1
|
Ha SM, Chang JM. [Interpretation of Image-Guided Biopsy Results and Assessment]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:361-371. [PMID: 37051381 PMCID: PMC10083635 DOI: 10.3348/jksr.2022.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/14/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
The success of image-guided breast biopsy depends on the biopsy method, needle selection, and appropriate technique based on the accurate judgment by the radiologist at biopsy. However, insufficient or inappropriate sampling of specimens may result in false-negative results or pathologic underestimation. Therefore, image-pathology concordance assessments after biopsy are essential for appropriate patient management. Particularly, the assessment of image-pathology concordance can avoid false-negative reports of breast cancer as a benign pathology. Therefore, this study aimed to discuss factors that impact the accurate interpretation of image-guided breast biopsy along with the appropriate assessments.
Collapse
|
2
|
Bachert SE, Jen A, Denison C, Kwait D, Rhei E, Karimova J, Chikarmane S, Hong X, Lester SC. Breast lesions associated with mammographic architectural distortion: a study of 588 core needle biopsies. Mod Pathol 2022; 35:728-738. [PMID: 34966173 DOI: 10.1038/s41379-021-00996-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
Architectural distortion (AD) on mammography is a localized alteration in the uniform texture of the breast characterized by lines radiating from a central point. Radiologic/pathologic correlation is challenging because the types of lesions associated with AD are not well defined and, thus, what signifies a discordant finding requiring excision is less clear. This retrospective case series was performed to elucidate the pathologic lesions associated with AD. Over a 6-year period, 588 core needle biopsies (CNBs) were performed for AD. Thirty-eight percent of the lesions were AD alone (single feature AD) and 62% had additional imaging features (multi-feature AD). Overall, 31% showed invasive carcinoma or ductal carcinoma in situ (DCIS), 37% showed benign lesions likely to correlate with AD, and 32% showed nonspecific benign findings. The invasive carcinomas tended to be low-grade (60%), ER-positive (98%), HER2-negative (98%), and often had lobular features (52%). Ninety-two percent were AJCC pathologic stage group I. Ninety-four cases of benign findings that correlated with AD without atypia underwent excision, and only one was found to have DCIS adjacent to the sclerosing lesion (1%). The remaining cases had benign findings without a clear correlate for AD. Sixty-eight cases without atypia underwent excision, and six multi-feature AD were upgraded to invasive carcinoma (9%). In conclusion, about one-third of CNBs for lesions associated with AD reveal carcinomas that are predominantly invasive, low-grade, ER-positive, HER2-negative, and low stage. Single-feature AD differed from multi-feature AD due to a lower number of carcinomas on CNB (18% vs 39%). For CNBs showing benign lesions on biopsy with a correlate for AD, the finding of malignancy on excision is low (1%). Radiologic/pathologic correlation and decisions to recommend excision will continue to be a challenge after CNB reveals nonspecific findings as some patients with multi-feature AD were found to have undetected invasive carcinomas.
Collapse
Affiliation(s)
- S Emily Bachert
- Department of Pathology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Aaron Jen
- Division of Breast Imaging, Department of Radiology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Christine Denison
- Division of Breast Imaging, Department of Radiology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Dylan Kwait
- Division of Breast Imaging, Department of Radiology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Esther Rhei
- Division of Breast Surgery, Department of Surgery, Brigham & Women's Hospital, Brigham and Women's Faulkner Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jane Karimova
- Division of Breast Imaging, Department of Radiology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sona Chikarmane
- Division of Breast Imaging, Department of Radiology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Xuefei Hong
- Department of Pathology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Faulkner Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan C Lester
- Department of Pathology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
3
|
Camacho A, Chung AD, Rigiroli F, Sari MA, Brook A, Siewert B, Ahmed M, Brook OR. Concordance Assessment of Pathology Results with Imaging Findings after Image-Guided Biopsy. J Vasc Interv Radiol 2021; 33:159-168.e1. [PMID: 34780925 DOI: 10.1016/j.jvir.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess the impact of radiology review for discordance between pathology results from computed tomography (CT)-guided biopsies versus imaging findings performed before a biopsy. MATERIALS AND METHODS In this retrospective review, which is compliant with the Health Insurance Portability and Accountability Act and approved by the institutional review board, 926 consecutive CT-guided biopsies performed between January 2015 and December 2017 were included. In total, 453 patients were presented in radiology review meetings (prospective group), and the results were classified as concordant or discordant. Results from the remaining 473 patients not presented at the radiology review meetings were retrospectively classified. Times to reintervention and to definitive diagnosis were obtained for discordant cases; of these, 49 (11%) of the 453 patients were in the prospective group and 55 (12%) of the 473 patients in the retrospective group. RESULTS Pathology results from CT-guided biopsies were discordant with imaging in 11% (104/926) of the cases, with 57% (59/104) of these cases proving to be malignant. In discordant cases, reintervention with biopsy and surgery yielded a shorter time to definitive diagnosis (28 and 14 days, respectively) than an imaging follow-up (78 days) (P < .001). The median time to diagnosis was 41 days in the prospective group and 56 days in the retrospective group (P = .46). When radiologists evaluated the concordance between pathology and imaging findings and recommended a repeat biopsy for the discordant cases, more biopsies were performed (50% [11/22] vs 13% [4/31]; P = .005). CONCLUSIONS Eleven percent of CT-guided biopsies yielded pathology results that were discordant with imaging findings, with 57% of these proving to be malignant on further workup.
Collapse
Affiliation(s)
- Andrés Camacho
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew D Chung
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Francesca Rigiroli
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mehmet Ali Sari
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Olga Rachel Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
4
|
Parikh JR, Sun J, Mainiero MB. What Causes the Most Stress in Breast Radiology Practice? A Survey of Members of the Society of Breast Imaging. JOURNAL OF BREAST IMAGING 2021; 3:332-342. [PMID: 34056593 PMCID: PMC8139609 DOI: 10.1093/jbi/wbab012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study is to determine the major stressors affecting practicing breast radiologists. METHODS All members of the Society of Breast Imaging within the United States received an email invitation to complete an anonymous survey evaluating stressors that may contribute to physician burnout. Stressors evaluated included pace at work, work-life balance, care of dependents, job security, financial strain, decreasing reimbursement, new regulations, delivering bad news, fear of getting sued, and dealing with difficult patients, radiologists, and administrators. RESULTS The overall response rate was 13.5% (312/2308). For those who opened the email, response rate was 24.6% (312/1269). The most prevalent stressors reported were working too fast (222/312, 71.2%), balancing demands of work with personal life (209/312, 70.0%), fear of getting sued (164/312, 52.6%), and dealing with difficult administrators (156/312, 50%). Prevalence of stress related to new regulation requirements, job security, financial strain, decreased reimbursement, dependent care, call, delivering bad news, and dealing with difficult patients, difficult referrers, and difficult radiologists were present in fewer than 50% of respondents. CONCLUSION The most prevalent sources of stress in breast imaging radiologists relate to working too fast and balancing demands of work with time needed for personal life.
