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Hua B, Yang G, An Y, Lou K, Chen J, Quan G, Yuan T. Clinical and Imaging Characteristics of Contrast-enhanced Mammography and MRI to Distinguish Microinvasive Carcinoma from Ductal Carcinoma In situ. Acad Radiol 2024:S1076-6332(24)00258-7. [PMID: 38734581 DOI: 10.1016/j.acra.2024.04.041] [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: 01/02/2024] [Revised: 04/14/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
RATIONALE AND OBJECTIVES The prognosis of ductal carcinoma in situ with microinvasion (DCISM) is more similar to that of small invasive ductal carcinoma (IDC) than to pure ductal carcinoma in situ (DCIS). It is particularly important to accurately distinguish between DCISM and DCIS. The present study aims to compare the clinical and imaging characteristics of contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) between DCISM and pure DCIS, and to identify predictive factors of microinvasive carcinoma, which may contribute to a comprehensive understanding of DCISM in clinical diagnosis and support surveillance strategies, such as surgery, radiation, and other treatment decisions. MATERIALS AND METHODS Forty-seven female patients diagnosed with DCIS were included in the study from May 2019 to August 2023. Patients were further divided into two groups based on pathological diagnosis: DCIS and DCISM. Clinical and imaging characteristics of these two groups were analyzed statistically. The independent clinical risk factors were selected using multivariate logistic regression and used to establish the logistic model [Logit(P)]. The diagnostic performance of independent predictors was assessed and compared using receiver operating characteristic (ROC) analysis and DeLong's test. RESULTS In CEM, the maximum cross-sectional area (CSAmax), the percentage signal difference between the enhancing lesion and background in the craniocaudal and mediolateral oblique projection (%RSCC, and %RSMLO) were found to be significantly higher for DCISM compared to DCIS (p = 0.001; p < 0.001; p = 0.008). Additionally, there were noticeable statistical differences in the patterns of enhancement morphological distribution (EMD) and internal enhancement pattern (IEP) between DCIS and DCISM (p = 0.047; p = 0.008). In MRI, only CSAmax (p = 0.012) and IEP (p = 0.020) showed significant statistical differences. The multivariate regression analysis suggested that CSAmax (in CEM or MR) and %RSCC were independent predictors of DCISM (all p < 0.05). The area under the curve (AUC) of CSAmax (CEM), %RSCC (CEM), Logit(P) (CEM), and CSAmax (MR) were 0.764, 0.795, 0.842, and 0.739, respectively. There were no significant differences in DeLong's test for these values (all p > 0.10). DCISM was significantly associated with high nuclear grade, comedo type, high axillary lymph node (ALN) metastasis, and high Ki-67 positivity compared to DCIS (all p < 0.05). CONCLUSION The tumor size (CSAmax), enhancement index (%RS), and internal enhancement pattern (IEP) were highly indicative of DCISM. DCISM tends to express more aggressive pathological features, such as high nuclear grade, comedo-type necrosis, ALN metastasis, and Ki-67 overexpression. As with MRI, CEM has the capability to help predict when DCISM is accompanying DCIS.
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Affiliation(s)
- Bei Hua
- Department of Radiology and Nuclear Medicine, The First Affiliated Hospital of Hebei Medical University, No.89 Donggang road, Shijiazhuang, Hebei, China
| | - Guang Yang
- Radiology Department, The Fourth Affiliated Hospital of Hebei Medical University, No.12 Jiankang road, Shijiazhuang, Hebei, China
| | - Yi An
- Department of Medical Service Division, The Fourth Affiliated Hospital of Hebei Medical University, No.12 Jiankang road, Shijiazhuang, Hebei, China
| | - Ke Lou
- Radiology Department, The Fourth Affiliated Hospital of Hebei Medical University, No.12 Jiankang road, Shijiazhuang, Hebei, China
| | - Jun Chen
- Radiology Department, The Fourth Affiliated Hospital of Hebei Medical University, No.12 Jiankang road, Shijiazhuang, Hebei, China.
| | - Guanmin Quan
- Department of Medical imaging, The Second Hospital of Hebei Medical University, No.215 Heping West road, Shijiazhuang, Hebei, China
| | - Tao Yuan
- Department of Medical imaging, The Second Hospital of Hebei Medical University, No.215 Heping West road, Shijiazhuang, Hebei, China
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Tweel JED, Ecclestone BR, Gaouda H, Dinakaran D, Wallace MP, Bigras G, Mackey JR, Reza PH. Photon Absorption Remote Sensing Imaging of Breast Needle Core Biopsies Is Diagnostically Equivalent to Gold Standard H&E Histologic Assessment. Curr Oncol 2023; 30:9760-9771. [PMID: 37999128 PMCID: PMC10670721 DOI: 10.3390/curroncol30110708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
Photon absorption remote sensing (PARS) is a new laser-based microscope technique that permits cellular-level resolution of unstained fresh, frozen, and fixed tissues. Our objective was to determine whether PARS could provide an image quality sufficient for the diagnostic assessment of breast cancer needle core biopsies (NCB). We PARS imaged and virtually H&E stained seven independent unstained formalin-fixed paraffin-embedded breast NCB sections. These identical tissue sections were subsequently stained with standard H&E and digitally scanned. Both the 40× PARS and H&E whole-slide images were assessed by seven breast cancer pathologists, masked to the origin of the images. A concordance analysis was performed to quantify the diagnostic performances of standard H&E and PARS virtual H&E. The PARS images were deemed to be of diagnostic quality, and pathologists were unable to distinguish the image origin, above that expected by chance. The diagnostic concordance on cancer vs. benign was high between PARS and conventional H&E (98% agreement) and there was complete agreement for within-PARS images. Similarly, agreement was substantial (kappa > 0.6) for specific cancer subtypes. PARS virtual H&E inter-rater reliability was broadly consistent with the published literature on diagnostic performance of conventional histology NCBs across all tested histologic features. PARS was able to image unstained tissues slides that were diagnostically equivalent to conventional H&E. Due to its ability to non-destructively image fixed and fresh tissues, and the suitability of the PARS output for artificial intelligence assistance in diagnosis, this technology has the potential to improve the speed and accuracy of breast cancer diagnosis.
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Affiliation(s)
- James E. D. Tweel
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Benjamin R. Ecclestone
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Hager Gaouda
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Deepak Dinakaran
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Michael P. Wallace
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Gilbert Bigras
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - John R. Mackey
- Illumisonics Inc., 22 King Street South, Suite 300, Waterloo, ON N2J 1N8, Canada; (D.D.); (J.R.M.)
| | - Parsin Haji Reza
- PhotoMedicine Labs, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (J.E.D.T.); (B.R.E.); (H.G.)
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Wang LC, Rao S, Schacht D, Bhole S. Reducing False Negatives in Biopsy of Suspicious MRI Findings. JOURNAL OF BREAST IMAGING 2023; 5:597-610. [PMID: 38416912 DOI: 10.1093/jbi/wbad024] [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] [Received: 09/14/2022] [Indexed: 03/01/2024]
Abstract
Breast MRI is a highly sensitive imaging modality that often detects findings that are occult on mammography and US. Given the overlap in appearance of benign and malignant lesions, an accurate method of tissue sampling for MRI-detected findings is essential. Although MRI-directed US and correlation with mammography can be helpful for some lesions, a correlate is not always found. MRI-guided biopsy is a safe and effective method of tissue sampling for findings seen only on MRI. The unique limitations of this technique, however, contribute to false negatives, which can result in delays in diagnosis and adverse patient outcomes; this is of particular importance as most MRI examinations are performed in the high-risk or preoperative setting. Here, we review strategies to minimize false negatives in biopsy of suspicious MRI findings, including appropriate selection of biopsy modality, use of meticulous MRI-guided biopsy technique, management after target nonvisualization, assessment of adequate lesion sampling, and determination of radiology-pathology concordance. A proposed management algorithm for MRI-guided biopsy results will also be discussed.
