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Vatteroni G, Pinna G, Trimboli RM, Levi R, Bolengo I, Patrone F, Volpe D, Fernandes B, Bernardi D. Role of ultrasound-guided vacuum-assisted breast biopsy in the management of radiologic-pathologic discordance: a retrospective single-centre study. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01864-1. [PMID: 39102107 DOI: 10.1007/s11547-024-01864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE To evaluate the efficacy of US-guided vacuum-assisted biopsy (US-VAB) in radiologic-pathologic (rad-path) discordance in women with suspicious breast lesions. METHODS Two thousand three hundred and sixty patients with 2385 BI-RADS category 4 and 5 lesions underwent percutaneous US-guided CNB. Thirty-six lesions were classified as discordant benign and underwent second-line US-VAB. A 14-gauge needle was utilized for CNB and 10-gauge for US-VAB. Final pathology was the reference standard for women who underwent surgery, imaging follow-up in other cases. Rates of malignancy for US-VAB and subsequent surgery were evaluated. Lesions with upgrade and no upgrade to second-line VAB were compared in terms of patient's age, lesion type and characteristics, size and BI-RADS category. Positive predictive value (PPV), negative predictive value (NPV) for BI-RADS categories and diagnostic performance for second-line US-VAB were calculated. p value < 0.05 was considered statistically significant (t-test, Mann-Whitney, χ2). RESULTS US-VAB identified 10 B2, 9 B3 and 17 B5 lesions with upgrade to malignancy of 47.2% (17/36). There were 8 invasive no special type, 7 ductal in situ, 1 invasive lobular carcinoma and 1 angiosarcoma, and their distribution among BI-RADS categories was: 2/2 in BI-RADS 5 (100%), 12/18 in BI-RADS 4C (67%) and 3/16 in BI-RADS 4B lesions (19%) (p = 0.006). Of the remaining 19 lesions, 6 underwent surgery and 2 were upgraded to ductal carcinoma in situ; 13 underwent radiological follow-up and one resulted malignant. False-negative rate for US-VAB was 15.8% (3/19) with final upgrade to malignancy of 55% (20/36). The univariate analysis revealed mass shape (p = 0.008) and BI-RADS categories (p = 0.006) to be associated with upgrade to malignancy. Sensitivity, specificity, PPV, NPV and accuracy for US-VAB were 85, 100, 100, 84 and 92%, respectively. CONCLUSIONS US-VAB identified almost 50% of cancers missed by CNB, avoiding surgical biopsies and validating as an effective mini-invasive approach in rad-path discordance.
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Affiliation(s)
- Giulia Vatteroni
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Pinna
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rubina Manuela Trimboli
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Riccardo Levi
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Isabella Bolengo
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Patrone
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Daria Volpe
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Bethania Fernandes
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Daniela Bernardi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Goh Y, Quek ST, Pillay P, Chou CP. Evaluation of architectural distortion with contrast-enhanced mammography. Clin Radiol 2024; 79:163-169. [PMID: 38114374 DOI: 10.1016/j.crad.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
Architectural distortion (AD) is the third most common abnormality detected on mammograms. In the absence of an accurate non-invasive tool to evaluate ADs, clinical management often requires surgical excision for histological diagnosis. This problem is expected to worsen with the growing use of digital breast tomosynthesis (DBT) and the resultant increasing detection of ADs. There is therefore a great clinical need for a diagnostic imaging tool to complement non-enhanced mammography for the evaluation of AD. Contrast-enhanced mammography (CEM) is an emerging breast imaging method that uses contrast media and the principle of dual-energy subtraction to evaluate vascularity of suspicious breast lesions. CEM, a cost-effective alternative to breast magnetic resonance imaging (MRI), can be used to evaluate AD by juxtaposing CEM images with non-enhanced mammograms for comparison. In this review, the authors aim to provide readers with an overview of the interpretation of AD on CEM using imaging examples. Relevant imaging features of CEM and their respective significance will be matched with information from a literature review. Finally, the authors would like to highlight the added value of CEM in relevant clinical applications in the assessment of AD.