Collapse
Affiliation(s)
- Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Jia Sun
- University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX, USA
| | - Martha B Mainiero
- Alpert Medical School of Brown University, Department of Diagnostic Imaging, Providence, RI, USA
| |
Collapse
|
5
|
Banks JS, Garner HW, Chow AZ, Peterson JJ, Bestic JM, Wessell DE. Radiology-pathology correlation for bone and soft tissue tumors or tumor-like masses: single institutional experience after implementation of a weekly conference. Skeletal Radiol 2021; 50:731-738. [PMID: 32965551 DOI: 10.1007/s00256-020-03616-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the frequency of non-diagnostic and discordant results from bone and soft tissue biopsies performed at our institution over a 3-year period and to investigate whether implementation of a weekly musculoskeletal radiology-pathology correlation conference decreased the time to appropriate patient management in cases of discordance. METHODS Consecutive image-guided core needle biopsy results obtained over a 12 month period of time were reviewed in a retrospective fashion. Following implementation of the correlation conference, subsequent consecutive image-guided core needle biopsy results obtained over a 26 month period of time were reviewed in a prospective fashion. For non-diagnostic and discordant cases, the time in days from date of availability of the biopsy result to date of documentation of a specific follow-up action plan was recorded. RESULTS Diagnostic yield was 96.5% and 94.9% for the retrospective and prospective periods, respectively. There were four discordant results in the retrospective cohort (1.7%) and seven discordant results in the prospective cohort (2.1%). Following implementation of the weekly correlation conference, there was significant decrease (p < 0.05) in median time from a discordant biopsy result to follow-up action plan. There were no unnecessary surgeries, litigation, or other unfavorable consequences in either cohort. CONCLUSION Image-guided core needle biopsies of bone and soft tissue provide high diagnostic yield, often with specific diagnoses. The statistically significant decrease in number of days to follow-up action plan for discordant results suggests radiology-pathology review has a positive impact on patient care. Subjective benefits from communication and educational standpoints are also noteworthy.
Collapse
Affiliation(s)
- James S Banks
- Department of Radiology, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL, 33180, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Andrew Z Chow
- Department of Radiology, Mayo Clinic Health System, 1025 Marsh Street, Mankato, MN, 56001, USA
| | - Jeffrey J Peterson
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Joseph M Bestic
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Daniel E Wessell
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| |
Collapse
|
6
|
Patel MM, Parikh JR. Patient Diversity in Breast Imaging: Barriers and Potential Solutions. JOURNAL OF BREAST IMAGING 2021; 3:98-105. [PMID: 38424834 DOI: 10.1093/jbi/wbaa092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 03/02/2024]
Abstract
Recent reports have highlighted disparities in breast cancer care related to patient diversity. Breast radiologists represent the face of breast imaging and are key players in advocating for patients to reduce these disparities. Diversity-related barriers for breast imaging patients, as they journey from screening to survivorship, include impediments to access and quality of care, gaps in communication, and lack of knowledge in both providers and patients. Potential strategies for overcoming these specific barriers include "culturally tailored" nurse navigators, mobile mammography, improved communication, patient and provider education, and breast radiologist involvement in advocacy efforts promoting diversity. As current trends in recommendations and guidelines for breast imaging include more numerous and advanced imaging modalities, it is important to acknowledge and address diversity-related disparities.
Collapse
Affiliation(s)
- Miral M Patel
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| |
Collapse
|
7
|
Discrepancies between radiological and histological findings in preoperative core needle (CNB) and vacuum-assisted (VAB) breast biopsies. J Cancer Res Clin Oncol 2020; 147:749-754. [PMID: 33284380 PMCID: PMC7873108 DOI: 10.1007/s00432-020-03481-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/22/2020] [Indexed: 11/25/2022]
Abstract
Background Ultrasound (US)-guided breast biopsy is a routine diagnostic method used to correlate imaging finding to a histological diagnosis which is still the gold standard in preoperative diagnostics. The accuracy of US-guided breast biopsies relies on a precise radiologic-histopathologic correlation, which is discussed amongst an interdisciplinary team of gynecologists, radiologists and pathologists. However, false-negative or non-diagnostic biopsy results occur. Hence, a thorough and honest discussion to clarify the reason for discrepancies and to decide the next diagnostic step between specialists of the different disciplines is warranted. In this retrospective study, we analyzed discrepant findings between imaging and pathology results on preoperative breast biopsies. Methods Core and vacuum-assisted breast biopsies from 232 patients were included in this study. Inclusion criteria were (1) non-diagnostic (B1) category on histology independent from imaging category and (2) histological benign (B2) category with a BIRADS 5 (Breast Imaging Reporting and Data System) rating on imaging. Histological diagnoses were retrieved from all cases. Follow-up data were available in most cases. Results 138 biopsies were classified as B1, 94 biopsies as B2 category. 51 of 138 B1 cases (37%) underwent re-biopsy. Re-biopsy found malignancy (B5) in 19 of 51 cases, and B3/4 (premalignant) lesions in 3 of 51 cases. All B2 cases underwent second-look imaging-diagnosis, in 57 of 94 cases (66%) consecutive direct surgery or re-biopsy. Of these, malignancy was diagnosed histologically in 26 of 57 cases (45.6%). Conclusion Determining imaging-pathology concordance after US-guided breast biopsy is essential. Discrepant cases and further diagnostic steps need to be discussed with an interdisciplinary approach.
Collapse
|
8
|
Radiologic-Pathologic Correlation for Nondiagnostic CT-Guided Lung Biopsies Performed for the Evaluation of Lung Cancer. AJR Am J Roentgenol 2020; 215:116-120. [PMID: 32160056 DOI: 10.2214/ajr.19.22244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. For nondiagnostic CT-guided lung biopsies, we tested whether radiologicpathologic correlation could identify patients who may benefit from repeat biopsy. MATERIALS AND METHODS. In this retrospective study, 1525 lung biopsies were performed between July 2013 and June 2017, 243 of which were nondiagnostic. Of these 243 lung biopsies, 98 were performed to evaluate for lung malignancy; 17 were excluded because of insufficient follow-up, leaving a total of 81 cases. The Brock and Herder models were used to calculate risk; in addition, cases were independently blindly reviewed by two thoracic radiologists who assigned a score from 1 (probably benign) to 5 (probably malignant). The final diagnosis was established by pathology results or benignancy was established if the lesion resolved or remained stable for at least 2 years. RESULTS. Of the 81 nondiagnostic lung biopsies, initial pathology results included 33 cases of inflammation, 28 cases of normal lung tissue or insufficient sample, 10 cases of organizing pneumonia, and 10 cases of atypical cells. 42% (34/81) of cases were eventually determined to be malignant (negative predictive value [NPV] of 58%). Pathology results of organizing pneumonia had the lowest rate of malignancy (2/10 = 20%), and pathology results of atypical cells had the highest rate of malignancy (5/10 = 50%, p = 0.51). Within this highly selected cohort, the Brock and Herder models were not predictive of malignancy, with areas under the ROC curve (AUCs) of 0.52 and 0.52, respectively. Evaluation by thoracic radiologists yielded AUCs of 0.85 and 0.77. When radiologist-assigned scores of 1 and 2 were considered as benign, the NPV was 90% and 95%. CONCLUSION. Review of nondiagnostic lung biopsies for radiologic-pathologic concordance by thoracic radiologists can triage patients who may benefit from repeat biopsy.