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Affiliation(s)
- Lilian C Wang
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - Sandra Rao
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - David Schacht
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - Sonya Bhole
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
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4
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Ko EY. [Ultrasound-Guided Intervention for Breast Lesions]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:332-344. [PMID: 37051398 PMCID: PMC10083634 DOI: 10.3348/jksr.2023.0019] [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: 02/19/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
The role of ultrasound-guided interventions in the diagnosis and treatment of breast lesions is gaining importance and prevalence, particularly as the instances of non-palpable breast lesion detection, breast-conserving surgery, and neoadjuvant chemotherapy are increasing. This review attempts to summarize the types and techniques of breast ultrasound-guided interventional procedures, such as biopsy, tissue marker insertion, and preoperative localization, and their indications. Furthermore, we highlight the pro and cons of the most commonly used procedures with the intention of promoting their use in clinical practice.
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ALTINTAŞ S, BAYRAK M. COVID-19 pandemisinin meme kanser teşhis sürecine etkisi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1103193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Purpose: The primary aim of thşis study was to evaluate difference in the number of patients with tru-cut biopsies to diagnose breast lesions between non-pandemic and pandemic periods.
Materials and Methods: In this study, the nonpandemic period and the pandemic period were compared, the periods for the pandemic times, between March 1, 2018, and 29 February 2020, and for the nonpandemic period, 1 March 2020 to 12 March 2022 to 12 March 2022. In each period, we have included all the tru-cut biopsies for suspected breast cancer. During the pandemic and non-pandemic period, the number of tru-cut biopsies BI-RADS and histopathological findings of the patients who experienced tru-cut biopsies were compared.
Results: The number of tru-cut biopsies performed during the nonpandemic and pandemic period was similar (1596, 1599). In the pandemic period, tru-cut biopsy histopathologic reports revealed that benign and high-risk cases decreased statistically, while invasive carcinoma cases increased by 1.9 (95% CI 1.6-2.2) times. During the pandemic period, US-guided BI-RADS 3 and BI-RADS 4a cases decreased statistically significantly, BBI-RADS 4b cases increased 1.4 (95% CI 1.1-2.2) times, BI-RADS 4c cases 1.7 (95% CI 1.2-2.2), BI-RADS 5 cases increased 2.1 (95% CI 1.4-3.1) times
Conclusion: There was no significant change in tru-cut biopsy numbers compared to the period of the pandemic and the non-pandemic period. However, the stage of the cancers captured during the period of the pandemic was higher.
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Affiliation(s)
- Süleyman ALTINTAŞ
- UNIVERSITY OF HEALTH SCIENCES, ADANA NUMUNE HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF MEDICAL PATHOLOGY
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A Machine Learning Ensemble Based on Radiomics to Predict BI-RADS Category and Reduce the Biopsy Rate of Ultrasound-Detected Suspicious Breast Masses. Diagnostics (Basel) 2022; 12:diagnostics12010187. [PMID: 35054354 PMCID: PMC8774734 DOI: 10.3390/diagnostics12010187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/01/2023] Open
Abstract
We developed a machine learning model based on radiomics to predict the BI-RADS category of ultrasound-detected suspicious breast lesions and support medical decision-making towards short-interval follow-up versus tissue sampling. From a retrospective 2015–2019 series of ultrasound-guided core needle biopsies performed by four board-certified breast radiologists using six ultrasound systems from three vendors, we collected 821 images of 834 suspicious breast masses from 819 patients, 404 malignant and 430 benign according to histopathology. A balanced image set of biopsy-proven benign (n = 299) and malignant (n = 299) lesions was used for training and cross-validation of ensembles of machine learning algorithms supervised during learning by histopathological diagnosis as a reference standard. Based on a majority vote (over 80% of the votes to have a valid prediction of benign lesion), an ensemble of support vector machines showed an ability to reduce the biopsy rate of benign lesions by 15% to 18%, always keeping a sensitivity over 94%, when externally tested on 236 images from two image sets: (1) 123 lesions (51 malignant and 72 benign) obtained from two ultrasound systems used for training and from a different one, resulting in a positive predictive value (PPV) of 45.9% (95% confidence interval 36.3–55.7%) versus a radiologists’ PPV of 41.5% (p < 0.005), combined with a 98.0% sensitivity (89.6–99.9%); (2) 113 lesions (54 malignant and 59 benign) obtained from two ultrasound systems from vendors different from those used for training, resulting into a 50.5% PPV (40.4–60.6%) versus a radiologists’ PPV of 47.8% (p < 0.005), combined with a 94.4% sensitivity (84.6–98.8%). Errors in BI-RADS 3 category (i.e., assigned by the model as BI-RADS 4) were 0.8% and 2.7% in the Testing set I and II, respectively. The board-certified breast radiologist accepted the BI-RADS classes assigned by the model in 114 masses (92.7%) and modified the BI-RADS classes of 9 breast masses (7.3%). In six of nine cases, the model performed better than the radiologist did, since it assigned a BI-RADS 3 classification to histopathology-confirmed benign masses that were classified as BI-RADS 4 by the radiologist.
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7
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Cozzi A, Schiaffino S, Fanizza M, Magni V, Menicagli L, Monaco CG, Benedek A, Spinelli D, Di Leo G, Di Giulio G, Sardanelli F. Contrast-enhanced mammography for the assessment of screening recalls: a two-centre study. Eur Radiol 2022; 32:7388-7399. [PMID: 35648209 PMCID: PMC9668944 DOI: 10.1007/s00330-022-08868-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the potential of contrast-enhanced mammography (CEM) for reducing the biopsy rate of screening recalls. METHODS Recalled women were prospectively enrolled to undergo CEM alongside standard assessment (SA) through additional views, tomosynthesis, and/or ultrasound. Exclusion criteria were symptoms, implants, allergy to contrast agents, renal failure, and pregnancy. SA and CEM were independently evaluated by one of six radiologists, who recommended biopsy or 2-year follow-up. Biopsy rates according to SA or recombined CEM (rCEM) were compared with the McNemar's test. Diagnostic performance was calculated considering lesions with available final histopathology. RESULTS Between January 2019 and July 2021, 220 women were enrolled, 207 of them (median age 56.6 years) with 225 suspicious findings analysed. Three of 207 patients (1.4%) developed mild self-limiting adverse reactions to iodinated contrast agent. Overall, 135/225 findings were referred for biopsy, 90/225 by both SA and rCEM, 41/225 by SA alone and 4/225 by rCEM alone (2/4 being one DCIS and one invasive carcinoma). The rCEM biopsy rate (94/225, 41.8%, 95% CI 35.5-48.3%) was 16.4% lower (p < 0.001) than the SA biopsy rate (131/225, 58.2%, 95% CI 51.7-64.5%). Considering the 124/135 biopsies with final histopathology (44 benign, 80 malignant), rCEM showed a 93.8% sensitivity (95% CI 86.2-97.3%) and a 65.9% specificity (95% CI 51.1-78.1%), all 5 false negatives being ductal carcinoma in situ detectable as suspicious calcifications on low-energy images. CONCLUSIONS Compared to SA, the rCEM-based work-up would have avoided biopsy for 37/225 (16.4%) suspicious findings. Including low-energy images in interpretation provided optimal overall CEM sensitivity. KEY POINTS • The work-up of suspicious findings detected at mammographic breast cancer screening still leads to a high rate of unnecessary biopsies, involving between 2 and 6% of screened women. • In 207 recalled women with 225 suspicious findings, recombined images of contrast-enhanced mammography (CEM) showed a 93.8% sensitivity and a 65.9% specificity, all 5 false negatives being ductal carcinoma in situ detectable on low-energy images as suspicious calcifications. • CEM could represent an easily available one-stop shop option for the morphofunctional assessment of screening recalls, potentially reducing the biopsy rate by 16.4%.
