taourel

D Hoa

C Chaveron

C Balu-Maestro

D Gros

M C Baranzelli

F Ettore

M F Bretz-Grenier

P Roger

Affiliations

Soon will be listed here.

Abstract

To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.

References

Lifrange E, Dondelinger R, Quatresooz P, Vandevorst G, Colin C . Stereotactic breast biopsy with an 8-gauge, directional, vacuum-assisted probe: initial experience. Eur Radiol. 2002; 12(9):2180-7. DOI: 10.1007/s00330-002-1382-6. View

Liberman L, Smolkin J, Dershaw D, Morris E, Abramson A, Rosen P . Calcification retrieval at stereotactic, 11-gauge, directional, vacuum-assisted breast biopsy. Radiology. 1998; 208(1):251-60. DOI: 10.1148/radiology.208.1.9646821. View

Liberman L, Gougoutas C, Zakowski M, LaTrenta L, Abramson A, Morris E . Calcifications highly suggestive of malignancy: comparison of breast biopsy methods. AJR Am J Roentgenol. 2001; 177(1):165-72. DOI: 10.2214/ajr.177.1.1770165. View

Lomoschitz F, Helbich T, Rudas M, Pfarl G, Linnau K, Stadler A . Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy. Radiology. 2004; 232(3):897-903. DOI: 10.1148/radiol.2323031224. View

Sittek H, Kessler M, Untch M, Reiser M . [Minimally invasive biopsy and preoperative marking of suspect mammary lesions]. Gynakol Geburtshilfliche Rundsch. 2004; 44(2):69-83. DOI: 10.1159/000076860. View

Sie A, Bryan D, Gaines V, Killebrew L, Kim C, Morrison C . Multicenter evaluation of the breast lesion excision system, a percutaneous, vacuum-assisted, intact-specimen breast biopsy device. Cancer. 2006; 107(5):945-9. DOI: 10.1002/cncr.22090. View

Jackman R, Burbank F, Parker S, Evans 3rd W, Lechner M, Richardson T . Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 2001; 218(2):497-502. DOI: 10.1148/radiology.218.2.r01fe35497. View

Margolin F, Kaufman L, Jacobs R, Denny S, Schrumpf J . Stereotactic core breast biopsy of malignant calcifications: diagnostic yield of cores with and cores without calcifications on specimen radiographs. Radiology. 2004; 233(1):251-4. DOI: 10.1148/radiol.2331031680. View

Pfarl G, Helbich T, Riedl C, Wagner T, Gnant M, Rudas M . Stereotactic 11-gauge vacuum-assisted breast biopsy: a validation study. AJR Am J Roentgenol. 2002; 179(6):1503-7. DOI: 10.2214/ajr.179.6.1791503. View

10.

Liberman L, Kaplan J, Morris E, Abramson A, Menell J, Dershaw D . To excise or to sample the mammographic target: what is the goal of stereotactic 11-gauge vacuum-assisted breast biopsy?. AJR Am J Roentgenol. 2002; 179(3):679-83. DOI: 10.2214/ajr.179.3.1790679. View

11.

Ghate S, Rosen E, Soo M, Baker J . MRI-guided vacuum-assisted breast biopsy with a handheld portable biopsy system. AJR Am J Roentgenol. 2006; 186(6):1733-6. DOI: 10.2214/AJR.05.0551. View

12.

Feig S, Saitas V, FINKEL G, Schwartz G . Stability of malignant breast microcalcifications. Radiology. 1994; 192(1):153-6. DOI: 10.1148/radiology.192.1.8208928. View

13.

Jackman R, Marzoni Jr F, Nowels K . Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques. AJR Am J Roentgenol. 1998; 171(5):1325-30. DOI: 10.2214/ajr.171.5.9798873. View

14.

Heywang-Kobrunner S, Schreer I, Decker T, Bocker W . Interdisciplinary consensus on the use and technique of vacuum-assisted stereotactic breast biopsy. Eur J Radiol. 2003; 47(3):232-6. DOI: 10.1016/s0720-048x(02)00196-1. View

15.

Kettritz U, Rotter K, Schreer I, Murauer M, Schulz-Wendtland R, Peter D . Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer. 2004; 100(2):245-51. DOI: 10.1002/cncr.11887. View

16.

Philpotts L, Shaheen N, Carter D, Lange R, Lee C . 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(3):683-7. DOI: 10.2214/ajr.172.3.10063860. View

17.

Darling M, Smith D, Lester S, Kaelin C, Selland D, Denison C . Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol. 2000; 175(5):1341-6. DOI: 10.2214/ajr.175.5.1751341. View

18.

Cox D, Bradley S, England D . The significance of mammotome core biopsy specimens without radiographically identifiable microcalcification and their influence on surgical management--a retrospective review with histological correlation. Breast. 2005; 15(2):210-8. DOI: 10.1016/j.breast.2005.06.001. View

19.

Homer M, Safaii H, Smith T, MARCHANT D . The relationship of mammographic microcalcification to histologic malignancy: radiologic-pathologic correlation. AJR Am J Roentgenol. 1989; 153(6):1187-9. DOI: 10.2214/ajr.153.6.1187. View

20.

Berg W, Krebs T, Campassi C, Magder L, Sun C . Evaluation of 14- and 11-gauge directional, vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model. Radiology. 1997; 205(1):203-8. DOI: 10.1148/radiology.205.1.9314986. View