Collapse
|
9
|
Guorgui J, Kinnaird A, Jayadevan R, Priester AM, Arnold CW, Marks LS. An Electronic Form for Reporting Results of Targeted Prostate Biopsy: Urology Integrated Diagnostic Report (Uro-IDR). Urology 2020; 138:188-193. [PMID: 31978527 DOI: 10.1016/j.urology.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/22/2019] [Accepted: 01/07/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To detail the development of an electronic report that graphically conveys all relevant information from targeted prostate biopsy. METHODS The Urology Integrated Diagnostic Report (Uro-IDR) is based on a published framework (RadPath) which enables the compilation of diagnostic data from urology, radiology, and pathology. Each component of the Uro-IDR is generated by the contributing clinician, is assembled in one document, and provides correlation of the 3 inputs at a glance. Upon completion, the Uro-IDR is automatically linked to the electronic medical record as an interactive file and can also be downloaded for offline sharing as a PDF. RESULTS At our institution, 1638 individual Uro-IDRs were generated between June 2016 and April 2019. There were 5715 views of these documents via the EMR. The average turnaround time for the creation of an individual report decreased from nearly 8 days at the time of its launch to 2 days after 6 months of use. The average time for report generation was 22 seconds for the pathologist and 69 seconds for the radiologist. An instructive video is linked to this article. CONCLUSION The Uro-IDR has proven to be a feasible, efficient, clinically useful form to concisely transmit key information about targeted prostate biopsy to both clinicians and patients.
Collapse
Affiliation(s)
- Jacob Guorgui
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095
| | - Adam Kinnaird
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095; Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095
| | - Rajiv Jayadevan
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095; Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095
| | - Alan M Priester
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095; Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095
| | - Corey W Arnold
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095; Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095; Department of Radiological Sciences, University of California, Los Angeles CA, 90024; Department of Pathology & Laboratory Medicine, University of California at Los Angeles, Los Angeles, CA 90095
| | - Leonard S Marks
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095; Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095.
| |
Collapse
|
10
|
Lane DL, Parikh JR. Finding Inspiration for the Next Generation of Breast Radiologists. JOURNAL OF BREAST IMAGING 2019; 1:239-243. [PMID: 38424750 DOI: 10.1093/jbi/wbz016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 03/02/2024]
Abstract
Challenges currently facing breast radiologists, including controversial screening mammography guidelines, radiologist burnout, and the perceived threat posed by artificial intelligence could deter potential candidates from pursuing a career in radiology. However, breast radiologists play a fulfilling role by decreasing the effect of breast cancer through both early detection and direct interaction with patients and interdisciplinary clinical colleagues. While perception is that artificial intelligence will threaten the need for radiologists, it is more likely that it will improve image interpretation and efficiency in workflow, thereby further improving patient care. Trainees can be engaged in breast imaging through interactive teaching methods and by role modeling clinical and image interpretation skills.
Collapse
Affiliation(s)
- Deanna L Lane
- University of Texas MD Anderson Cancer Center, Department of Radiology, MD Houston, TX
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Radiology, MD Houston, TX
| |
Collapse
|
11
|
Use of Contrast-Enhanced MRI in Management of Discordant Core Biopsy Results. AJR Am J Roentgenol 2019; 212:1157-1165. [PMID: 30835519 DOI: 10.2214/ajr.18.20157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. Evaluating concordance between core biopsy results and imaging findings is an integral component of breast intervention. Pathologic results deemed benign discordant reflect concern that a malignancy may have been incorrectly sampled. Standard of care currently is surgical excision, although a large percentage of these lesions will be benign at final pathologic analysis. The purpose of this study was to determine whether inclusion of contrast-enhanced MRI would optimize patient care. MATERIALS AND METHODS. Forty-five patients with 46 lesions were identified who underwent contrast-enhanced MRI after receiving discordant ultrasound or stereotactic biopsy results between 2012 and mid 2018. These findings were classified BI-RADS category 4 at diagnostic imaging. Disease-positive was defined as all malignancies and borderline lesions. RESULTS. Fourteen patients had suspicious MRI findings; 31 patients did not. Negative or benign MRI findings were validated by stability at imaging follow-up of at least 1 year in 27 patients (28 lesions) and at least 6 months in four patients. Eight of the total of 46 discordant lesions were ultimately malignant, a rate of 17.3%, an expected result for BI-RADS 4 lesions. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI calculated in the group of 41 patients (42 lesions) with documented stability for at least 1 year were 100%, 93.3%, 85.7%, and 100%. The false-negative rate of MRI was 0%; the false-positive rate was 2 of 30 (6.7%). CONCLUSION. In the management of discordant benign core biopsy results, contrast-enhanced MRI facilitated successful triage of patients to surgery; 31 of the original 45 patients (68.9%) avoided surgery.
Collapse
|
12
|
Jung I, Kim MJ, Moon HJ, Yoon JH, Kim EK. Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience. Ultrasonography 2018; 37:55-62. [PMID: 28641365 PMCID: PMC5769943 DOI: 10.14366/usg.17028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study assessed the outcomes of ultrasound (US)-guided core needle biopsies (CNBs) of breast lesions with at least 2 years of follow-up to determine the false-negative rate and to evaluate the diagnostic accuracy of CNB. METHODS We retrospectively analyzed 13,254 consecutive US-guided 14-gauge CNBs for breast lesions. We excluded biopsies if non-malignant biopsy result was not confirmed by surgical excision or US-guided vacuum-assisted biopsy, or fewer than 2 years of follow-up data were available. A total of 4,186 biopsies were excluded, and 9,068 breast masses from 7,039 women were included. The pathologic findings from each CNB were assessed using the standard diagnostic reference, defined based on the results of surgical excision, vacuum-assisted biopsy, or at least 2 years of long-term imaging follow-up. The false-negative rate and underestimation rate were calculated. RESULTS Of the 9,068 CNBs, benign pathology was found in 64.2%, high-risk results in 3.5%, and malignant results in 32.3%. Of the 5,821 benign CNBs, an additional malignancy was found at excision in 63 lesions, leading to a false-negative rate of 2.0% (63 of 3,067). The underestimation rate was 33.6% (111 of 330) for ductal carcinoma in situ and 24.5% (79 of 322) for high-risk results at surgical excision. Most false-negative diagnoses (84.1%, 53 of 63) were recognized through imaging-histology correlations, and immediate rebiopsies were performed. Ten malignancies (15.9%, 10 of 63) had delayed diagnoses and showed progression in follow-up US imaging. CONCLUSION US-guided 14-gauge CNB provided optimal diagnostic information. Imaging-histology correlations and appropriate imaging follow-up should be performed to avoid delayed diagnoses.
Collapse
Affiliation(s)
- Inha Jung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
You JY, Suh HJ, Kim Y, Jun JK, Ojeda-Fournier H, Ko K. Follow-up Outcomes of Benign Pathology Initially Assigned as Breast Imaging Reporting and Data System Category 4A and 3. J Breast Cancer 2017; 20:304-309. [PMID: 28970857 PMCID: PMC5620446 DOI: 10.4048/jbc.2017.20.3.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This retrospective study investigated if the initially assigned category 4A or 3 in concordant benign lesions, after ultrasound (US)-guided core needle biopsy, could affect follow-up compliance. METHODS Eight hundred thirty-eight concordant benign lesions, after core needle biopsy (674, initial category 4A group and 164, category 3 group) and follow-up US, were included in our study. If an immediate surgical excision-a surgical excision before the next follow-up-exists, those cases with pathologic reports were collected. Statistical comparisons for the result of follow-up US compliance, additional biopsy, and malignant rates among 6-month, 12-month, and long-term intervals were performed by using the chi-square test. The log-rank test was used to compare compliance rates in the timing of first follow-up between the two groups, with a significance level of 0.05. RESULTS The number of immediate surgical excision was higher in the category 4A group (11.1%) than in the category 3 group (6.1%); only one cancer was found in the category 4A group. The patients' compliance rate in a 6-month follow-up showed an increase (p=0.003) in the category 4A group. The additional biopsy rate was higher in the initial category 4A group (10.9%) than in the category 3 group (1.9%) with statistical significance (p=0.001); four cancers were found on additional biopsy in the category 4 group. No cancer was detected in the initial category 3 group, both on immediate surgical excision and follow-up. CONCLUSION The initial category 4A or 3 of the Breast Imaging Reporting and Data System could be a significant factor that affects immediate surgical excision and follow-up compliance. Cancers were detected only in the initial category 4A group of concordant benign lesions. More attention should be paid to the concordant benign lesions from the initial category 4A group than from the category 3 group.