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Affiliation(s)
- Andrea Cozzi
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy
| | - Simone Schiaffino
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Marianna Fanizza
- grid.419425.f0000 0004 1760 3027Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Veronica Magni
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy
| | - Laura Menicagli
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Cristian Giuseppe Monaco
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Adrienn Benedek
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Diana Spinelli
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Giovanni Di Leo
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Giuseppe Di Giulio
- grid.419425.f0000 0004 1760 3027Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Francesco Sardanelli
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy ,grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
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Ultrasound Guided Core Breast Biopsies. Tech Vasc Interv Radiol 2021; 24:100776. [PMID: 34861968 DOI: 10.1016/j.tvir.2021.100776] [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: 11/23/2022]
Abstract
Core needle biopsies are common procedures performed in breast imaging centers. Utilizing ultrasound guidance for biopsy of suspicious findings within the breast and axilla is the standard of care when lesions are visible on ultrasound. Most ultrasound guided breast biopsies are performed by radiologists interpreting breast imaging who correlate findings across modalities including mammography, ultrasound and breast MRI, however interventional radiologists may perform in some practice settings. Appropriate knowledge of complete breast imaging is important not only for localization, but for determining radiologic-pathologic concordance. Proper localization, technique, and post biopsy management are essential to the success of the procedure and providing proper care for patients. This article discusses indications, strategies for accurate targeting, how-to biopsy techniques, post biopsy considerations and radiologic-pathologic concordance incorporating recommendations from the American College of Radiology Practice Parameter for the Performance of Ultrasound-guided Percutaneous Breast Interventional procedures.
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Bhatt AA, Whaley DH, Lee CU. Ultrasound-Guided Breast Biopsies: Basic and New Techniques. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1427-1443. [PMID: 32997819 PMCID: PMC8246574 DOI: 10.1002/jum.15517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 05/28/2023]
Abstract
Ultrasound-guided breast biopsies can be challenging to perform, especially when the target is adjacent to the nipple, skin, or implant or when the target is small and in very posterior, dense fibroglandular tissue. Oftentimes, a slightly modified approach can result in a diagnostic biopsy specimen with minimal complications. After a brief review of basic techniques for ultrasound-guided breast biopsies that includes a review of conventional breast biopsy devices, a presentation of procedural modifications and techniques to consider for more challenging cases is described. In particular, novel open-trough and tandem-needle techniques are detailed. Several cases using these techniques are then presented.
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Affiliation(s)
- Asha A. Bhatt
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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10
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Clinical practice guidelines for ultrasound-guided breast lesions and lymph nodes biopsy: Chinese society of breast surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl) 2021; 134:1393-1395. [PMID: 34039868 PMCID: PMC8213268 DOI: 10.1097/cm9.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Mathelin C, Molière S. [The HRT follow-up consultation. What to do in case of breast tumour (clinical or radiological) and microcalcifications. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:485-492. [PMID: 33757919 DOI: 10.1016/j.gofs.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective was to evaluate the diagnostic value of clinical examination and complementary imaging in the exploration of a breast lump or microcalcifications occurring in a postmenopausal woman taking hormonal replacement therapy (HRT), based on a systematic review of the literature in order to make recommendations for HRT management. METHODS A literature review was conducted using Medline, Cochrane Library data and international recommendations in French and English until 2020. RESULTS In the presence of a clinical breast mass in postmenopausal women, there is no clinical evidence to rule out cancer. A double evaluation by mammography and ultrasound is recommended and allows the imaging to be classified into 5 BI-RADS categories. The diagnostic management of masses classified BI-RADS 4 and 5 should be based on percutaneous sampling, with microbiopsy being the first step. A total of four situations may arise: 1. Clinical examination has detected a breast mass, but there is no imaging abnormality. In this case, the imaging NPV is high (>96%). If the clinical lesion increases in size, a tissue biopsy should be performed, while continued routine breast screening is recommended if the lesion remains stable and HRT can be continued. 2. Clinical examination, mammography, and ultrasound are in favour of a cyst. Simple cysts can be punctured if painful. There is no contraindication to continuing HRT in the case of simple cysts. Management options for complicated and complex cysts are no different from those offered to women without HRT. Continuation of HRT must consider their histological nature. 3. Clinical examination, mammography, and ultrasonography suggest a benign solid tumour. The management of these benign breast lesions (fibroadenoma…) is not different in women taking an HRT and there is no contraindication to continue the HRT. 4: Clinical examination, imaging and microbiopsy diagnose a malignant tumour. It is imperative that the HRT be stopped, whatever the hormonal dependence of the tumour and whether it is invasive or in situ. The management of the cancerous tumour must consider the updated breast cancer treatment guidelines. In the presence of microcalcifications, the course of action to be taken depends on the BI-RADS classification, established according to the morphology and arrangement of the calcifications. In case of suspicious microcalcifications (BI-RADS 4 or 5), a guided macrobiopsy should be performed. Diagnostic and therapeutic management in these patients is no different from that offered to women without HRT. Discontinuation of HRT is necessary in cases of malignancy (in situ or invasive cancer). CONCLUSION A rigorous multidisciplinary approach is necessary for the exploration of a breast mass or microcalcifications in a postmenopausal woman.
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Affiliation(s)
- C Mathelin
- Service de chirurgie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67033 Strasbourg cedex, France; CHRU, Hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France; IGBMC, Institut de génétique et de biologie moléculaire et cellulaire, biologie du cancer, CNRS UMR 7104, INSERM U964, Université de Strasbourg, Illkirch, France.
| | - S Molière
- CHRU, Hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France; Unité d'imagerie mammaire, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette. 67033 Strasbourg cedex, France
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Atypical Ductal Hyperplasia on Ultrasonography-Guided Vacuum-Assisted Biopsy of the Breast: Considerations for Further Surgical Excision. Ultrasound Q 2021; 36:192-198. [PMID: 32511211 DOI: 10.1097/ruq.0000000000000478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purposes of this study are to evaluate the upgrade rate of atypical ductal hyperplasia (ADH) diagnosed with ultrasonography (US)-guided vacuum-assisted biopsy (VAB) to malignancy and to identify the factors behind the underestimation. We retrospectively reviewed the pathologic results of US-guided VAB of the breast. A total of 50 ADH lesions that were surgically excised or with more than 12 months of follow-up were included. The upgrade rate of ADH was determined by dividing the number of lesions that were proven malignant on surgical excision by the total number of ADH diagnosed on VAB. Clinical, radiologic, procedural, and pathologic variables were analyzed to identify the factors behind the underestimation. The upgrade rate of ADH was found to be 16.0% (8/50 lesions). In univariable and multivariable analyses, the upgrade rates of ADH did not significantly differ among variables. In a subgroup analysis, according to history of breast cancer, the upgrade rates of ADH were significantly lower for lesions of mass than for lesions of nonmass (0% [0/23 lesions] vs 28.6% [4/14 lesions], P = 0.015), and for lesions without calcifications than for lesions with calcifications (0% [0/22 lesions] vs 26.7% [4/15 lesions], P = 0.021) in the negative history subgroup. ADH lesions in masses or without calcifications in patients without a family or personal history of breast cancer were associated with low upgrade rates. Thus, we suggest that ADH with these features can be followed rather than surgically excised after US-guided VAB.