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Affiliation(s)
- Y Goh
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - S T Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - P Pillay
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - C-P Chou
- Kaohsiung Veterans General Hospital, Radiology Department, No. 386, Dazhong 1st Rd, Zuoying Dist., Kaohsiung City 81362, Taiwan, ROC.
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Tari DU, De Lucia DR, Santarsiere M, Santonastaso R, Pinto F. Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience. Cancers (Basel) 2023; 15:5720. [PMID: 38136264 PMCID: PMC10742222 DOI: 10.3390/cancers15245720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson's correlation and χ2 test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41-84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76-1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.
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Affiliation(s)
- Daniele Ugo Tari
- Department of Breast Imaging, Caserta Local Health Authority, District 12 “Palazzo della Salute”, 81100 Caserta, Italy; (D.R.D.L.); (M.S.)
| | - Davide Raffaele De Lucia
- Department of Breast Imaging, Caserta Local Health Authority, District 12 “Palazzo della Salute”, 81100 Caserta, Italy; (D.R.D.L.); (M.S.)
| | - Marika Santarsiere
- Department of Breast Imaging, Caserta Local Health Authority, District 12 “Palazzo della Salute”, 81100 Caserta, Italy; (D.R.D.L.); (M.S.)
| | | | - Fabio Pinto
- Department of Radiology, “A. Guerriero” Hospital, Caserta Local Health Authority, 81025 Marcianise, Italy;
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Zhang M, Mesurolle B, Theriault M, Meterissian S, Morris EA. Imaging of breast cancer-beyond the basics. Curr Probl Cancer 2023:100967. [PMID: 37316336 DOI: 10.1016/j.currproblcancer.2023.100967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/12/2023] [Accepted: 05/20/2023] [Indexed: 06/16/2023]
Abstract
Imaging of breast cancer is the backbone of breast cancer screening, diagnosis, preoperative/treatment assessment and follow-up. The main modalities are mammography, ultrasound and magnetic resonance imaging, each with its own advantages and disadvantages. New emerging technologies have also enabled each modality to improve on their weaknesses. Imaging-guided biopsies have allowed for accurate diagnosis of breast cancer, with low complication rates. The purpose of this article is to review the common modalities for breast cancer imaging in current practice with emphasis on the strengths and potential weaknesses, discuss the selection of the best imaging modality for the specific clinical question or patient population, and explore new technologies / future directions of breast cancer imaging.
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Affiliation(s)
- Michelle Zhang
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada.
| | - Benoit Mesurolle
- Department of Radiology, Elsan, Pôle Santé République, Clermont-Ferrand, France
| | - Melanie Theriault
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Izumori A, Takahashi M, Sasa S, Inoue H, Tangoku A, Kanematsu M, Sasa M. False-negatives due to poor specimens can be prevented based on the macroscopic findings for breast Vacuum-Assisted Biopsy specimens. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:51-64. [PMID: 35466146 DOI: 10.2152/jmi.69.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE Ultrasound-guided breast tissue biopsy is an essential technique for diagnosing breast disease, but sample errors reduce its accuracy. This study investigated whether the histopathological results can be inferred from the macroscopic findings for Ultrasound-guided breast Vacuum Assisted Biopsy (VAB) specimens. METHODS Biopsy specimens from 101 patients who underwent mammary gland VAB were photographed with a smartphone, and the relationships between the macroscopic findings and the pathological results were examined. RESULTS A significant difference was observed with regard to the presence/absence of turbidity: malignancy was detected in 33/37 (89%) specimens with turbidity and in 2/47 (4%) cases without turbidity (p<0.001). A significant difference was also observed regarding the surface properties:malignancy was detected in 14/70 (19%) smooth specimens and in 24/29 (83%) rough specimens (p<0.001). Also, malignancy was detected in 11/13 (85%) specimens with white spots, and the difference was significant (p<0.001). In addition, the characteristics of intraductal papilloma, fibroadenoma, and mastopathy could be confirmed by macroscopic findings. CONCLUSIONS When needle-biopsy of a lesion that is targeted for resection yields macroscopic findings that match the predicted histopathological findings, it can be thought that the biopsy had been properly performed. This means that false-negatives due to poor specimens can be prevented. J. Med. Invest. 69 : 51-56, February, 2022.