Collapse
Affiliation(s)
- Ji Young You
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hee Jung Suh
- Cancer Prevention and Early Detection Center, National Cancer Center, Goyang, Korea
| | - Yunju Kim
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Haydee Ojeda-Fournier
- Department of Radiology, Moores Cancer Center, UC San Diego Health System, La Jolla, USA
| | - Kyounglan Ko
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| |
Collapse
|
14
|
Park VY, Kim EK, Moon HJ, Yoon JH, Kim MJ. Evaluating imaging-pathology concordance and discordance after ultrasound-guided breast biopsy. Ultrasonography 2017; 37:107-120. [PMID: 29169231 PMCID: PMC5885481 DOI: 10.14366/usg.17049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/17/2017] [Accepted: 08/19/2017] [Indexed: 11/04/2022] Open
Abstract
Ultrasound (US)-guided breast biopsy has become the main method for diagnosing breast pathology, and it has a high diagnostic accuracy, approaching that of open surgical biopsy. However, methods for confirming adequate lesion retrieval after US-guided biopsy are relatively limited and false-negative results are unavoidable. Determining imaging-pathology concordance after US-guided biopsy is essential for validating the biopsy result and providing appropriate management. In this review article, we briefly present the results of US-guided breast biopsy; describe general aspects to consider when establishing imaging-pathology concordance; and review the various categories of imaging-pathology correlations and corresponding management strategies.
Collapse
Affiliation(s)
- Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Collado-Mesa F, Klevos G, Arheart K, Banks J, Yepes M, Net J. Time Spent by Breast Imaging Radiologists to Perform Value-Added Activities at an Academic Cancer Center. Cancer Control 2017; 24:120-124. [PMID: 28441366 DOI: 10.1177/107327481702400204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Health care reform in the United States has generated a paradigm shift in the practice of radiology aimed at increasing the degree of patient-centered care. We conducted a study to quantify the amount of time breast imaging radiologists spend on value-added activities at an academic comprehensive cancer center located in Miami, Florida, and accredited by the American College of Radiology as a Breast Imaging Center of Excellence. METHODS A prospective, observational study was conducted during a period of 20 consecutive workdays. Three participating breast imaging radiologists maintained a real-time log of each activity performed. A generalized linear model was used to perform a 1-way analysis of variance. An alpha level of .05 was used to determine statistical significance. RESULTS The average daily time dedicated to these activities was 92.1 minutes (range, 56.4-132.2). The amount of time significantly differed among breast imaging radiologists and correlated with their assigned daily role (P < .001 for both) but was independent of their years of experience. The daily role that required the most time was the interpretation of diagnostic imaging studies, which is when most interactions with patients, their relatives, and referring physicians occurred. The specific activity that required the most time was preparing for and participating in tumor boards. CONCLUSIONS Our findings suggest that the breast imaging radiologists who participated in this study dedicated a significant amount of their time to value-added activities to help improve patients' experience across the continuity of their care. We propose that similar studies be conducted at other institutions to better assess the magnitude of this finding across different breast imaging care settings.
Collapse
|
16
|
Lesslie MD, Parikh JR. Multidisciplinary Tumor Boards: An Opportunity for Radiologists to Demonstrate Value. Acad Radiol 2017; 24:107-110. [PMID: 27793581 DOI: 10.1016/j.acra.2016.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 11/27/2022]
Abstract
In response to healthcare reform, a necessary evolution of radiology has shifted from generating volume to demonstrating value. Multidisciplinary tumor boards provide a critical opportunity for radiologists to demonstrate their value to their clinical colleagues, their patients, administrations, and society.
Collapse
|
17
|
Mayo RC, Parikh JR. Breast Imaging: The Face of Imaging 3.0. J Am Coll Radiol 2016; 13:1003-7. [DOI: 10.1016/j.jacr.2016.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/09/2016] [Indexed: 01/17/2023]
|
18
|
Bhayroo S, Perumal LY, Buccimazza I. A retrospective analysis of ultrasound-guided large core needle biopsies of breast lesions at a regional public hospital in Durban, KwaZulu-Natal, South Africa. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Histological confirmation of a breast lesion is an important step to determine the aetiology and direct further management. Evidence supports ultrasound-guided large core needle biopsy (US-LCNB) (14 gauge) as the preferred diagnostic method over traditional open surgical biopsy.Objective: To assess the influence of technical variables on the diagnostic yield of breast specimens obtained by using US-LCNB, and the sensitivity of detecting malignancy during the study period.Methods: A retrospective chart review was conducted of all patients who had US-LCNBs from March 2011 – September 2012 at Addington Hospital in Durban, KwaZulu-Natal. Histopathological findings were correlated to the size of the breast lesion, rank of the radiologist performing the procedure and the number of cores obtained. The sensitivity of the technique was determined.Results: During the study period, 147 biopsies were performed. The majority of lesions were>5 mm (85.5%). The average number of cores was 4, and 79.5% of the biopsies were performed by the senior radiologist. Of the 147 biopsies, 132 specimens were eligible for inclusion in the study. Histopathology revealed 71 malignant lesions of which 60 were confirmed histologically at excision. In 11 patients, no excision was performed. Therefore, the sensitivity of detecting malignancy was 100%.Conclusion: Although the study did not establish a statistically significant relationship between the above mentioned technical variables and the histological outcome, the overall diagnostic yield and the sensitivity of detecting malignancy using US-LCNB is comparable to other similar international studies. A prospective study with long-term follow-up of patients would be of value.
Collapse
|
19
|
|
20
|
Improving Patient Care by Incorporation of Multidisciplinary Breast Radiology-Pathology Correlation Conference. Can Assoc Radiol J 2015; 67:122-9. [PMID: 26632099 DOI: 10.1016/j.carj.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/11/2015] [Accepted: 07/05/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE It is well known that radiologic-pathologic correlation is critical in managing patients with breast disease. Although regular multidisciplinary conferences addressing radiologic-pathologic correlation are common at most major academic institutions, this approach is not universal in community-based settings or even some of the smaller academic practices. This study was performed to assess the impact of a weekly multidisciplinary conference on patient care to determine whether all breast practices should adopt this approach as a means to streamline and improve the quality of patient care. METHODS We reviewed cases of percutaneous breast core biopsies presented at our weekly breast radiology-pathology correlation conference from July 1, 2008, to June 30, 2012. Each reviewed case was assigned to 1 of 4 categories (concordant → concordant, concordant → discordant, discordant → discordant, and discordant → concordant) based on the "initial" and "final" impressions of concordance between radiology and pathology. Changes in concordance, histopathological diagnosis, or management that occurred during the conference were recorded prospectively and analysed. Changes in management that were considered significant included changes in recommendations for surgery, repeat core biopsy, or follow-up imaging. RESULTS Of 1387 presented at the conference, 1313 (94.7%) had no change during the meeting, confirming 1279 (92.2%) concordant and 34 (2.4%) discordant cases. A total of 74 (5.3%) cases had a change during the conference: 22 of 74 (29.7%) were changed from discordant to concordant, avoiding surgical excision in 15 and short interval imaging in 7; 23 of 74 (31.1%) were changed from concordant to discordant; on excision 3 were cancer, 3 atypia, 10 benign, 2 stable on follow-up imaging, and 5 lost to follow-up; the remaining 29 of 74 (39.2%) stayed concordant after review, but had a change in management, avoiding surgery in 14 and short interval imaging in 15. Overall, as a result of this conference, repeat biopsy or excision was recommended in 23, surgery was avoided in 29, short interval imaging avoided in 22, and cancer detected in 3 cases. CONCLUSIONS Our weekly breast radiology-pathology correlation conference impacted patient management in up to 5.3% of cases. These results support the need to incorporate a weekly multidisciplinary case review of breast core biopsies into all breast care practices. Such a conference maximizes cancer detection, identifies discordant cases in a timely manner, decreases follow-up imaging, and avoids unnecessary surgical intervention.
