MR imaging-guided 10-gauge vacuum-assisted breast biopsy: histological characterisation

The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review & meta-analysis

INTRODUCTION

High-risk or B3 breast lesions are considered lesions of uncertain malignant potential and comprise between 5 and 12% of initial biopsy results. We sought to perform a systematic review and meta-analysis of studies published within the last twenty years to determine the pooled Positive Predictive Value (PPV) of VAB in selected B3 lesions.

METHODS

The study report is based on the guidelines of PRISMA and Meta-Analysis of Observational Studies in Epidemiology.

OUTCOMES

The primary outcome of this study was to determine the PPV of VAB in determining final histological diagnosis in B3 breast lesions using pooled estimates. The secondary outcomes were to determine if needle gauge or the re-classification of Lobular Carcinoma in Situ(LCIS) introduced in 2012 influenced pooled estimates.

RESULTS

78 studies incorporating 6,377 B3 lesions were included in this review, 1214 of which were upgraded to DCIS or invasive malignancy following surgical excision(19%). The pooled PPV of VAB in Atypical Ductal Hyperplasia(ADH) and Lobular Neoplasia(LN) were 0.79(CI 0.76-0.83) and 0.84(CI 0.8-0.88). VAB of Flat Epithelial Atypia(FEA), radial scar and papillary lesions with/without atypia all had a pooled PPV >90% (underestimation rates 7%, 1%, 5% and 3% respectively). Needle gauge size and the change in LCIS classification did not appear to influence underestimation rates on subgroup analysis.

CONCLUSION

Results from this meta-analysis suggests it is reasonable to perform VAB as definitive treatment for certain B3 lesions, specifically LN, FEA, radial scar, and papillary lesions when specific criteria are fulfilled. Surgical excision should continue as the mainstay of treatment for ADH.

A systematic review and meta-analysis: value of ultrasound-guided vacuum-assisted biopsy in the diagnosis and treatment of breast lesions

Background

In recent years, according to global statistics, breast cancer is the main disease affecting women. Ultrasound-guided vacuum-assisted biopsy (VAB) has become a frequently used method for breast cancer detection because of its accuracy, simplicity, and fewer complications.

Methods

In PubMed, Medline, EMbase and Cochrane central register of controlled trials, the retrieval time was from the establishment of the database to March 2021, and the keywords included breast tumor, breast cancer-related diseases, breast lesions, vacuum-assisted breast biopsy, sensitivity and specificity. Meta-analysis was performed using RevMan5.3 software provided by the Cochrane Collaboration.

Results

A total of 10 articles were included using a random-effects model that pooled the sensitivity, specificity, and other accuracy measures of VAB. The summary receiver operating characteristic (SROC) characteristic curve was used to summarize the overall accuracy. The sensitivity range was 0.94 to 1.00 (mean, 0.981; 95% CI, 0.972-0.987) with a specificity range of 0.87-1.00 (mean, 0.999; 95% CI, 0.997-0.999). The preoperative platelet-lymphocyte ratio (PLR) was 93.84 (95% CI, 41.55-211.95), the neutrophil to lymphocyte ratio (NLR) was 0.05 (95% CI, 0.03-0.09), the sensitivity and specificity of χ² were 37.10 (P=0.011) and 32.00 (P=0.043), respectively, while those of PLR, NLR, and duration of response (DOR) were 46.98 (P=0.001), 54.92 (P=0.001), and 43.49 (P=0.002), respectively. Differences were considerable.

Discussion

In this meta-analysis, a total of 10 articles were included. VAB is an accurate type of biopsy to detect female breast cancer. The results of the meta-analysis were stable, and VAB had high sensitivity (98%) and specificity (nearly 100%).