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Affiliation(s)
- Ayumi Izumori
- Department of Breast Surgery, Takamatsu Heiwa Hospital.,Tokushima Breastcare Clinic
| | | | - Soichiro Sasa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Science, Tokushima University Graduate School
| | - Hiroaki Inoue
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Science, Tokushima University Graduate School
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Science, Tokushima University Graduate School
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Ambinder EB, Calhoun BC. Risk-Associated Lesions of the Breast in Core Needle Biopsies: Current Approaches to Radiological-Pathological Correlation. Surg Pathol Clin 2022; 15:147-157. [PMID: 35236630 DOI: 10.1016/j.path.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Image-guided core needle biopsies (CNBs) of the breast frequently result in a diagnosis of a benign or atypical lesion associated with breast cancer risk. The subsequent clinical management of these patients is variable, reflecting a lack of consensus on criteria for selecting patients for clinical and radiological follow-up versus immediate surgical excision. In this review, the evidence from prospective studies of breast CNB with radiological-pathological correlation is evaluated and summarized. The data support an emerging consensus on the importance of radiologic-pathologic correlation in standardizing the selection of patients for active surveillance versus surgery.
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Affiliation(s)
- Emily B Ambinder
- Breast Imaging Division, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine
| | - Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 160 N. Medical Drive, Campus Box 7525, Chapel Hill, NC 27599, USA.
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Olayinka O, Kaur G, Agarwal R, Staradub V, Chacho MS, Vidhun R. Impact of multidisciplinary radiologic-pathologic correlation conference for benign image-guided breast biopsies on discordance rates and patient outcomes in a community teaching hospital. Ann Diagn Pathol 2021; 57:151864. [PMID: 34972038 DOI: 10.1016/j.anndiagpath.2021.151864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
As the assessment for radiologic-pathologic concordance, particularly for benign image-guided breast biopsies, is crucial in the management of patients with imaging abnormalities, many health institutions now conduct multidisciplinary conferences to assess the imaging and pathology findings in patients who had image-guided needle biopsy. We aimed to identify the radiologic-pathologic discordance rates and changes in patient outcomes resulting from the implementation of radiologic-pathologic correlation conferences in a community teaching hospital. Twenty-two (5.6%) out of 393 cases presented were deemed discordant given that the imaging characteristics of the lesions were far too suspicious radiologically to correlate with the benign pathology. Six cases were recommended for further imaging (four had stable lesion on follow- up, one was lost to follow-up and one case eventually had surgical excision which showed atypia); 14 cases for repeat core needle/excisional biopsy (seven had surgical excision with benign histology, five did not have surgery but showed stable lesion on imaging, two were lost to follow-up); one case for close imaging follow-up (lesion ultimately disappeared); the remaining case for second opinion (no follow-up data). The rad-path correlation conference led to a higher level of patient care with significant change in practice across our hospital network.
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Affiliation(s)
- Oluwaseyi Olayinka
- Department of Pathology & Laboratory Medicine, Danbury Hospital Nuvance Health, Danbury, CT, USA.