Collapse
|
21
|
Dratwa C, Jalaguier-Coudray A, Thomassin-Piana J, Gonin J, Chopier J, Antoine M, Trop I, Darai E, Thomassin-Naggara I. Breast MR biopsy: Pathological and radiological correlation. Eur Radiol 2015; 26:2510-9. [PMID: 26511630 DOI: 10.1007/s00330-015-4071-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/04/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Chloé Dratwa
- Department of Radiology, AP-HP, Hôpital Tenon, 75020, Paris, France.
| | | | | | - Julie Gonin
- Department of Pathology, AP-HP, Hôpital Tenon, 75020, Paris, France
| | - Jocelyne Chopier
- Department of Radiology, AP-HP, Hôpital Tenon, 75020, Paris, France
| | - Martine Antoine
- Department of Pathology, AP-HP, Hôpital Tenon, 75020, Paris, France
| | - Isabelle Trop
- Department of Radiology, Hôtel-Dieu de Montréal, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, H2W 1T8
| | - Emile Darai
- Department of Gynaecology and Obstetrics, AP-HP, Hôpital Tenon, 75020, Paris, France.,UPMC Univ Paris 06, IUC, Sorbonne Universités, 75005, Paris, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, AP-HP, Hôpital Tenon, 75020, Paris, France.,UPMC Univ Paris 06, IUC, Sorbonne Universités, 75005, Paris, France.,INSERM, UMR970, Equipe 2, Imagerie de l'angiogenèse, 75005, Paris, France
| |
Collapse
|
22
|
Importance of anatomopathological-imaging correlations for the validation of a breast biopsy results. Diagn Interv Imaging 2015; 97:247-56. [PMID: 26385837 DOI: 10.1016/j.diii.2015.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
|
23
|
Gestion d’un résultat bénin après prélèvement mammaire. Recommandations et conduite à tenir. IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Soyder A, Taşkin F, Ozbas S. Imaging-histological discordance after sonographically guided percutaneous breast core biopsy. Breast Care (Basel) 2015; 10:33-7. [PMID: 25960723 DOI: 10.1159/000370219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objectives of this study were to determine the frequency of imaging-histological discordance and to compare the frequency of carcinoma between discordant lesions at ultrasound (US)-guided core needle biopsy. MATERIALS AND METHODS From November 2009 to June 2012, we performed US-guided 14-gauge core needle biopsies on 989 breast lesions in 961 women. We reviewed 58 (5.8%) cases that had imaging-histological discordance after percutaneous breast biopsy and underwent subsequent excisional biopsy. The clinical, radiological, and histological findings were reviewed for those 58 cases. RESULTS Among the 58 cases, subsequent excisions revealed 16 (27.5%) malignancies, which were categorized as 9 (15.5%) invasive ductal carcinomas, 4 (6.9%) malignant phyllodes tumors, and 3 (5.1%) ductal carcinomas in situ. CONCLUSION The malignancy rate of 27.5% suggests that surgical excision should be performed in those cases presenting with imaging-histological discordance after US-guided core biopsy. Careful correlation of clinical, radiological, and histological results as well as appropriate follow-up are essential. We have submitted a short version of this work as a poster presentation during the 2012 European Society of Surgery (ESS) Congress in Istanbul/Turkey.
Collapse
Affiliation(s)
- Aykut Soyder
- Department of General Surgery, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | - Füsun Taşkin
- Department of Radiology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | | |
Collapse
|
25
|
Imaging-histologic discordance at percutaneous biopsy of the lung. Acad Radiol 2015; 22:481-7. [PMID: 25601302 DOI: 10.1016/j.acra.2014.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 11/13/2014] [Accepted: 11/25/2014] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to quantify the degree of imaging-histologic discordance in a cohort of patients undergoing computed tomography (CT)-guided lung biopsy for focal lung disease. MATERIALS AND METHODS A retrospective review was performed of 186 patients who underwent percutaneous lung biopsy of a parenchymal lesion at our institution between January and December 2009. Diagnostic radiology reports of CT or positron emission tomography-CTs performed before biopsy were used to classify the lesion as malignant or benign by five readers. Pathology reports of the biopsied lesions were classified by three readers. Inter-reader agreement and imaging-histologic concordance were quantified using kappa statistics. Discordant benign cases were then revisited to determine downstream effects. RESULTS Inter-reader agreement on report content was substantial or almost perfect with kappas >0.783. Kappas for concordance were as follows: malignant (0.448), primary lung cancer (0.517), metastatic disease to lung (0.449), benign (0.510), and overall agreement (0.381). Of the twelve discordant benign cases that were revisited, four were found to be false negatives, resulting in a delay in diagnosis. CONCLUSIONS Our study of imaging-histologic discordance in percutaneous biopsy of lung lesions supports the need for imaging report standardization and improved integration and communication between the fields of radiology and pathology.
Collapse
|
26
|
Johnson JM, Johnson AK, O'Meara ES, Miglioretti DL, Geller BM, Hotaling EN, Herschorn SD. Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology 2014; 275:54-60. [PMID: 25423143 DOI: 10.1148/radiol.14140036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the cancer detection rate and stage after benign stereotactic or ultrasonography (US)-guided core breast biopsy between patients with short-interval follow-up (SIFU) and those who return to annual screening. MATERIALS AND METHODS The Breast Cancer Surveillance Consortium (BCSC) registry and the BCSC Statistical Coordinating Center received institutional review board approval for active and passive consent processes and a waiver of consent. All procedures were HIPAA compliant. BCSC data for 1994-2010 were used to compare ipsilateral breast cancer detection rates and tumor characteristics for diagnoses within 3 months after SIFU (3-8 months) versus return to annual screening (RTAS) mammography (9-18 months) after receiving a benign pathology result from image-guided breast biopsy. RESULTS In total, 17 631 biopsies with benign findings were identified with SIFU or RTAS imaging. In the SIFU group, 27 ipsilateral breast cancers were diagnosed in 10 715 mammographic examinations (2.5 cancers per 1000 examinations) compared with 16 cancers in 6916 mammographic examinations in the RTAS group (2.3 cancers per 1000 examinations) (P = .88). Sixteen cancers after SIFU (59%; 95% confidence interval [CI]: 39%, 78%) were invasive versus 12 after RTAS (75%; 95% CI: 48%, 93%). The invasive cancer rate was 1.5 per 1000 examinations after SIFU (95% CI: 0.9, 2.4) and 1.7 per 1000 examinations (95% CI: 0.9, 3.0) after RTAS (P = .70). Among invasive cancers, 25% were late stage (stage 2B, 3, or 4) in the SIFU group (95% CI: 7%, 52%) versus 27% in the RTAS group (95% CI: 6%, 61%). Positive lymph nodes were found in seven (44%; 95% CI: 20%, 70%) invasive cancers after SIFU and in three (25%; 95% CI: 5%, 57%) invasive cancers after RTAS. CONCLUSION Similar rates of cancer detection were found between SIFU and RTAS after benign breast biopsy with no significant differences in stage, tumor size, or nodal status, although the present study was limited by sample size. These findings suggest that patients with benign radiologic-pathologic-concordant percutaneous breast biopsy results could return to annual screening.