Upgrade Rate of Percutaneously Diagnosed Pure Atypical Ductal Hyperplasia: Systematic Review and Meta-Analysis of 6458 Lesions

Background Management of percutaneously diagnosed pure atypical ductal hyperplasia (ADH) is an unresolved clinical issue. Purpose To calculate the pooled upgrade rate of percutaneously diagnosed pure ADH. Materials and Methods A search of MEDLINE and EMBASE databases was performed in October 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines were followed. A fixed- or random-effects model was used, along with subgroup and meta-regression analyses. The Newcastle-Ottawa scale was used for study quality, and the Egger test was used for publication bias. Results Of 521 articles, 93 were analyzed, providing data for 6458 ADHs (5911 were managed with surgical excision and 547 with follow-up). Twenty-four studies used core-needle biopsy; 44, vacuum-assisted biopsy; 21, both core-needle and vacuum-assisted biopsy; and four, unspecified techniques. Biopsy was performed with stereotactic guidance in 29 studies; with US guidance in nine, with MRI guidance in nine, and with mixed guidance in eight. Overall heterogeneity was high (I² = 80%). Subgroup analysis according to management yielded a pooled upgrade rate of 29% (95% confidence interval [CI]: 26%, 32%) for surgically excised lesions and 5% (95% CI: 4%, 8%) for lesions managed with follow-up (P < .001). Heterogeneity was entirely associated with surgically excised lesions (I² = 78%) rather than those managed with follow-up (I² = 0%). Most variability was explained by guidance and needle caliper (P = .15). At subgroup analysis of surgically excised lesions, the pooled upgrade rate was 42% (95% CI: 31%, 53%) for US guidance, 23% (95% CI: 19%, 27%) for stereotactic biopsy, and 32% (95% CI: 22%, 43%) for MRI guidance, with heterogeneity (52%, 63%, and 56%, respectively) still showing the effect of needle caliper. When the authors considered patients with apparent complete lesion removal after biopsy (subgroups in 14 studies), the pooled upgrade rate was 14% (95% CI: 8%, 23%). Study quality was low to medium; the risk of publication bias was low (P = .10). Conclusion Because of a pooled upgrade rate higher than 2% (independent of biopsy technique, needle size, imaging guidance, and apparent complete lesion removal), atypical ductal hyperplasia diagnosed with percutaneous needle biopsy should be managed with surgical excision. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Brem in this issue.

Magnetic resonance imaging-guided vacuum-assisted breast biopsy: experience and preliminary results of 205 procedures

Objective

To demonstrate the frequency of malignancy and histological characteristics of lesions in patients submitted to vacuum-assisted breast biopsy guided by magnetic resonance imaging (MRI).

Materials and Methods

This was a retrospective study of MRI-guided vacuum-assisted breast biopsies performed between April 2008 and December 2016, in which we analyzed clinical and epidemiological data, as well as the BI-RADS classification and histopathological results. We compared nodules and non-nodular enhancements, in terms of their correlation with malignancy, using chi-square test.

Results

Among 215 cases referred for MRI-guided vacuum-assisted breast biopsy, the procedure was contraindicated in 10 cases (5%) and was technically feasible in the remaining 205 (95%). Non-nodular enhancements were observed in 135 cases (66%), and nodules were observed in 70 (34%), with a mean diameter of 2.2 cm (range, 0.5-9.6 cm) and 0.97 cm (range, 0.5-2.2 cm), respectively. Of the 205 lesions analyzed, 43 (21%) were malignant, 129 (63%) were benign, and 33 (16%) were classified as high-risk lesions. The most common histological findings were invasive ductal carcinoma and, in high-risk cases, lobular neoplasia. There was no significant difference between nodules and non-nodular enhancements in terms of the rate of malignancy (p = 0.725).

Conclusion

In our sample, the overall malignancy rate was 21%. However, to improve the assessment of these results, it is necessary to correlate them with the surgical data and with data from the follow-up of benign cases.

High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up

OBJECTIVE:

To determine whether breast MRI-guided vacuum-assisted biopsy (MRI-VAB) high-risk lesion histology influences surgical or long-term imaging follow-up outcomes.

METHODS:

Patients with imaging-concordant high-risk findings on 9-gauge breast MRI-VAB between January 2007 and July 2012 who had surgical histopathology or 2 year imaging follow-up were retrospectively reviewed.