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Henry-Tillman R, Kabongo M, Laryea J, Pinder L, Bittenbinder R, Osgood G, Hicks M, Hicks M, Parham G. The Ability to Look: Management of Breast Disease in the Democratic Republic of the Congo Using Smart Ultrasound Technology. J Am Coll Surg 2020; 232:636-640. [PMID: 33348015 DOI: 10.1016/j.jamcollsurg.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The vast majority of women with breast cancer in sub-Saharan Africa present with advanced stage disease, due primarily to the lack of opportunities for early detection and treatment. As part of a larger effort to increase access to diagnostic and therapeutic services for women's cancers in the Democratic Republic of Congo (DRC), we implemented a curriculum to train the local workforce and a program to build the supportive infrastructure for the diagnosis and treatment of breast cancer at a private sector health facility (Biamba Marie Mutombo Hospital) in Kinshasa. STUDY DESIGN After onsite trainings in the DRC by a US breast surgeon (RT), Congolese surgeons, general physicians, physician assistants, and nurses used the Phillips Lumify smart-phone ultrasound device to perform and interpret the results of whole breast ultrasound on symptomatic women. Surgeons were trained to perform ultrasound-guided core needle biopsy on those who met the criteria for tissue diagnosis, after which they trained nurses to do the same. RESULTS Over 3 years, 5,211 patients were identified as having a breast abnormality on clinical breast examination. Ultrasound abnormalities were noted in 1,493 (27%) patients, of which 632 (42%) met the criteria for ultrasound-guided core needle biopsy or fine needle aspiration. Pathology reports were available on 368 (58%) patients who underwent biopsy, of which 164 were malignant and 204 benign. CONCLUSIONS We demonstrated how the "ability to look" using smart technology can be successfully used to augment clinical breast exam and triage patients for biopsy in a resource-constrained African setting.
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Affiliation(s)
- Ronda Henry-Tillman
- University of Arkansas for Medical Sciences, Department of Surgery, Winthrop P Rockefeller Cancer Institute, Little Rock, AR.
| | - Mathew Kabongo
- Biamba Marie Mutombo Hospital, Democratic Republic of the Congo
| | - Jonathan Laryea
- University of Arkansas for Medical Sciences, Department of Surgery, Winthrop P Rockefeller Cancer Institute, Little Rock, AR
| | - Leeya Pinder
- University of Washington, Department of Oncology, Seattle, WA
| | - Rebecca Bittenbinder
- University of Arkansas for Medical Sciences, Department of Surgery, Winthrop P Rockefeller Cancer Institute, Little Rock, AR
| | - Geoffrey Osgood
- University of Arkansas for Medical Sciences, Department of Surgery, Winthrop P Rockefeller Cancer Institute, Little Rock, AR
| | - Maya Hicks
- Howard University College of Medicine, Washington, DC
| | - Michael Hicks
- Michigan Cancer Institute, Pontiac, MI; University of North Carolina at Chapel Hill, Department of Obstetrics & Gynecology, Chapel Hill, NC; Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka, Zambia
| | - Groesbeck Parham
- Biamba Marie Mutombo Hospital, Democratic Republic of the Congo; University of North Carolina at Chapel Hill, Department of Obstetrics & Gynecology, Chapel Hill, NC; Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, Lusaka, Zambia
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Jung I, Han K, Kim MJ, Moon HJ, Yoon JH, Park VY, Kim EK. Annual Trends in Ultrasonography-Guided 14-Gauge Core Needle Biopsy for Breast Lesions. Korean J Radiol 2020; 21:259-267. [PMID: 32090518 PMCID: PMC7039722 DOI: 10.3348/kjr.2019.0695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/16/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To examine time trends in ultrasonography (US)-guided 14-gauge core needle biopsy (CNB) for breast lesions based on the lesion size, Breast Imaging-Reporting and Data System (BI-RADS) category, and pathologic findings. Materials and Methods We retrospectively reviewed consecutive US-guided 14-gauge CNBs performed from January 2005 to December 2016 at our institution. A total of 22,297 breast lesions were included. The total number of biopsies, tumor size (≤ 10 mm to > 40 mm), BI-RADS category (1 to 5), and pathologic findings (benign, high risk, ductal carcinoma in situ [DCIS], invasive cancer) were examined annually, and the malignancy rate was analyzed based on the BI-RADS category. Results Both the total number of US scans and US-guided CNBs increased while the proportion of US-guided CNBs to the total number of US scans decreased significantly. The number of biopsies classified based on the tumor size, BI-RADS category, and pathologic findings all increased over time, except for BI-RADS categories 1 or 2 and category 3 (odds ratio [OR] = 0.951 per year, 95% confidence interval [CI]: 0.902, 1.002 and odds ratio = 0.979, 95% CI: 0.970, 0.988, respectively). Both the unadjusted and adjusted total malignancy rates and the DCIS rate increased significantly over time. BI-RADS categories 4a, 4b, and 4c showed a significant increasing trend in the total malignancy rate and DCIS rate. Conclusion The malignancy rate in the results of US-guided 14-gauge CNB for breast lesions increased as the total number of biopsies increased from 2005 to 2016. This trend persisted after adjusting for the BI-RADS category.
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Affiliation(s)
- Inha Jung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Yonsei Biomedical Research Institute, 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
| | - 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.
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Gruber I, Oberlechner E, Heck K, Hoopmann U, Böer B, Fugunt R, Gall C, Hartkopf AD, Helms G, Hoffmann SM, Ott C, Röhm C, Stäbler A, Wallwiener D, Brucker SY, Hahn M. Percutaneous Ultrasound-Guided Core Needle Biopsy: Comparison of 16-Gauge versus 14-Gauge Needle and the Effect of Coaxial Guidance in 1065 Breast Biopsies - A Prospective Randomized Clinical Noninferiority Trial. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:534-543. [PMID: 31791085 DOI: 10.1055/a-1014-2628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Ultrasound-guided core needle biopsy (CNB) is considered the standard assessment to diagnose sonographically visible suspicious breast mass lesions. Based on nonrandomized trials, the current German guidelines recommend at least three cylinders with ≤ 14-gauge needle biopsy. However, no recommendation is made as to how many specimens are needed with a smaller needle size, such as 16-gauge, or if biopsy with coaxial guidance improves diagnostic accuracy and quality. Therefore, in a prospective monocentric unblinded randomized controlled clinical noninferiority trial, the diagnostic accuracy of 16-gauge versus 14-gauge core needle biopsy, with and without coaxial guidance, was evaluated. MATERIALS AND METHODS 1065 breast biopsies were included in order to analyze the number of core samples necessary to obtain an appropriate rate of diagnostic quality adequate for histological evaluation, and to achieve high diagnostic accuracy and diagnostic yield. Histological results were verified by surgery or long-term follow-up of at least two years up to five years. RESULTS In order to obtain an additive diagnostic accuracy of > 99 %, a minimum of two cylinders with 14-gauge biopsy were required. The diagnostic accuracy and the diagnostic quality of 14-gauge biopsy were not affected by the coaxial technique. When performing a 16-gauge biopsy, five cylinders were required to achieve an additive diagnostic accuracy of > 99 %. Without coaxial guidance, 16-gauge CNB required at least three samples, whereas five needle passes with coaxial-guided 16-gauge biopsy were needed. CONCLUSION The diagnostic accuracy and quality of ultrasound-guided 16-gauge core needle biopsy were inferior to the 14-gauge needle size, regardless of the use of a coaxial technique.