Collapse
Affiliation(s)
- Jason M Johnson
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (J.M.J.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.K.J.); Group Health Research Institute, Seattle, Wash (E.S.O., D.L.M.); and Division of Breast Imaging, Department of Radiology, Fletcher Allen Health Care, Burlington, Vt (B.M.G., E.N.H., S.D.H.)
| | | | | | | | | | | | | |
Collapse
|
27
|
Chopier J, Dratwa C, Antoine M, Gonin J, Thomassin Naggara I. Radiopathological correlations: masses, non-masslike enhancements and MRI-guided biopsy. Diagn Interv Imaging 2014; 95:213-25. [PMID: 24456894 DOI: 10.1016/j.diii.2013.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MRI-guided biopsy is a recent interventional breast technique. Validating the procedure poses a new problem because the signal targeted is created by the injection of a paramagnetic contrast agent and is thus transitory. In the first instance, the procedure is validated by the radiologist, who checks that targeting is accurate and inserts a clip at the end of the procedure, and secondly by analysis of the histopathological results, which should be representative of the lesion. The pathologist needs to know the nature of the image, i.e. whether it is of mass or non-masslike enhancement, and its BI-RADS classification. The objective is that the image and the pathological result should concur. If the result is non-specific and benign, a follow-up MRI is required six months later.
Collapse
Affiliation(s)
- J Chopier
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France.
| | - C Dratwa
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France
| | - M Antoine
- Histopathology Department, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - J Gonin
- Histopathology Department, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - I Thomassin Naggara
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France
| |
Collapse
|
28
|
Trends in breast biopsies for abnormalities detected at screening mammography: a population-based study in the Netherlands. Br J Cancer 2013; 109:242-8. [PMID: 23695018 PMCID: PMC3708556 DOI: 10.1038/bjc.2013.253] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/26/2013] [Accepted: 04/26/2013] [Indexed: 01/07/2023] Open
Abstract
Background: Diagnostic surgical breast biopsies have several disadvantages, therefore, they should be used with hesitation. We determined time trends in types of breast biopsies for the workup of abnormalities detected at screening mammography. We also examined diagnostic delays. Methods: In a Dutch breast cancer screening region 6230 women were referred for an abnormal screening mammogram between 1 January 1997 and 1 January 2011. During two year follow-up clinical data, breast imaging-, biopsy-, surgery- and pathology-reports were collected of these women. Furthermore, breast cancers diagnosed >3 months after referral (delays) were examined, this included review of mammograms and pathology specimens to determine the cause of the delays. Results: In 41.1% (1997–1998) and in 44.8% (2009–2010) of referred women imaging was sufficient for making the diagnosis (P<0.0001). Fine-needle aspiration cytology decreased from 12.7% (1997–1998) to 4.7% (2009–2010) (P<0.0001), percutaneous core-needle biopsies (CBs) increased from 8.0 to 49.1% (P<0.0001) and surgical biopsies decreased from 37.8 to 1.4% (P<0.0001). Delays in breast cancer diagnosis decreased from 6.7 to 1.8% (P=0.003). Conclusion: The use of diagnostic surgical breast biopsies has decreased substantially. They have mostly been replaced by percutaneous CBs and this replacement did not result in an increase of diagnostic delays.
Collapse
|
29
|
Perrot N, Jalaguier-Coudray A, Frey I, Thomassin-Naggara I, Chopier J. US-guided core needle biopsy: false-negatives. How to reduce them? Eur J Radiol 2012; 82:424-6. [PMID: 22483600 DOI: 10.1016/j.ejrad.2012.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Perrot
- Radiology Department, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
| | | | | | | | | |
Collapse
|
30
|
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 IN MEDICINE & BIOLOGY 2011; 37:1771-1778. [PMID: 21856068 DOI: 10.1016/j.ultrasmedbio.2011.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 07/11/2011] [Accepted: 07/18/2011] [Indexed: 05/31/2023]
Abstract
The objective of this study was to determine the frequency of imaging-histologic discordance and to compare the frequency of carcinoma between concordant and discordant lesions in sonographically (US)-guided 14-gauge core needle biopsies (CNBs). From January 2005 to December 2006, we performed US-guided 14-gauge automated CNB on 3339 breast lesions and obtained benign results in 2194 cases. Five radiologists prospectively reviewed the pathologic reports in conjunction with the imaging. We included a total of 1588 lesions that were either excised (n = 658) or followed up for at least 2 years (n = 930) after CNB. We evaluated the rate of discordance and the clinical findings for both discordant and concordant lesions. We also analyzed the clinical and imaging differences between the upgrade and non-upgrade groups. Imaging-histologic discordance was present in 103 of 1588 (6.5%) lesions. The upgrade rate was 6.8% (7/103) in discordant lesions and 0.4% (6/1485) in concordant lesions (p < 0.01). Lesion size, Breast Imaging, Reporting and Data System (BI-RADS) category and the presence or absence of symptoms was statistically significant between the upgrade and non-upgrade groups in discordant cases (p < .05). Imaging-histologic discordance is an indication for excision because it has a higher upgrade rate than concordant lesions.
Collapse
Affiliation(s)
- Eun Ju Son
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
31
|
Vandromme MJ, Umphrey H, Krontiras H. Image-guided methods for biopsy of suspicious breast lesions. J Surg Oncol 2011; 103:299-305. [PMID: 21337562 DOI: 10.1002/jso.21795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The widespread use of breast imaging has resulted in the increased detection of clinically occult suspicious breast lesions. Between 1999 and 2004 the number of breast biopsies in the United States has increased steadily. The armamentarium of methods to biopsy suspicious breast lesions has also increased significantly since the early 1990s with technological advancements for both surgical breast biopsy and percutaneous image guided breast biopsies.
Collapse
Affiliation(s)
- Marianne J Vandromme
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, UK
| | | | | |
Collapse
|
32
|
Ultrasound-guided core-needle biopsy of breast lesions. Insights Imaging 2011; 2:493-500. [PMID: 22347970 PMCID: PMC3259303 DOI: 10.1007/s13244-011-0090-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/24/2010] [Accepted: 03/17/2011] [Indexed: 12/11/2022] Open
Abstract
Objective To review the role of ultrasound-guided core-needle biopsy (CNB) in the management of breast lesions. Methods Review of the most relevant literature on this topic. Results This technique shows a high sensitivity value of about 97.5% and it offers many advantages over other imaging techniques to guide a biopsy: non-ionising radiation, low cost, full control of the needle in real time, accessibility in difficult locations, multidirectional punctures and excellent comfort for patients and radiologists. All of these advantages have made this technique the most widespread used to perform a biopsy for a suspicious breast lesion. The most important limitation is the failure to perform a biopsy for lesions that are not seen on ultrasound. An adequate radiological–pathological correlation is necessary to minimise the false-negative results. Conclusion Ultrasound-guided CNB has proven to be a reliable technique for performing a biopsy for breast lesions that can be clearly seen on ultrasound.