RESULTS:

90 patients with 99 lesions were included. Lesions were atypical ductal hyperplasia (ADH) (n = 21), lobular neoplasia [n = 36; atypical lobular hyperplasia (ALH) (n = 22), lobular carcinoma in situ (LCIS) (n = 6), and ALH plus LCIS (n = 8)], and other high-risk lesion (n = 42; papillary lesions, radial scar, flat epithelial atypia, atypia unspecified). Of 53 excised lesions, 6 (11%) were upgraded to invasive cancer or ductal carcinoma in situ (DCIS). 4 of 21 (19%) ADH lesions were upgraded to DCIS. 2 of 36 (6%) lobular neoplasia lesions, both combined ALH and LCIS, were upgraded to DCIS, and invasive lobular carcinoma, respectively. The remaining 46 lesions were managed conservatively with imaging follow-up: 17 (37%) had mammography only, while 29 (63%) had mammography and MRI follow-up. There was no evidence of breast cancer development at the site of MRI-VAB in the cases with only imaging follow-up.

CONCLUSION:

We conclude that the upgrade rate for high-risk lesions at MRI-VAB at surgical excision is low. Surgical excision is warranted for ADH and combined ALH-LCIS lesions. For other lesions, a multidisciplinary approach to decide on personalized management may be appropriate.

ADVANCES IN KNOWLEDGE:

Surgical excision is warranted for ADH lesions and combined ALH-LCIS lesions identified at breast MRI-VAB. A multidisciplinary approach to patient management of other high-risk lesions may be appropriate.

Breast MR biopsy: Pathological and radiological correlation

PURPOSE

To identify pathological features for sample analysis of magnetic resonance imaging-guided vaccum-assisted breast biopsy (MRIgVaBB) to optimize radio pathological correlation and identify discordant benign result.

MATERIAL AND METHODS

Databases of two centres were queried to identify MRIgVaBB performed between January 2009 and February 2013. A cohort of 197 women (mean age: 54.5 years (24-77)) with 208 lesions was identified. We retrospectively analyzed all prebiopsy MRI examinations according to the new BI-RADS lexicon, and all biopsy samples to describe the lesion of interest, its interface with the surrounding breast tissue and other associated features.

RESULTS

The malignancy rate was 26.0 % (54/208) with an underestimation rate of 15.67 % (5/32). A visible interface at pathology between a biopsied lesion and the surrounding breast tissue was more frequently identified in mass enhancement compared to NME or focus (p = 0.0003). Regional NME was correlated with a high degree of fibrosis (p = 0.001) and the presence of PASH (p = 0.0007). Linear or segmental NME was correlated with the presence of periductal mastitis (p = 0.0003).

CONCLUSION

The description of a visible interface between the target lesion and the surrounding tissue is crucial to confirm the correct targeting of an MR mass or a NME.

KEY POINTS

• Pathological interface correlated with magnetic resonance mass and focal non-mass enhancement (NME). • Linear or segmental NME correlated with mastitis or ductal carcinoma in situ. • Fibrosis and pseudoangiomatous stromal hyperplasia (PASH) are correlated with regional NME.

The risk of upgrade for atypical ductal hyperplasia detected on magnetic resonance imaging-guided biopsy: a study of 100 cases from four academic institutions

AIMS

To identify variables that can predict upgrade for magnetic resonance imaging (MRI)-detected atypical ductal hyperplasia (ADH).

METHODS AND RESULTS

We reviewed 1655 MRI-guided core biopsies between 2005 and 2013, yielding 100 (6%) cases with ADH. The pathological features of ADH and MRI findings were recorded. An upgrade was considered when the subsequent surgical excision yielded invasive carcinoma (IC) or ductal carcinoma in situ (DCIS). The rate of ADH between institutions was 3.3-7.1%, with an average of 6%. A total of 15 (15%) cases had upgrade, 12 DCIS and three IC. When all cases were included, only increased number of involved cores was statistically significant (P = 0.02). When cases with concurrent lobular neoplasia (LN) were excluded (n = 14), increased number of ADH foci and increased number of involved cores were statistically significant (P = 0.002, P = 0.009). We analysed the data separately from a single institution (n = 61). Increased number of foci, increased number of total cores and involved cores and larger ADH size predicted upgrade with statistical significance.

CONCLUSIONS

The incidence of ADH in MRI-guided core biopsy is rare. The rate of upgrade is comparable to mammographically detected ADH, warranting surgical excision. Similar to mammographically detected lesions, the volume of the ADH predicts the upgrade.

MRI-guided breast biopsy: outcomes and effect on patient management

INTRODUCTION

The purpose of this study was to correlate the pathology results of MRI-guided breast biopsies at our institution with MRI findings and patient clinical history characteristics. The effect of MRI-guided breast biopsies on surgical management in patients with a new diagnosis of breast cancer was also assessed.