| | - Gagandeep Kaur
- Department of Pathology & Laboratory Medicine, Danbury Hospital Nuvance Health, Danbury, CT, USA
| | - Rakhee Agarwal
- Department of Research and Innovation, Danbury Hospital Nuvance Health, Danbury, CT, USA
| | | | - Mary S Chacho
- Department of Pathology & Laboratory Medicine, Danbury Hospital Nuvance Health, Danbury, CT, USA
| | - Ramapriya Vidhun
- Department of Pathology & Laboratory Medicine, Danbury Hospital Nuvance Health, Danbury, CT, USA
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Lange MB, Petersen LJ, Nielsen MB, Zacho HD. Validity of negative bone biopsy in suspicious bone lesions. Acta Radiol Open 2021; 10:20584601211030662. [PMID: 34377541 PMCID: PMC8323434 DOI: 10.1177/20584601211030662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background The presence of malignant cells in bone biopsies is considered gold standard to verify occurrence of cancer, whereas a negative bone biopsy can represent a false negative, with a risk of increasing patient morbidity and mortality and creating misleading conclusions in cancer research. However, a paucity of literature documents the validity of negative bone biopsy as an exclusion criterion for the presence of skeletal malignancies. Purpose To investigate the validity of a negative bone biopsy in bone lesions suspicious of malignancy. Material and Method A retrospective cohort of 215 consecutive targeted non-malignant skeletal biopsies from 207 patients (43% women, 57% men, median age 64, and range 94) representing suspicious focal bone lesions, collected from January 1, 2011, to July 31, 2013, was followed over a 2-year period to examine any additional biopsy, imaging, and clinical follow-up information to categorize the original biopsy as truly benign, malignant, or equivocal. Standard deviations and 95% confidence intervals were calculated. Results 210 of 215 biopsies (98%; 95% CI 0.94-0.99) showed to be truly benign 2 years after initial biopsy. Two biopsies were false negatives (1%; 95% CI 0.001-0.03), and three were equivocal (lack of imaging description). Conclusion Our study documents negative bone biopsy as a valid criterion for the absence of bone metastasis. Since only 28% had a confirmed diagnosis of prior cancer and not all patients received adequately sensitive imaging, our results might not be applicable to all cancer patients with suspicious bone lesions.
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Affiliation(s)
- Mine B Lange
- Department of Radiology, Department of Diagnostic Imaging, University Hospital of North Zealand, Hilleroed, Denmark.,Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Lars J Petersen
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael B Nielsen
- Department of Radiology, National University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helle D Zacho
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Alwagdani NM, Alnefaie SM, Kurshid A, Kewan H. Atypical ductal hyperplasia of the breast mimics breast cancer presentation treated surgically: a case report and literature review. J Surg Case Rep 2021; 2021:rjab325. [PMID: 34336186 PMCID: PMC8318601 DOI: 10.1093/jscr/rjab325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
Atypical ductal hyperplasia (ADH) is considered a benign lesion with increased malignant potential. ADH represents ~3% of total benign breast biopsy results. A 60-year-old woman with no family history of breast cancer presented with multiple painless lumps in the right breast and palpable right axillary lymph nodes. Ultrasonography and mammography showed typical features of breast cancer. However, core needle biopsy revealed ADH without infiltrating malignancy. Based on a multidisciplinary decision, a right simple mastectomy with sentinel lymph node biopsy was chosen as the best treatment plan. The postoperative histopathology report showed the spread of ductal carcinoma in situ (DCIS) in all quadrants without any evidence of invasive cancer. It is challenging to obtain an accurate diagnosis of clinically palpable and multicentric ADH or DCIS based on preoperative radiological and histological evaluation, especially when dissonance between these two evaluation modalities exists.
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Affiliation(s)
| | - Sahar M Alnefaie
- Department of General Surgery, Taif University and Alhada Hospital for Armed Forces, Taif, Saudi Arabia
| | - Arif Kurshid
- Department of General Surgery, Alhada Hospital for Armed Forces, Taif, Saudi Arabia
| | - Hanady Kewan
- Department of Radiology, Alhada Hospital for Armed Forces, Taif, Saudi Arabia
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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.
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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
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Ram S, Regen-Tuero H, Baird GL, Lourenco AP. Compliance with Short-Interval Follow-up MRI after Benign Concordant MRI-guided Breast Biopsy. JOURNAL OF BREAST IMAGING 2021; 3:64-71. [PMID: 38424838 DOI: 10.1093/jbi/wbaa089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate compliance with short-interval follow-up MRI after benign concordant MRI-guided breast biopsy. METHODS This institutional review board-approved retrospective study included all benign concordant MRI-guided biopsies performed between January 1, 2010, and May 1, 2018. The following was collected from the electronic medical record: patient and lesion characteristics, short-interval follow-up MRI recommendation, communication to referring physician, follow-up imaging, repeat biopsies, biopsy outcome, and patient insurance status. Compliance with recommendations was defined as follow-up MRI within 9 months of biopsy. RESULTS Among 98 patients, there were 107 lesions with benign concordant MRI-guided biopsy results that met study criteria. After excluding 7 patients who underwent subsequent mastectomy, 50/91 (54.9%) patients were recommended short-interval follow-up MRI. Of these, 33/50 (66.0%) had a short-interval follow-up MRI. Direct communication of the short-interval follow-up recommendation was documented in the biopsy report for 4/50 (8%) patients. Subsequent MRI was available for 77/107 (72%) lesions at a median of 29 months following MRI-guided biopsy (range, 3-96 months). Subsequent mammography was available for 21/30 (70%) remaining lesions at a median of 47 months following MRI-guided biopsy (range, 23-88 months). There were two repeat biopsies, with one subsequent malignancy, resulting in a false-negative rate of 0.9% (1/107). CONCLUSION When short-interval follow-up MRI was recommended following benign concordant MRI-guided breast biopsy, compliance was 66.0%. Lack of communication of the recommendation may at least partially explain the low compliance. The low false-negative rate (0.9%) suggests routine short-interval follow-up MRI may be unnecessary following benign concordant MRI-guided biopsy.