Collapse
|
33
|
Youk JH, Kim EK, Kim MJ, Ko KH, Kwak JY, Son EJ, Choi J, Kang HY. Concordant or discordant? Imaging-pathology correlation in a sonography-guided core needle biopsy of a breast lesion. Korean J Radiol 2011; 12:232-40. [PMID: 21430941 PMCID: PMC3052615 DOI: 10.3348/kjr.2011.12.2.232] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 10/05/2010] [Indexed: 11/16/2022] Open
Abstract
An imaging-guided core needle biopsy has been proven to be reliable and accurate for the diagnosis of both benign and malignant diseases of the breast, and has replaced surgical biopsy. However, the possibility of a false-negative biopsy still remains. Imaging-pathology correlation is of critical importance in imaging-guided breast biopsies to detect such a possible sampling error and avoid a delay in diagnosis. We will review five possible categories and corresponding management after performing an imaging-pathology correlation in a sonography-guided core needle biopsy of a breast lesion, as well as illustrate the selected images for each category in conjunction with the pathologic finding. Radiologists should be familiar with the imaging features of various breast pathologies and be able to appropriately correlate imaging findings with pathologic results after a core needle biopsy.
Collapse
Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Molleran V. Postbiopsy management. Semin Roentgenol 2010; 46:40-50. [PMID: 21134527 DOI: 10.1053/j.ro.2010.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Virginia Molleran
- Breast Imaging Department, UC Health/University Hospital, Cincinnati, OH, USA.
| |
Collapse
|
35
|
Youk JH, Kim EK, Kim MJ, Kwak JY, Son EJ. Performance of hand-held whole-breast ultrasound based on BI-RADS in women with mammographically negative dense breast. Eur Radiol 2010; 21:667-75. [PMID: 20853108 DOI: 10.1007/s00330-010-1955-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/21/2010] [Accepted: 07/30/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the performance of breast ultrasound based on BI-RADS final assessment categories in women with mammographically negative dense breast. METHODS Of 3,820 cases with mammographically negative dense breast and subsequent hand-held bilateral whole-breast ultrasound, a total of 1,507 cases in 1,046 women who had biopsy or at least 2-year follow-up ultrasound constituted the basis of this retrospective study. Cancer rate of each sonographic BI-RADS category was determined and medical audit was performed separately in screening-general, screening-treated, and diagnostic group. RESULTS A total of 43 cases (2.9%) were confirmed as malignancy. Cancer rate among BI-RADS categories was significantly different (p < 0.0001). Among three groups, the cancer rate was significantly different (p < 0.0001) and the highest in diagnostic group (15.8%, 22 of 139). Abnormal interpretation rate, PPV of biopsy performed, cancer detection rate, and rate of early stage cancer, and the size of invasive cancer were significantly different among three groups and the highest in diagnostic group. Regarding cancer characteristics, the proportion of advanced cancer was the highest in diagnostic group. CONCLUSION Breast ultrasound based on BI-RADS as an adjunctive to negative mammography can be useful for predicting malignancy in women with dense breast.
Collapse
Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, South Korea
| | | | | | | | | |
Collapse
|
36
|
Zhu C, Burnside ES, Sisney GA, Salkowski LR, Harter JM, Yu B, Ramanujam N. Fluorescence spectroscopy: an adjunct diagnostic tool to image-guided core needle biopsy of the breast. IEEE Trans Biomed Eng 2009; 56:2518-28. [PMID: 19272976 DOI: 10.1109/tbme.2009.2015936] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We explored the use of a fiber-optic probe for in vivo fluorescence spectroscopy of breast tissues during percutaneous image-guided breast biopsy. A total of 121 biopsy samples with accompanying histological diagnosis were obtained clinically and investigated in this study. The tissue spectra were analyzed using partial least-squares analysis and represented using a set of principal components (PCs) with dramatically reduced data dimension. For nonmalignant tissue samples, a set of PCs that account for the largest amount of variance in the spectra displayed correlation with the percent tissue composition. For all tissue samples, a set of PCs was identified using a Wilcoxon rank-sum test as showing statistically significant differences between: 1) malignant and fibrous/benign; 2) malignant and adipose; and 3) malignant and nonmalignant breast samples. These PCs were used to distinguish malignant from other nonmalignant tissue types using a binary classification scheme based on both linear and nonlinear support vector machine (SVM) and logistic regression (LR). For the sample set investigated in this study, the SVM classifier provided a cross-validated sensitivity and specificity of up to 81% and 87%, respectively, for discrimination between malignant and fibrous/benign samples, and up to 81% and 81%, respectively, for discriminating between malignant and adipose samples. Classification based on LR was used to generate receiver operator curves with an area under the curve (AUC) of 0.87 for discriminating malignant versus fibrous/benign tissues, and an AUC of 0.84 for discriminating malignant from adipose tissue samples. This study demonstrates the feasibility of performing fluorescence spectroscopy during clinical core needle breast biopsy, and the potential of this technique for identifying breast malignancy in vivo.
Collapse
Affiliation(s)
- Changfang Zhu
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Schueller G, Schueller-Weidekamm C, Helbich TH. Accuracy of ultrasound-guided, large-core needle breast biopsy. Eur Radiol 2008; 18:1761-73. [PMID: 18414872 DOI: 10.1007/s00330-008-0955-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 01/31/2008] [Accepted: 02/23/2008] [Indexed: 11/30/2022]
Abstract
Ultrasound-guided, large-core needle biopsy (US-LCNB) of suspicious breast lesions is acknowledged as less invasive and less expensive and less time consuming than surgical biopsy, and provides a histologic diagnosis with a comparable high degree. US-LCNB has been proven to help reduce the number of unnecessary surgeries for benign disease. Its limitations, however, are false-negative results and underestimation of disease. Thus, the demand for breast teams is to carefully adhere to the principles of triple assessment and imaging-histologic correlation, and follow-up of lesions with a specific benign histology after biopsy. Also, the acceptance of guidelines and rigorous quality controls help to reliably minimize the delay in the diagnosis of breast cancer in patients with false-negative biopsies. This paper aims to summarize the equipment and methods as well as the benefits and limitations of US-LCNB. Also, guidelines of quality assessment are suggested. Finally, recent developments which may help to overcome the limitations of US-LCNB will be discussed, i.e., directional vacuum-assisted biopsy (VAB), three-dimensional (3D) US-guided biopsy, as well as the use of tissue harmonic imaging (THI) and compound imaging (CI) during biopsy.