PATIENTS AND METHODS

In this Health Insurance Portability and Accountability Act-compliant study we retrospectively reviewed all MRI-guided breast biopsies performed from March 2006 to May 2012. Clinical history, MRI features, and pathology outcomes were reviewed. In patients who underwent breast MRI to evaluate extent of disease, any change in surgical management resulting from the MRI-guided biopsy was recorded. Statistical analysis included binary logistic regression and independent Student t test.

RESULTS

Two-hundred fifteen lesions in 168 patients were included, of which 23 (10.7%) were malignant, 43 (20%) were high-risk, and 149 (69.3%) were benign. No clinical characteristic was associated with malignancy in our cohort. MRI features associated with malignancy were: larger size (mean 2.6 cm vs. 1.3 cm; P = .046), washout kinetics (18% malignancy rate; P = .02), and marked background parenchymal enhancement (40% malignancy rate; P < .001-.03). Nineteen (28%) of the 67 patients with a new diagnosis of breast cancer who underwent MRI-guided breast biopsy had a change in surgical management based on the biopsy result.

CONCLUSION

Malignancy rate was associated with lesion size, washout kinetics, and marked background enhancement of the breast parenchyma but was not associated with any clinical history characteristics. Preoperative MRI-guided breast biopsies changed surgical management in 28% of women with a new diagnosis of breast cancer.

Histological Assessment of Breast Lesions Identified Exclusively by Magnetic Resonance

Radiologic–pathologic correlation of lesions diagnosed by magnetic resonance (MR) is precluded by insufficient data on histological characteristics of lesions suspicious on MR but not visible on concurrent mammogram or ultrasound. The objective of this study was to describe histological features of breast lesions diagnosed exclusively by MR. The participants underwent MR-guided breast biopsy between 2007 and 2012 for a suspicious lesion not identified by mammography or ultrasound. Histology slides were interpreted retrospectively by a breast pathologist. Of 126 patients (126 lesions), 34 (27%) had new breast cancer, 51 (40.5%) previous breast cancer, and 41 (32.5%) dense breasts or a significant family history of breast cancer. MR identified 23 (18.3%) invasive cancers: 20 were Grade 1 and 17 were ductal. Of the 126 lesions, 16 (13%) were ductal carcinoma in situ (DCIS), four were atypical ductal hyperplasia and atypical lobular hyperplasia (3%), and 68 (54%) were benign. Fifteen biopsies (12%) had no significant pathology. Five DCIS lesions were upgraded to T1 invasive cancers. Approximately 30 per cent of suspicious lesions detected exclusively by MR are invasive or in situ cancers that are predominantly low grade. Further studies are needed to determine if malignant lesions can be prospectively distinguished by MR characteristics.

MRI vacuum-assisted breast biopsies

The indications, technique, results and limitations of MRI vacuum-assisted breast biopsies are discussed from a review of the literature. This was initially a home-grown technique and its development was slowed down by several factors. As a result of major technical advances, it has become a reliable and very consistent procedure with a low rate of underestimation. It is now an undisputed technique when suspicious MRI enhancement is seen with no corresponding mammography or ultrasound features.

MRI-guided vacuum-assisted breast biopsy: comparison with stereotactically guided and ultrasound-guided techniques

Objectives

To analyse the development of MRI-guided vacuum-assisted biopsy (VAB) in Switzerland and to compare the procedure with stereotactically guided and ultrasound-guided VAB.

Methods

We performed a retrospective analysis of VABs between 2009 and 2011. A total of 9,113 VABs were performed. Of these, 557 were MRI guided.

Results

MRI-guided VAB showed the highest growth rate (97 %) of all three procedures. The technical success rates for MRI-guided, stereotactically guided and ultrasound-guided VAB were 98.4 % (548/557), 99.1 % (5,904/5,960) and 99.6 % (2,585/2,596), respectively. There were no significant differences (P = 0.12) between the MRI-guided and the stereotactically guided procedures. The technical success rate for ultrasound-guided VAB was significantly higher than that for MRI-guided VAB (P < 0.001). There were no complications using MRI-guided VAB requiring open surgery. The malignancy diagnosis rate for MRI-guided VAB was similar to that for stereotactically guided VAB (P = 0.35).