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Affiliation(s)
- Ines Gruber
- Department of Women's Health, University of Tübingen, Germany
| | | | - Kerstin Heck
- Frauenklinik, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany
| | - Uta Hoopmann
- Department of Women's Health, University of Tübingen, Germany
| | - Bettina Böer
- Department of Women's Health, University of Tübingen, Germany
| | - Regina Fugunt
- Department of Women's Health, University of Tübingen, Germany
| | - Christian Gall
- Department of Women's Health, University of Tübingen, Germany
| | | | - Gisela Helms
- Department of Women's Health, University of Tübingen, Germany
| | | | - Claudia Ott
- Department of Women's Health, University of Tübingen, Germany
| | - Carmen Röhm
- Department of Women's Health, University of Tübingen, Germany
| | - Annette Stäbler
- Institute of Pathology and Neuropathology, University of Tübingen, Germany
| | | | - Sara Y Brucker
- Department of Women's Health, University of Tübingen, Germany
| | - Markus Hahn
- Department of Women's Health, University of Tübingen, Germany
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Meucci R, Pistolese Chiara A, Perretta T, Vanni G, Portarena I, Manenti G, Ryan Colleen P, Castrignanò A, Di Stefano C, Ferrari D, Lamacchia F, Pellicciaro M, Materazzo M, Buonomo Oreste C. MR imaging-guided vacuum assisted breast biopsy: Radiological-pathological correlation and underestimation rate in pre-surgical assessment. Eur J Radiol Open 2020; 7:100244. [PMID: 32715029 PMCID: PMC7369605 DOI: 10.1016/j.ejro.2020.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Magnetic Resonance(MR) guided percutaneous procedures(MRgVABB) have been developed and largely employed to reduce the need of surgical biopsies for suspicious lesions which can be detected only by MR(MR-only lesion). The present study aims to investigate correlation between imaging, histological features of MRgVABB and surgical specimens of MR-only lesions. METHODS We retrospectively enrolled 56 patients with a total of 61 lesions. Each finding was defined as Mass-Enhancement(ME) or Non-ME(NME) and classified according to BI-RADS. MRgVABB and surgical data were collected. Concordance between MR, MRgVABB and open biopsy was calculated. Underestimation Rate(UR) of MRgVABB with surgery was obtained. RESULTS B2 and B5b lesions were statistically associated with NME and ME, respectively. No statistical association was found to B3 nor to B5a with radiological features. UR was 10 %; underestimated lesions were strongly associated with the presence of a ME on MR imaging. Moreover, B3 lesions are associated with higher UR. CONCLUSION Radiological features should influence patient management aiming to construct a correct diagnostic and therapeutic plan. When MR is prescribed for breast cancer staging for ME-MR-only lesions, we suggest surgical open biopsy instead of MRgVABB when upfront surgery is the treatment of choice.
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Affiliation(s)
- Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Adriana Pistolese Chiara
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Guglielmo Manenti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Patricia Ryan Colleen
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Antonella Castrignanò
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Donatella Ferrari
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Claudio Buonomo Oreste
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
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Asian Society of Mastology (ASOMA)–Proposed Standards for Care of Breast Cancer Patients. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02223-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Schiaffino S, Calabrese M, Melani EF, Trimboli RM, Cozzi A, Carbonaro LA, Di Leo G, Sardanelli F. Upgrade Rate of Percutaneously Diagnosed Pure Atypical Ductal Hyperplasia: Systematic Review and Meta-Analysis of 6458 Lesions. Radiology 2019; 294:76-86. [PMID: 31660803 DOI: 10.1148/radiol.2019190748] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Management of percutaneously diagnosed pure atypical ductal hyperplasia (ADH) is an unresolved clinical issue. Purpose To calculate the pooled upgrade rate of percutaneously diagnosed pure ADH. Materials and Methods A search of MEDLINE and EMBASE databases was performed in October 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines were followed. A fixed- or random-effects model was used, along with subgroup and meta-regression analyses. The Newcastle-Ottawa scale was used for study quality, and the Egger test was used for publication bias. Results Of 521 articles, 93 were analyzed, providing data for 6458 ADHs (5911 were managed with surgical excision and 547 with follow-up). Twenty-four studies used core-needle biopsy; 44, vacuum-assisted biopsy; 21, both core-needle and vacuum-assisted biopsy; and four, unspecified techniques. Biopsy was performed with stereotactic guidance in 29 studies; with US guidance in nine, with MRI guidance in nine, and with mixed guidance in eight. Overall heterogeneity was high (I2 = 80%). Subgroup analysis according to management yielded a pooled upgrade rate of 29% (95% confidence interval [CI]: 26%, 32%) for surgically excised lesions and 5% (95% CI: 4%, 8%) for lesions managed with follow-up (P < .001). Heterogeneity was entirely associated with surgically excised lesions (I2 = 78%) rather than those managed with follow-up (I2 = 0%). Most variability was explained by guidance and needle caliper (P = .15). At subgroup analysis of surgically excised lesions, the pooled upgrade rate was 42% (95% CI: 31%, 53%) for US guidance, 23% (95% CI: 19%, 27%) for stereotactic biopsy, and 32% (95% CI: 22%, 43%) for MRI guidance, with heterogeneity (52%, 63%, and 56%, respectively) still showing the effect of needle caliper. When the authors considered patients with apparent complete lesion removal after biopsy (subgroups in 14 studies), the pooled upgrade rate was 14% (95% CI: 8%, 23%). Study quality was low to medium; the risk of publication bias was low (P = .10). Conclusion Because of a pooled upgrade rate higher than 2% (independent of biopsy technique, needle size, imaging guidance, and apparent complete lesion removal), atypical ductal hyperplasia diagnosed with percutaneous needle biopsy should be managed with surgical excision. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Brem in this issue.
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Affiliation(s)
- Simone Schiaffino
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Massimo Calabrese
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Enrico Francesco Melani
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Rubina Manuela Trimboli
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Andrea Cozzi
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Luca Alessandro Carbonaro
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Giovanni Di Leo
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Francesco Sardanelli
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
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Crnogorac M, Ivanac G, Tomasović-Lončarić Č, Žic R, Kelava T, Brkljačić B. SONOELASTOGRAPHIC FEATURES OF HIGH-RISK BREAST LESIONS AND DUCTAL CARCINOMA IN SITU - A PILOT STUDY. Acta Clin Croat 2019; 58:13-22. [PMID: 31363320 PMCID: PMC6629205 DOI: 10.20471/acc.2019.58.01.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.
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Affiliation(s)
| | - Gordana Ivanac
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Čedna Tomasović-Lončarić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Rado Žic
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Tomislav Kelava
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Boris Brkljačić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
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Suthakorn J, Tanaiutchawoot N, Wiratkapan C, Ongwattanakul S. Breast biopsy navigation system with an assisted needle holder tool and 2D graphical user interface. Eur J Radiol Open 2018; 5:93-101. [PMID: 30109245 PMCID: PMC6090089 DOI: 10.1016/j.ejro.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022] Open
Abstract
Objective This paper proposes the development of a breast biopsy navigation system with an assisted needle holder tool for a coaxial needle and a graphical user interface, which utilizes an optical tracking device to localize the needle position relative to the ultrasound image with the aim to improve performance especially for a new radiologist or an inexperienced group. Materials and methods The system consists of an assisted needle holder tool, which as an attachment for the 2D ultrasound transducer and the graphical user interface (GUI) that shows the needle pathway, needle line and warning signs. An optical tracking system is used to track the needle motion, ultrasound image and transform all information to with respect to the technique. The system is evaluated using a phantom made from gel candle. There were nine experienced and eight inexperienced participants who performed the breast biopsy intervention, using three methods: the freehand method, only the needle holder tool guidance, and the whole navigation guidance (GUI + assisted needle holder). Results The results demonstrate a success rate of over 90% using only assisted needle holder and the whole system to perform breast biopsy for the experienced and inexperienced groups, whereas for the inexperienced group a success rate of 57.5% was achieved using the freehand method. The use of only assisted needle holder for breast biopsy reduces the time for a procedure in the inexperienced group by 6 s when compared to the freehand method. Conclusion The authors believe that this navigation system can be applied in a clinical setting and give an advantage to inexperienced radiologists who must successfully perform clinical breast biopsy.