Collapse
Affiliation(s)
- G Schueller
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | | | | |
Collapse
|
38
|
Sonographically guided 14-gauge core needle biopsy of breast masses: a review of 2,420 cases with long-term follow-up. AJR Am J Roentgenol 2008; 190:202-7. [PMID: 18094312 DOI: 10.2214/ajr.07.2419] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to determine the diagnostic accuracy of sonographically guided core needle biopsy for breast masses by evaluating the outcomes of benign biopsies that had at least a 2-year follow-up. MATERIALS AND METHODS In this retrospective study, we included a total of 2,420 lesions from 2,198 women who had undergone sonographically guided 14-gauge core needle biopsy. For evaluating the diagnostic accuracy of this procedure, the pathologic results were reviewed and correlated with rebiopsy or long-term imaging follow-up. Agreement rate, high-risk underestimate rate, ductal carcinoma in situ (DCIS) underestimate rate, and false-negative rate were assessed. The false-negative diagnoses of core needle biopsy were reviewed in detail. RESULTS The pathologic results for the core needle biopsies were malignant in 52%, high-risk in 4%, and benign in 44%. The agreement rate was 96% (2,328 of 2,420). The underestimate rate was 29% (36 of 126) for DCIS and 27% (25 of 93) for high-risk (52% for 27 atypical ductal hyperplasia (ADH), 17% for 66 non-ADH). Of 1,071 benign lesions, malignancy was found at rebiopsy in 31 lesions (25 immediate and six delayed false-negative diagnoses), and the false-negative rate was 2.4% (31 of 1,312). The frequency of malignancy in lesions that had rebiopsy because of suspicious imaging findings (19.1%, 26 of 136) was significantly higher than that because of suspicious physical findings or request by patient or physician (0.9%, five of 584). CONCLUSION Sonographically guided 14-gauge core needle biopsy is an accurate method for evaluating breast masses. Imaging-pathologic correlation and follow-up of benign biopsy are essential for a successful breast biopsy program.
Collapse
|
39
|
Perkins C, Balma D, Garcia R. Why current breast pathology practices must be evaluated. A Susan G. Komen for the Cure white paper: June 2006. Breast J 2007; 13:443-7. [PMID: 17760664 DOI: 10.1111/j.1524-4741.2007.00463.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Ending breast cancer has long been the mission of Susan G. Komen for the Cure. To this end, the organization has a strong interest and proven track record in ensuring public investment in quality breast health and breast cancer care. Recently, Susan G. Komen for the Cure identified major issues in the practice of pathology that have a negative impact on the lives of thousands of breast cancer patients in the United States. These issues were identified through a comprehensive literature review and interviews conducted in 2005-2006 with experts in oncology, breast pathology, surgery, and radiology. The interviewees practiced in community, academic, and cooperative group settings. Komen for the Cure has identified four areas that have a direct impact on the quality of care breast cancer patients receive in the United States, the accuracy of breast pathology diagnostics, the effects of current health insurance, and reimbursement policies on patients who are evaluated for a possible breast cancer diagnosis, the substantial decrease in tissue banking participation, particularly during a time of rapid advances in biologically correlated clinical science and the role for the Susan G. Komen for the Cure, pathology professional societies and the Federal government in ensuring that breast pathology practices meet the highest possible standards in the United States Concerns surrounding the quality and practice of breast pathology are not limited to diagnostic accuracy. Other considerations include, training and proficiency of pathologists who are evaluating breast specimens, the lack of integration of pathologists in the clinical care team, inadequate compensation for the amount of work required to thoroughly analyze specimens, potential loss in translational research as a result of medical privacy regulations, and the lack of mandatory uniform pathology practice standards without any way to measure the degree of variation or to remedy it.
Collapse
Affiliation(s)
- Cheryl Perkins
- Susan G. Komen for the Cure, 5005 LBJ Freeway, Suite 250, Dallas, TX 75244, USA.
| | | | | |
Collapse
|
40
|
Andreu FJ, Sáez A, Sentís M, Rey M, Fernández S, Dinarès C, Tortajada L, Ganau S, Palomar G. Breast core biopsy reporting categories—An internal validation in a series of 3054 consecutive lesions. Breast 2007; 16:94-101. [PMID: 16982194 DOI: 10.1016/j.breast.2006.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 06/16/2006] [Accepted: 06/16/2006] [Indexed: 11/29/2022] Open
Abstract
We reviewed 3226 consecutive core biopsies (CBs) of 3054 mammographically detected breast lesions performed at our Centre from November 1993 to June 2003. CB diagnoses, classified according to the Non-operative Diagnosis Subgroup of the British National Health Service Breast Cancer Screening Programme (NHSBSP), were B5 (37.1%), B4 (0.5%), B3 (7.6%), B2 (50.9%) and B1 (3.9%). It was necessary to repeat the procedure in 172 cases (5.3%). The values for absolute sensitivity and specificity are 90.8% and 83.8%, respectively. The positive predictive value for categories B4 and B5 is 100%, with no false-positives. The positive predictive value for category B3 is 16.3%. The negative predictive value for B2 category is 97.2%, with a false-negative rate of 3.5%. In conclusion, this system of analysis has enabled us to confirm that our CB results surpass the minimum recommended standards proposed by the NHSBSP.
Collapse
Affiliation(s)
- Francisco Javier Andreu
- Pathology Department, UDIAT-Centre Diagnòstic Corporació Parc Taulí, Parc Taulí, s/n., 08208 Sabadell, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Nori J, Vanzi E, Bazzocchi M, Bufalini FN, Distante V, Branconi F, Susini T. Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy. Am J Surg 2007; 193:16-20. [PMID: 17188081 DOI: 10.1016/j.amjsurg.2006.02.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 02/20/2006] [Accepted: 02/20/2006] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sentinel node biopsy (SNB) is a time-consuming procedure that can be avoided in presence of axillary metastases. The aim of this study was to assess the accuracy of ultrasound scan (US) in the prediction of axillary nodes status in patients scheduled for SNB. METHODS Axillary US was performed and when feasible, a core biopsy of suspicious nodes was taken. The nodal status as assessed by US and/or core biopsy was compared with final histology. RESULTS Of the 132 patients enrolled, 31 (23.5%) had suspicious axillary nodes according to US; 19 (61.3%) were true positive, whereas 12 cases (38.7%) were not. In 14 of 31 suspicious cases an US-guided core-biopsy was taken, which in 11 of 14 cases (78.5%) confirmed the neoplastic involvement. Overall, core biopsy of the nodes correctly predicted the final histology in 13 of 14 cases (92.8%). CONCLUSIONS The US of axillary nodes, possibly associated with core biopsy, improved the preoperative evaluation of breast cancer patients scheduled for SNB.
Collapse
Affiliation(s)
- Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
42
|
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. [PMID: 17235000 DOI: 10.1148/rg.271065029] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonographically (US) guided core needle biopsy is currently recognized as a reliable alternative to surgical biopsy for the histopathologic diagnosis of breast lesions. However, despite advances in biopsy devices and techniques, false-negative diagnoses are unavoidable and may delay the diagnosis and treatment of breast cancer. The most common reasons for false-negative diagnosis are (a) technical or sampling errors, (b) failure to recognize or act on radiologic-histologic discordance, and (c) lack of imaging follow-up after a benign biopsy result. Technical difficulties (eg, poor lesion or needle visualization, deeply located lesions, dense fibrotic tissue) cause inaccurate sampling but can be reduced by using modified standard techniques. Radiologic-histologic correlation is also of critical importance in US-guided core needle biopsy. Radiologic-histologic discordance occurs when the histologic results do not provide a sufficient explanation for the imaging features and indicates that the lesion may not have been sampled adequately, so that repeat biopsy is warranted. Appropriate follow-up imaging is invaluable; even patients with concordant benign findings after US-guided core needle biopsy are directed to undergo follow-up imaging because there may be delays in the recognition of false-negative findings. Optimization of technique, radiologic-histologic correlation, and postbiopsy follow-up protocols are recommended to reduce the occurrence of false-negative diagnosis at US-guided core needle biopsy performed by radiologists.
Collapse
Affiliation(s)
- Ji Hyun Youk
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, South Korea
| | | | | | | | | |
Collapse
|