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Affiliation(s)
- Shruthi Ram
- Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | | | - Grayson L Baird
- Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | - Ana P Lourenco
- Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
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12
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Ghaemian N, Haji Ghazi Tehrani N, Nabahati M. Accuracy of mammography and ultrasonography and their BI-RADS in detection of breast malignancy. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:573-579. [PMID: 34820065 PMCID: PMC8590403 DOI: 10.22088/cjim.12.4.573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/02/2021] [Accepted: 03/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to compare the diagnostic accuracy of mammography and ultrasonography and their breast imaging-reporting and data system (BI-RADS) classification versus breast core needle biopsy (CNB) findings in distinguishing the breast masses. METHODS This cross-sectional study was conducted during 2016-2018 on female patients who were referred to a radiology center in Babol, northern Iran, for routine screening and/or for CNB. Patients underwent sonography and mammography by a senior radiologist. The breast lesions were also evaluated according to BI-RADS classification. CNB was performed on the breast masses by the same radiologist and pathological procedures were performed by an expert pathologist. Descriptive statistics were used to analyze the data. RESULTS In total, 213 breast masses were finally assessed, of which 107 (50.2 %) masses were benign and 106 (49.8 %) masses were malignant. The sensitivity for mammography and ultrasound alone was 72.6% and 68.9%, respectively. This rate for combined mammography and ultrasound was 84.9%. About BI-RADS classification, 28 masses were classified as BI-RADS 3, 99 as BI-RADS 4A, 4 as BI-RADS 4B, 18 as BI-RADS 4C, and 64 as BI-RADS 5. BI-RADS 4A had the highest sensitivity (70.1%) among BI-RADS categories. The highest specificity pertained to BI-RADS 3 and 5 (100%) among BI-RADS categories. Also, the highest accuracy was related to BI-RADS 5 (80.3%). CONCLUSION The results of the present study showed that combined mammography and ultrasound had a higher rate of accuracy than mammography or ultrasound alone. Furthermore, the imaging methods BI-RADS classification had an acceptable positive predictive value.
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Affiliation(s)
- Naser Ghaemian
- Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | | | - Mehrdad Nabahati
- Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran,Correspondence: Mehrdad Nabahati, Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Ganjafrooz Street, Babol, 47176-47745, Iran. E-mail: , Tel: 0098 1132252071, Fax: 0098 1132252071
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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.