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Affiliation(s)
- Jackrit Suthakorn
- Center for Biomedical and Robotics Technology (BART LAB) Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Thailand
| | - Narucha Tanaiutchawoot
- Center for Biomedical and Robotics Technology (BART LAB) Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Thailand
| | - Cholatip Wiratkapan
- Breast Diagnostic Center, Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Songpol Ongwattanakul
- Center for Biomedical and Robotics Technology (BART LAB) Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Thailand
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Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters. Clin Imaging 2018; 50:302-307. [DOI: 10.1016/j.clinimag.2018.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 04/13/2018] [Accepted: 05/01/2018] [Indexed: 12/30/2022]
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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.
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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
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Effect of Needle Size in Ultrasound-guided Core Needle Breast Biopsy: Comparison of 14-, 16-, and 18-Gauge Needles. Clin Breast Cancer 2017; 17:536-543. [DOI: 10.1016/j.clbc.2017.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 11/20/2022]
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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.
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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
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Song SE, Cho N, Han W. Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI. Eur Radiol 2017; 27:5196-5203. [PMID: 28687909 DOI: 10.1007/s00330-017-4924-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate whether the post-clip placement MRI following second-look ultrasound (US)-guided core biopsy is useful to confirm the adequate sampling of suspicious lesions identified on breast MRI. METHODS Between 2014 and 2016, 31 consecutive women with 34 suspicious lesions that had not been identified on previous mammography or US were detected using MRI. Among them, 26 women with 29 lesions (mean size 1.5 cm, range 0.5-5.8 cm) found by second-look US underwent US-guided biopsy, subsequent clip insertion and post-clip placement MRI. Five women with five lesions that were not found by second-look US underwent MRI-guided biopsy. The technical success rate and lesion characteristics were described. RESULTS The technical success rate was 96.6% (28/29). One failure case was a benign, 1.1-cm non-mass enhancement. Of the 28 success cases, 23 (82.1%) were masses and 5 (17.9%) were non-mass enhancements; 17 (60.7%) were benign, 4 (14.3%) were high-risk and 7 (25.0%) were malignant lesions. The technical success rate was 100% (28/28) for masses and 83.3% (5/6) for non-mass enhancements. CONCLUSIONS Post-clip placement MRI following US-guided biopsy is useful in confirming the adequate sampling of lesions identified on MRI. This method could be an alternative to MRI-guided biopsy for lesions visible on US. KEY POINTS • Post-clip MRI is useful for confirming adequate sampling of US-guided biopsy. • Post-clip MRI following US-guided biopsy revealed a 96.6 % technical success rate. • One technical failure case was a benign, 1.1-cm non-mass enhancement. • The technical success rate of US-guided biopsy for non-mass enhancements was 83.3 %.
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Affiliation(s)
- Sung Eun Song
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Centre, Seoul, Republic of Korea.
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Bilan d’extension du cancer du sein : ne rien rater, ne pas surestimer. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Surridge CA, Goodier MD. An analysis of diagnostic practices in a mammography unit in a tertiary hospital in South Africa. SA J Radiol 2017. [DOI: 10.4102/sajr.v21i1.1059] [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: Breast cancer is the most common cancer in females in South Africa. The reporting of breast imaging has been standardised internationally using the Breast Imaging and Reporting Data System (BI-RADS), which includes guidelines for reporting of breast lesions and further management. Ultrasound-guided core-needle breast (UGCNB) biopsy is a widely used method of obtaining histological diagnoses of breast lesions to assist with planning definitive management.Objectives: To perform an audit of the UGCNB biopsies performed at the Grey’s Hospital Mammography Department and assess the accuracy of the radiologists’ use of the BI-RADS scoring system.Methods: Records of all patients who underwent UGCNB biopsy between 01 January 2014 and 31 October 2015 were reviewed. A retrospective study was performed.Results: A total of 304 UGCNB biopsies were performed on 291 patients. The mean age was 49.2 (s.d. = 15.9) years. Tissue samples from 303 lesions were adequate for histological assessment, and of these, 51% of the lesions were malignant whilst 49% were benign. The most common malignant and benign diagnoses were invasive ductal carcinoma and fibroadenoma respectively. The BI-RADS scoring of the radiologists demonstrated a positive predictive value of 61.6% for the identification of possible malignant lesions.Conclusion: This study describes the patient and lesion profile and unit practices in a tertiary hospital setting in South Africa. The radiologists’ application of the BI-RADS scoring largely conforms to the BI-RADS guidelines. The study highlights several challenges encountered by a breast imaging programme in an under-resourced setting as well as making recommendations in overcoming these challenges.
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Sonographic Appearance of Lesions Diagnosed as Lobular Neoplasia at Sonographically Guided Biopsies. AJR Am J Roentgenol 2017; 208:669-675. [PMID: 28075608 DOI: 10.2214/ajr.15.15056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to review the sonographic features of breast lesions yielding lobular neoplasia (LN) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine if imaging findings or clinical features can be used to predict an upgrade to malignancy. MATERIALS AND METHODS Of the 8205 sonographically guided breast biopsies (14-gauge cores) performed from 2007 through 2014, 22 yielded a diagnosis of LN, which means that LN was the most severe pathologic lesion. Imaging features were analyzed in consensus by two radiologists. Correlation of biopsy findings with definitive pathologic results was performed when available. RESULTS Twenty-two LN lesions (20 patients [mean age ± SD, 52.05 ± 13.66 years]) were diagnosed at biopsy. Of the LN lesions that were seen on mammography (6/22, 27.3%), most lesions appeared as masses (3/6, 50%). On sonography, LN lesions (mean size, 8.10 mm) appeared as masses (15/22, 68.2%) with oval shape (10/15, 66.7%), well-circumscribed or microlobulated margins (11/15, 73.3%), hypoechoic echotexture (10/15, 66.7%), posterior enhancement (73.3%, 11/15), and parallel orientation (8/15, 53.3%). Most of the masses were categorized as BI-RADS category 4 (21/22, 95.5%). Seven lesions (7/22, 31.8%) appeared as areas of shadowing or distortion without discrete masses. Twenty (20/22, 90.9%) lesions were excised surgically, and pathology results led to an upgrade in five lesions (5/20, 25% [one nonmass lesion and four masses]). Neither mammographic nor sonographic features were associated with malignant outcome (p > 0.05). CONCLUSION LN diagnosed at sonographically guided 14-gauge core needle biopsy does not show any specific features according to the BI-RADS lexicon and is associated with a 25% underestimation rate. No clinical or imaging characteristic is predictive of malignancy.
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Chen J, Wang Z, Lv Q, Du Z, Tan Q, Zhang D, Xiong B, Zeng H, Gou J. Comparison of Core Needle Biopsy and Excision Specimens for the Accurate Evaluation of Breast Cancer Molecular Markers: a Report of 1003 Cases. Pathol Oncol Res 2017; 23:769-775. [PMID: 28074330 DOI: 10.1007/s12253-017-0187-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/02/2017] [Indexed: 02/05/2023]
Abstract
In this study, we compared the accuracy of marker evaluation in core needle biopsy (CNB) specimens versus excision specimens (ESs) from breast cancer patients. This retrospective study used data collected from the breast cancer database at the West China Hospital, China. Immunohistochemistry (IHC) results from CNB specimens and ESs were compared, using estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 as markers. Molecular subtyping and endocrine therapy usage correlations based on CNB samples and ESs were evaluated. The results obtained from CNB samples and ESs exhibited substantial agreement for the detection of ER (κ = 0.522), PR (κ = 0.441), and HER2 (κ = 0.451), and also influenced endocrine therapy usage. Fair and poor correlations were observed for Ki-67 staining and molecular subtyping (κ = 0.195), respectively. This disagreement might be attributable to a combination of heterogeneity and large tumor size. This study indicates that the discordance rate in molecular marker staining between CNB specimens and ESs is significant enough that results obtained with CNB specimens should be used cautiously or verified using ESs.