Conclusion

MRI-guided VAB is a safe and accurate procedure that provides insight into clinical breast findings.

Key points

• Three vacuum-assisted breast biopsy (VAB) procedures were compared.

• Technical success rates were high for all three VAB procedures.

• Medical complications were relatively low using all three VAB procedures.

• The use of MRI-guided vacuum-assisted breast biopsy is growing.

Radiologic-pathologic correlation at breast MR imaging: what is the appropriate management for high-risk lesions?

Breast magnetic resonance (MR) imaging is increasingly performed for a variety of indications, most commonly with the goal of detecting breast cancer. Percutaneous biopsy (usually under MR guidance or ultrasound if there is a correlating finding) is commonly used to evaluate suspicious imaging findings detected on MR imaging with the goal of identifying malignancy. It is important to be familiar with the characteristics and management of high-risk lesions detected or biopsied under MR guidance. This review focuses on the appearance of a variety of breast lesions detected on MR imaging that require excision with focus on pathologic correlation.

Outcome analysis of 9-gauge MRI-guided vacuum-assisted core needle breast biopsies

OBJECTIVE

The purpose of this article is to correlate 9-gauge MRI-guided vacuum-assisted breast biopsy with surgical histologic findings to determine the upgrade rate and to correlate the frequency of MRI-guided vacuum-assisted breast biopsy cancer diagnosis with breast MRI indications and enhancement characteristics of targeted lesions.

MATERIALS AND METHODS

A database search was performed of all MRI-guided vacuum-assisted breast biopsies performed from January 1, 2005, to September 31, 2010. The breast MRI indications, history, age, risk factors, lesion size, enhancement characteristics, and pathologic diagnoses at MRI-guided vacuum-assisted breast biopsy and at surgery were documented. Fisher exact test and analysis of variance were used for statistical analysis.

RESULTS

A total of 218 lesions underwent MRI-guided vacuum-assisted breast biopsy in 197 women (mean age, 52 years; range, 28-76 years), of which 85 (39%) had surgical correlation. Of the 218 lesions, 48 (22%) were malignant, 133 (61%) were benign, and 37 (17%) were high risk according to MRI-guided vacuum-assisted breast biopsy. Ten of 85 lesions (12%) were upgraded to malignancy at surgery, with a final malignancy rate of 25%. The frequency of malignancy was significantly higher in patients presenting for diagnostic (50/177 [28%]) versus screening (4/41 [10%]; p < 0.05) evaluation, patients with ipsilateral cancer (22/49 [45%]; p < 0.001), and lesions with washout kinetics (34/103 [33%]; p < 0.05) and was relatively higher in lesions with nonmasslike enhancement (26/76 [34%]; p = 0.07), which represented ductal carcinoma in situ in the majority of cases (17/26 [65%]; p < 0.005).

CONCLUSION

Patients with ipsilateral cancer who have additional suspicious lesions identified on MRI require careful evaluation and biopsy to exclude additional sites of cancer that may impact surgical management.

Imaging features and management of high-risk lesions on contrast-enhanced dynamic breast MRI

OBJECTIVE

Women at high risk for breast cancer and women with newly diagnosed breast cancer often undergo breast MRI. With the increasing availability of MRI-guided biopsy, high-risk lesions are not infrequently encountered. These high-risk lesions include atypical ductal hyperplasia, lobular carcinoma in situ, atypical lobular hyperplasia, papilloma, radial scar, and flat epithelial cell atypia. The management of these lesions is controversial and is often extended to high-risk lesions detected on mammography and ultrasound, with surgical excision usually recommended. The increasing use of MRI for suspicious lesions necessitates review of the imaging characteristics, frequency, and surgical outcome of high-risk lesions identified at MRI. This article addresses the frequency of high-risk lesions detected on breast MRI according to the current literature and discusses MRI features of high-risk lesions, including morphologic and enhancement kinetic characteristics. The surgical outcome for high-risk lesions identified at MRI-guided biopsy will be discussed. Finally, appropriate management guidelines for high-risk lesions identified on MRI-guided biopsy will be determined.