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Huang SC, Liang JD, Hsu SJ, Hong TC, Yang HC, Kao JH. Direct comparison of biopsy techniques for hepatic malignancies. Clin Mol Hepatol 2020; 27:305-312. [PMID: 33317239 PMCID: PMC8046634 DOI: 10.3350/cmh.2020.0301] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/25/2020] [Indexed: 01/04/2023] Open
Abstract
Background/Aims The core needle biopsy (CNB), fine needle aspiration cytology (FNAC) and touch imprint cytology (TIC) are commonly used tools for the diagnosis of hepatic malignancies. However, little is known about the benefits and criteria for selecting appropriate technique among them in clinical practice. We aimed to compare the sensitivity of ultrasound-guided CNB, FNAC, TIC as well as combinations for the diagnosis of hepatic malignancies, and to determine the factors associated with better sensitivity in each technique. Methods From January 2018 to December 2019, a total of 634 consecutive patients who received ultrasound-guided liver biopsies at the National Taiwan University Hospital was collected, of whom 235 with confirmed malignant hepatic lesions receiving CNB, FNAC and TIC simultaneously were enrolled for analysis. The clinical and procedural data were compared. Results The sensitivity of CNB, FNAC and TIC for the diagnosis of malignant hepatic lesions were 93.6%, 71.9%, and 85.1%, respectively. Add-on use of FNAC or TIC to CNB provided additional sensitivity of 2.1% and 0.4%, respectively. FNAC exhibited a significantly higher diagnostic rate in the metastatic cancers (P=0.011), hyperechoic lesions on ultrasound (P=0.028), and those with depth less than 4.5 cm from the site of needle insertion (P=0.036). Conclusions The sensitivity of CNB is superior to that of FNAC and TIC for the diagnosis of hepatic malignancies. Nevertheless, for shallow (depth <4.5 cm) and hyperechoic lesions not typical for primary liver cancers, FNAC alone provides excellent sensitivity.
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Affiliation(s)
- Shang-Chin Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ja-Der Liang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Jer Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Chan Hong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Hung-Chih Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Ong JS, Whitewood F, Taylor DB, Dissanayake D. Positive molecular breast imaging: challenges and problem solving with contrast-enhanced spectral mammography. BMJ Case Rep 2019; 12:12/10/e230043. [PMID: 31586952 DOI: 10.1136/bcr-2019-230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Molecular breast imaging (MBI) is a relatively new technique with high sensitivity for breast cancer detection. However, because it only provides limited anatomical information, cross-correlation of MBI findings with conventional breast imaging modalities such as full field digital mammography can be challenging. We report a case of a positive MBI study in a supplemental screening setting, where cross-correlation of MBI, ultrasound, mammogram and biopsy findings was difficult. Contrast-enhanced spectral mammography (CESM) demonstrated a hypervascular lesion at the biopsy clip, helping to prove imaging/histopathological concordance. This case highlights the challenges of incorporating MBI into conventional imaging workup, as well as the use of CESM in problem solving.
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Affiliation(s)
- Jeremy Sl Ong
- Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Felicity Whitewood
- Breast Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Deepthi Dissanayake
- Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
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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.
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Schizas N, Lazopoulos A, Krimiotis D, Rallis T, Paliouras D, Gogakos A, Chatzinikolaou F, Sarafis P, Domeyer P, Zarogoulidis P, Tsiouda T, Sardeli C, Laskou S, Koulouris C, Pavlidis E, Mantalobas S, Giannakidis D, Kesisoglou I, Sapalidis K, Barbetakis N. Beware of hemopneumothorax following core needle breast biopsy. Respir Med Case Rep 2018; 25:49-51. [PMID: 30013911 PMCID: PMC6019816 DOI: 10.1016/j.rmcr.2018.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/16/2018] [Accepted: 06/17/2018] [Indexed: 11/22/2022] Open
Abstract
Minimal diagnostic procedures are conducted regularly by the radiologists for several lesions within the body. The usual methodology is biopsy with a needle, either fine needle aspiration or core biopsy. The guidance is under CT or U/S. Fine needle aspiration has usually small diameter in comparison to the core biopsy. In any case the radiologist will choose the appropriate method based on the site of the lesion and safety of the patient. Pneumothorax and hemothorax are adverse effects that can be managed either on site with the help of a small catheter, however; there are cases where video-assisted thoracic surgery is needed in order to manage a more severe case. In the current study we present such a case where video-assisted surgery was necessary.
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Affiliation(s)
- Nikos Schizas
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Achileas Lazopoulos
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Dimitris Krimiotis
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Thomas Rallis
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Dimitris Paliouras
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Apostolos Gogakos
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | | | - Pavlos Sarafis
- Nursing Department, Cyprus University of Technology, Cyprus
| | | | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Theodora Tsiouda
- Pulmonary Department-Oncology Unit, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Chrysanthi Sardeli
- Obstetric Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece
| | - Stella Laskou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Charilaos Koulouris
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Efstathios Pavlidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Stylianos Mantalobas
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Dimitris Giannakidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Nikos Barbetakis
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
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