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Affiliation(s)
- Jie Chen
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zu Wang
- Tumor Molecular Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qing Lv
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Zhenggui Du
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qiuwen Tan
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | | | | | - Helin Zeng
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Juxiang Gou
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Huang ML, Hess K, Candelaria RP, Eghtedari M, Adrada BE, Sneige N, Fornage BD. Comparison of the accuracy of US-guided biopsy of breast masses performed with 14-gauge, 16-gauge and 18-gauge automated cutting needle biopsy devices, and review of the literature. Eur Radiol 2016; 27:2928-2933. [PMID: 27844099 DOI: 10.1007/s00330-016-4651-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of ultrasound (US)-guided core needle biopsy (CNB) of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. METHODS We retrospectively reviewed the charts of 1,112 patients who underwent US-guided breast CNB with 14-gauge, 16-gauge and 18-gauge needles. Cases with surgical excision or a minimum of 2 years of imaging follow-up were included. Rates of sample inadequacy, discordance with surgical or imaging findings and upgrade of DCIS to invasive cancer or high-risk lesion to in situ or invasive cancer were computed for each needle size. RESULTS The study included 703 CNBs: 203 performed with 14-gauge, 235 with 16-gauge and 265 with 18-gauge needles. There were no significant differences between 14-gauge, 16-gauge and 18-gauge needles in rates of specimen inadequacy (0 %, 0.4 % and 1.9 %, respectively) (p = 0.084); surgical discordance (2.6 %, 2.9 % and 3.8 %) (p = 0.76); imaging discordance (0 %, 0 % and 2 %) (p = 1.0); DCIS upgrade (43 %, 43 % and 36 %) (p = 1.00) or high-risk lesion upgrade (38 %, 25 % and 55 %) (p = 0.49). CONCLUSION There was no statistically significant difference in diagnostic accuracy of US-guided CNB of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. KEY POINTS • Percutaneous image-guided breast core needle biopsy (CNB) is the standard of care. • Breast CNB with 14-gauge, 16-gauge and 18-gauge needles has similar diagnostic accuracy. • Smaller gauge needles can be confidently used for ultrasound-guided breast CNB.
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Affiliation(s)
- Monica L Huang
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA.
| | - Kenneth Hess
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Rosalind P Candelaria
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Mohammad Eghtedari
- UC San Diego Health Sciences, 3855 Health Sciences Dr., #0846, La Jolla, CA, 92093-0846, USA
| | - Beatriz E Adrada
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Nour Sneige
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0085, Houston, TX, 77030, USA
| | - Bruno D Fornage
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
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Lee SE, Moon JE, Rho YH, Kim EK, Yoon JH. Which supplementary imaging modality should be used for breast ultrasonography? Comparison of the diagnostic performance of elastography and computer-aided diagnosis. Ultrasonography 2016; 36:153-159. [PMID: 27764908 PMCID: PMC5381849 DOI: 10.14366/usg.16033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/24/2016] [Accepted: 09/24/2016] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of this study was to evaluate and compare the diagnostic performance of grayscale ultrasonography (US), US elastography, and US computer-aided diagnosis (US-CAD) in the differential diagnosis of breast masses. Methods A total of 193 breast masses in 175 consecutive women (mean age, 46.4 years) from June to August 2015 were included. US and elastography images were obtained and recorded. A US-CAD system was applied to the grayscale sonograms, which were automatically analyzed and visualized in order to generate a final assessment. The final assessments of breast masses were based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, while elasticity scores were assigned using a 5-point scoring system. The diagnostic performance of grayscale US, elastography, and US-CAD was calculated and compared. Results Of the 193 breast masses, 120 (62.2%) were benign and 73 (37.8%) were malignant. Breast masses had significantly higher rates of malignancy in BI-RADS categories 4c and 5, elastography patterns 4 and 5, and when the US-CAD assessment was possibly malignant (all P<0.001). Elastography had higher specificity (40.8%, P=0.042) than grayscale US. US-CAD showed the highest specificity (67.5%), positive predictive value (PPV) (61.4%), accuracy (74.1%), and area under the curve (AUC) (0.762, all P<0.05) among the three diagnostic tools. Conclusion US-CAD had higher values for specificity, PPV, accuracy, and AUC than grayscale US or elastography. Computer-based analysis based on the morphologic features of US may be very useful in improving the diagnostic performance of breast US.
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Affiliation(s)
- Si Eun Lee
- Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Eun Moon
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Rho
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Hari S, Kumari S, Srivastava A, Thulkar S, Mathur S, Veedu PT. Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study. Indian J Med Res 2016; 143:597-604. [PMID: 27488003 PMCID: PMC4989833 DOI: 10.4103/0971-5916.187108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background & objectives: Biopsy of palpable breast masses can be performed manually by palpation guidance or under imaging guidance. Based on retrospective studies, image guided biopsy is considered more accurate than palpation guided breast biopsy; however, these techniques have not been compared prospectively. We conducted this prospective study to verify the superiority and determine the size of beneficial effect of image guided biopsy over palpation guided biopsy. Methods: Over a period of 18 months, 36 patients each with palpable breast masses were randomized into palpation guided and image guided breast biopsy arms. Ultrasound was used for image guidance in 33 patients and mammographic (stereotactic) guidance in three patients. All biopsies were performed using 14 gauge automated core biopsy needles. Inconclusive, suspicious or imaging-histologic discordant biopsies were repeated. Results: Malignancy was found in 30 of 36 women in palpation guided biopsy arm and 27 of 36 women in image guided biopsy arm. Palpation guided biopsy had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 46.7, 100, 100, 27.3 per cent, respectively, for diagnosing breast cancer. Nineteen of 36 women (52.8%) required repeat biopsy because of inadequate samples (7 of 19), suspicious findings (2 of 19) or imaging-histologic discordance (10 of 19). On repeat biopsy, malignancy was found in all cases of imaging-histologic discordance. Image guided biopsy had 96.3 per cent sensitivity and 100 per cent specificity. There was no case of inadequate sample or imaging-histologic discordance with image guided biopsy. Interpretation & conclusions: Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.
