Randomized controlled trial of stereotactic 11-G vacuum-assisted core biopsy for the diagnosis and management of mammographic microcalcification

The effectiveness of ultrasound-guided core needle biopsy in detecting lymph node metastases in the axilla in patients with breast cancer: systematic review and meta-analysis

OBJECTIVE

This study aimed to perform a meta-analysis to investigate the diagnostic safety and accuracy of Ultrasound-Guided Core Needle Biopsy (US-CNB) Axillary Lymph Nodes (ALNs) region in patients with Breast Cancer (BC).

METHODS

The authors searched the electronic databases PubMed, Scopus, Embase, and Web of Science for clinical trials about US-CNB for the detection of ALNs in breast cancer patients. The authors extracted and pooled raw data from the included studies and performed statistical analyses using Meta-DiSc 1.4 and Review Manager 5.3 software. A random effects model was used to calculate the data. At the same time, data from the Ultrasound-guided Fine-Needle Aspiration (US-FNA) were introduced for comparison with the US-CNB. In addition, the subgroup was performed to explore the causes of heterogeneity. (PROSPERO ID: CRD42022369491).

RESULTS

In total, 18 articles with 2521 patients were assessed as meeting the study criteria. The overall sensitivity was 0.90 (95% CI [Confidence Interval], 0.87‒0.91; p = 0.00), the overall specificity was 0.99 (95% CI 0.98‒1.00; p = 0.62), the overall area under the curve (AUC) was 0.98. Next, in the comparison of US-CNB and US-FNA, US-CNB is better than US-FNA in the diagnosis of ALNs metastases. The sensitivity was 0.88 (95% CI 0.84‒0.91; p = 0.12) vs. 0.73 (95% CI 0.69‒0.76; p = 0.91), the specificity was 1.00 (95% CI 0.99‒1.00; p = 1.00) vs. 0.99 (95% CI 0.67‒0.74; p = 0.92), and the AUC was 0.99 vs. 0.98. Subgroup analysis showed that heterogeneity may be related to preoperative Neoadjuvant Chemotherapy (NAC) treatment, region, size of tumor diameter, and the number of punctures.

CONCLUSION

US-CNB has a satisfactory diagnostic performance with good specificity and sensitivity in the preoperative diagnosis of ALNs in BC patients.

A mimic of breast carcinoma 1-year post vacuum-assisted excision of a benign breast lesion

A 64-year-old woman underwent vacuum-assisted excision (VAE) for a biopsy-proven radial scar in the right breast detected during screening mammography. A follow-up mammogram was performed at 1 year following multidisciplinary team discussion. This demonstrated a 1 cm mass adjacent to the biopsy clip at the site of the prior VAE. A repeat biopsy of the mass was performed which revealed benign scar tissue. This is the first reported case of post-VAE scar tissue mimicking breast carcinoma on mammography.

Accuracy and outcomes of stereotactic vacuum-assisted breast biopsy for diagnosis and management of nonpalpable breast lesions

Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpable lesions detected by mammography. Considering the diagnostic effectiveness, a direct comparison of SVAB and open surgical biopsy (OSB) is lacking. We performed a retrospective review of 276 (33.8%) SVAB and 541 (66.2%) OSB to compare the diagnostic accuracy and the total number of procedures the patients underwent. The negative predictive values of OSB and SVAB were 99.77% and 99.61%, and their false-negative rates were 0.96% and 4.76%, respectively. SVAB, as the first-line biopsy method, obviated 92.3% of operations. All malignancies diagnosed using SVAB could be treated with single therapeutic surgery. By contrast, 48% of malignancies of OSB group received two operations. Breast Imaging Reporting and Data System (BI-RADS) category used at the study correlated well with the percentage of malignancy and can thus be used to predict biopsy results. Our study concluded that SVAB is reliable for diagnosing nonpalpable breast lesions and is the better biopsy method for categories 3 and 4A lesions, which reduces the benign surgery rate. For lesions with a higher likelihood of malignancy, BI-RADS 4B, 4C and 5, SVAB has an advantage over OSB, which lowers the total number of operations for malignancy treatment.

High-attenuation artifact reduction in breast tomosynthesis using a novel reconstruction algorithm

PURPOSE

To assess the effect on reducing the out-of-plane artifacts from metal objects in breast tomosynthesis (BT) using a novel artifact-reducing reconstruction algorithm in specimen radiography.

METHODS AND MATERIALS

The study was approved by the Regional Ethical Review Board. BT images of 18 partial- and whole mastectomy specimens from women with breast cancer were acquired before and after a needle was inserted close to the lesion. The images were reconstructed using both a standard reconstruction algorithm, and a novel algorithm; the latter uses pre-segmentation to remove highly attenuating artifact-inducing objects from projection images before reconstruction. Images were separately reconstructed with and without segmentation, and combined into an artifact-reduced reconstruction. Standard and artifact-reduced BT-algorithms were compared visually and quantitatively using clinical images of mastectomy specimens and a physical anthropomorphic phantom. Six readers independently assessed the visibility of the lesion with and without artifact-reduction in a side-by-side comparison. A quantitative analysis was performed, comparing the signal-difference to background ratio (SDBR) and artifact spread function (ASF) between the two reconstruction methods.

RESULTS

The magnitude of out-of-plane artifacts was clearly reduced with the novel reconstruction compared to BT-images without artifact reduction. Lesion masking by artifacts was largely averted; tumour visibility was comparable to standard BT images without a needle. In 76 ± 8% (standard deviation) of cases overall, readers could confidently state needle location. The same figure was 94 ± 6% for whole mastectomy cases, compared to 62 ± 17% for partial mastectomies. With metal artifact reduction, SDBR increased by 97% in the phantom, and by 69% in the mastectomies. The artifact spread function was substantially narrower.

CONCLUSION

Artifact reduction in BT using a novel reconstruction method enables qualitatively and quantitatively improved clinical use of BT when metal artifacts can be a limiting factor such as in tomosynthesis-guided biopsy.

Is risk-stratified breast cancer screening economically efficient in Germany?

OBJECTIVES

Risk stratification has so far been evaluated under the assumption that women fully adhere to screening recommendations. However, the participation in German cancer screening programs remains low at 54%. The question arises whether risk-stratified screening is economically efficient under the assumption that adherence is not perfect.

METHOD

We have adapted a micro-simulation Markov model to the German context. Annual, biennial, and triennial routine screening are compared with five risk-adapted strategies using thresholds of relative risk to stratify screening frequencies. We used three outcome variables (mortality reduction, quality-adjusted life years, and false-positive results) under the assumption of full adherence vs. an adherence rate of 54%. Strategies are evaluated using efficiency frontiers and probabilistic sensitivity analysis (PSA).

RESULTS

The reduced adherence rate affects both performance and cost; incremental cost-effectiveness ratios remain constant. The results of PSA show that risk-stratified screening strategies are more efficient than biennial routine screening under certain conditions. At any willingness-to-pay (WTP), there is a risk-stratified alternative with a higher likelihood of being the best choice. However, without explicit decision criteria and WTP, risk-stratified screening is not more efficient than biennial routine screening. Potential improvements in the adherence rates have significant health gains and budgetary implications.

CONCLUSION

If the participation rate for mammographic screening is as low as in Germany, stratified screening is not clearly more efficient than routine screening but dependent on the WTP. A more promising design for future stratified strategies is the combination of risk stratification mechanisms with interventions to improve the low adherence in selected high-risk groups.