CONCLUSION

To our knowledge, no studies to date show definitive and specific characteristics for high-risk lesions. Underestimation of malignancy on MRI-guided biopsy currently warrants surgical management for all high-risk lesions. There is a need for prospective larger power studies.

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound

PURPOSE

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up.

RESULTS

Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered.

CONCLUSIONS

Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.

Magnetic resonance-guided vacuum-assisted breast biopsy: results in 100 Japanese women

PURPOSE

The aim of this study was to clarify the frequency of malignancy and the histopathological characteristics of the lesions in patients undergoing magnetic resonance imaging (MRI)-guided vacuum-assisted biopsy (VAB).

MATERIALS AND METHODS

A retrospective review of 100 consecutive patients with 102 lesions who had undergone MRI-guided VAB was performed. The biopsies were performed on a 1.5-T MR scanner using a commercially available biopsy system. None of the lesions seen with MRI could be detected by mammography or second-look ultrasonography.

RESULTS

The average lesion sizes of the focus, mass, and nonmass lesions before the biopsy were 4.5, 8.2, and 21 mm, respectively. Twelve patients (12%) had lesions located in the deep portion of the breast, close to the pectoral muscle. The biopsy was successfully performed without important side effects in all patients. Histopathological findings were invasive ductal carcinoma in 6 (6%), in situ carcinoma in 28 (27%), and high-risk and benign in 68 (67%). Two high-risk lesions were upgraded to ductal carcinoma in situ (DCIS), and three DCIS lesions were upgraded to invasive ductal carcinoma at surgical excision.

CONCLUSION

The high rate of DCIS might be a unique feature among Japanese women. However, MRI-guided VAB is necessary for MRI-only visible suspicious lesions in Japan.

Update on percutaneous needle biopsy of nonmalignant breast lesions

Certain nonmalignant lesions encountered on percutaneous breast biopsies pose dilemmas with regard to the most appropriate clinical management subsequent to needle biopsy (ie, surgical excision vs. follow-up). These lesions include columnar cell lesions, atypical ductal hyperplasia, lobular neoplasia, papillary lesions, radial scars, fibroepithelial lesions, and mucocele-like lesions. As minimally invasive diagnostic procedures are now standard it is more important than ever to be aware of the limitations of percutaneous biopsy, particularly with regard to apparently benign lesions because of the risk that the radiologically detected lesion may harbor malignant disease not represented in the biopsy specimen. This underscores the importance of radiologic-pathologic correlation. Increasingly, radiologists are adopting vacuum-assisted devices using larger gauge needles. The changing practices among radiologists are reflected in recent studies which have enriched the literature. In addition, magnetic resonance imaging is being used more frequently in breast imaging, resulting in pathologists more often encountering benign biopsies with uncertain imaging correlation. These changes prompted evaluation of the recent literature and its possible effect on management concerns. This review focuses on management issues following the diagnosis of nonmalignant lesions diagnosed on percutaneous breast biopsy and highlights imaging terms commonly used in breast radiology reports to facilitate accurate radiologic-pathologic correlation.

Cost-effectiveness analysis of two vacuum-assisted breast biopsy systems: Mammotome and Vacora

PURPOSE

This study was undertaken to compare the cost effectiveness of two vacuum-assisted breast biopsy devices, the Mammotome and Vacora systems.

MATERIALS AND METHODS

Between January and June 2006, 238 vacuum-assisted breast biopsies were performed at our radiology department. Five out of 238 lesions were excluded because of inadequate sampling. The Mammotome system was used in 108/233 lesions and the Vacora system in 125/233. Fifty-eight lesions underwent ultrasound-guided breast biopsy, and 50 lesions underwent mammography-guided biopsy with both Mammotome and Vacora devices. Magnetic-resonance-guided biopsy was possible with the Vacora system only (17/125 lesions).

RESULTS

All procedures were successfully completed. No significant differences were found between the results of the Mammotome and Vacora biopsies in terms of effectiveness: sensitivity was 84.4% and 86.2%, respectively, and specificity 100%. In terms of cost, the Mammotome system has higher costs per procedure compared with the Vacora.

CONCLUSIONS

Our clinical results confirm the diagnostic accuracy of both the Mammotome and Vacora systems, whereas our cost analysis shows that there is a considerable difference, mostly related to the initial investment.