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Affiliation(s)
- Smriti Hari
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Kumari
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Srivastava
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prasad Thotton Veedu
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
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Yoon JH, Song MK, Kim EK. Semi-Quantitative Strain Ratio in the Differential Diagnosis of Breast Masses: Measurements Using One Region-of-Interest. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1800-1806. [PMID: 27166015 DOI: 10.1016/j.ultrasmedbio.2016.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/04/2016] [Accepted: 03/28/2016] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to evaluate the diagnostic performances of semi-quantitative strain ratio measured by using one region-of-interest (ROI) on breast US elastography images. Two hundred one breast masses of 165 women (mean age: 47.2 y) were included. Ultrasonography (US) and elastography images of the masses were obtained and prospectively analyzed according to elasticity pattern, strain ratio, and final Breast Imaging-Reporting and Data System (BI-RADS) assessments. Of the 201 breast masses, 127 (63.2%) were benign and 74 (36.8%) were malignant. Elastography pattern and strain ratio (cut-off of 1.44) had significantly higher specificity than gray-scale US, 39.4% and 61.4% versus 29.1%, respectively (all p < 0.05). Area under the receiver operating characteristics curve (Az) was highest for gray-scale US (0.646), without statistical significances, than for elastography pattern (0.596, p = 0.159) or strain ratio (0.625, p = 0.610). Semi-quantitative strain ratio measured from one ROI has comparable diagnostic performances to gray-scale US, which may contribute to more accurate differential diagnosis of breast masses seen on US.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Kyung Song
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
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Kuang Y, Hilgers A, Sadiq M, Cochran S, Corner G, Huang Z. Modelling and characterisation of a ultrasound-actuated needle for improved visibility in ultrasound-guided regional anaesthesia and tissue biopsy. ULTRASONICS 2016; 69:38-46. [PMID: 27022669 DOI: 10.1016/j.ultras.2016.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
Clear needle visualisation is recognised as an unmet need for ultrasound guided percutaneous needle procedures including regional anaesthesia and tissue biopsy. With inadequate needle visibility, these procedures may result in serious complications or a failed operation. This paper reports analysis of the modal behaviour of a previously proposed ultrasound-actuated needle configuration, which may overcome this problem by improving needle visibility in colour Doppler imaging. It uses a piezoelectric transducer to actuate longitudinal resonant modes in needles (outer diameter 0.8-1.2mm, length>65mm). The factors that affect the needle's vibration mode are identified, including the needle length, the transducer's resonance frequency and the gripping position. Their effects are investigated using finite element modelling, with the conclusions validated experimentally. The actuated needle was inserted into porcine tissue up to 30mm depth and its visibility was observed under colour Doppler imaging. The piezoelectric transducer is able to generate longitudinal vibration with peak-to-peak amplitude up to 4μm at the needle tip with an actuating voltage of 20Vpp. Actuated in longitudinal vibration modes (distal mode at 27.6kHz and transducer mode at 42.2kHz) with a drive amplitude of 12-14Vpp, a 120mm needle is delineated as a coloured line in colour Doppler images, with both needle tip and shaft visualised. The improved needle visibility is maintained while the needle is advanced into the tissue, thus allowing tracking of the needle position in real time. Moreover, the needle tip is highlighted by strong coloured artefacts around the actuated needle generated by its flexural vibration. A limitation of the technique is that the transducer mode requires needles of specific lengths so that the needle's resonance frequency matches the transducer. This may restrict the choice of needle lengths in clinical applications.
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Affiliation(s)
- Y Kuang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - A Hilgers
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - M Sadiq
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - S Cochran
- Institute for Medical Science and Technology (IMSaT), University of Dundee, Dundee DD2 1FD, UK
| | - G Corner
- Department of Medical Physics, Ninewells Hospital, University of Dundee, DD1 9SY, UK
| | - Z Huang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK.
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Six-Month Short-Interval Imaging Follow-Up for Benign Concordant Core Needle Biopsy of the Breast: Outcomes in 1444 Cases With Long-Term Follow-Up. AJR Am J Roentgenol 2016; 207:912-917. [PMID: 27340732 DOI: 10.2214/ajr.15.15853] [Citation(s) in RCA: 8] [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 The purpose of this study is to assess whether 6-month imaging follow-up after benign core needle breast biopsy is important for patient outcomes and whether it depends on nonspecific versus definitive benign biopsy results. MATERIALS AND METHODS Consecutive breast biopsies from 2003 to 2010 were analyzed. Benign concordant lesions with at least 2 years of follow-up were assessed. Pathologic abnormalities were further characterized as having definitive or nonspecific features. A two-tailed Fisher exact test was used to assess the difference in pathologic features among lesions that had progressed. RESULTS Of 3256 cases, 1705 biopsies in 1602 women were benign concordant and were recommended for 6-month imaging follow-up; the compliance rate was 94.9%. Of these, 1444 biopsies were confirmed as benign with long-term follow-up or excision. At pathologic analysis, 805 (55.7%) benign lesions had definitive features and 639 (44.3%) had nonspecific features. Thirty-four (2.4%) lesions progressed; this was similar for the lesions with definitive (2.6%) and nonspecific (2.0%) features (p = 0.60). The false-negative rate was 0.18%, with a mean of 5.0 cores sampled per lesion. CONCLUSION For lesions with benign concordant biopsy results, selection of the follow-up interval should not be dictated by whether the pathologic features are definitive or nonspecific. The number of lesions that progress at imaging follow-up is low. The false-negative rate is low, regardless of modality or lesion type. A low false-negative rate is achievable with a reasonable number of core samples. The 6-month follow-up interval benefits only a small number of patients. Our results suggest that routine imaging after core needle biopsy is safe.
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Yoon JH, Kim MJ, Lee HS, Kim SH, Youk JH, Jeong SH, Kim YM. Validation of the fifth edition BI-RADS ultrasound lexicon with comparison of fourth and fifth edition diagnostic performance using video clips. Ultrasonography 2016; 35:318-26. [PMID: 27184655 PMCID: PMC5040135 DOI: 10.14366/usg.16010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to evaluate the positive predictive value (PPV) and the diagnostic performance of the ultrasonographic descriptors in the fifth edition of BI-RADS, comparing with the fourth edition using video clips. Methods From September 2013 to July 2014, 80 breast masses in 74 women (mean age, 47.5±10.7 years) from five institutions of the Korean Society of Breast Imaging were included. Two radiologists individually reviewed the static and video images and analyzed the images according to the fourth and fifth edition of BI-RADS. The PPV of each descriptor was calculated and diagnostic performances between the fourth and fifth editions were compared. Results Of the 80 breast masses, 51 (63.8%) were benign and 29 (36.2%) were malignant. Suspicious ultrasonographic features such as irregular shape, non-parallel orientation, angular or spiculated margins, and combined posterior features showed higher PPV in both editions (all P<0.05). No significant differences were found in the diagnostic performances between the two editions (all P>0.05). The area under the receiver operating characteristics curve was higher in the fourth edition (0.708 to 0.690), without significance (P=0.416). Conclusion The fifth edition of the BI-RADS ultrasound lexicon showed comparable performance to the fourth edition and can be useful in the differential diagnosis of breast masses using ultrasonography.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostastistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Hye Jeong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - You Me Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Choi ER, Han BK, Ko ES, Ko EY, Choi JS, Cho EY, Nam SJ. Initial Experience with a Wireless Ultrasound-Guided Vacuum-Assisted Breast Biopsy Device. PLoS One 2015; 10:e0144046. [PMID: 26630136 PMCID: PMC4667874 DOI: 10.1371/journal.pone.0144046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 11/12/2015] [Indexed: 01/12/2023] Open
Abstract
Objective To determine the imaging characteristic of frequent target lesions of wireless ultrasound (US)-guided, vacuum-assisted breast biopsy (Wi-UVAB) and to evaluate diagnostic yield, accuracy and complication of the device in indeterminate breast lesions. Materials and Methods From March 2013 to October 2014, 114 women (age range, 29–76 years; mean age, 50.0 years) underwent Wi-UVAB using a 13-gauge needle (Mammotome Elite®; Devicor Medical Products, Cincinnati, OH, USA). In 103 lesions of 96 women with surgical (n = 81) or follow-up (n = 22) data, complications, biopsy procedure, imaging findings of biopsy targets and histologic results were reviewed. Results Mean number of biopsy cores was 10 (range 4–25). Nine patients developed moderate bleeding. All lesions were suspicious on US, and included non-mass lesions (67.0%) and mass lesions (33.0%). Visible calcifications on US were evident in 57.3% of the target lesions. Most of the lesions (93.2%) were nonpalpable. Sixty-six (64.1%) were malignant [ductal carcinoma in situ (DCIS) rate, 61%] and 12 were high-risk lesions (11.7%). Histologic underestimation was identified in 11 of 40 (27.5%). DCIS cases and in 3 of 9 (33.3%) high-risk lesions necessitating surgery. There was no false-negative case. Conclusion Wi-UVAB is very handy and advantageous for US-unapparent non-mass lesions to diagnose DCIS, especially for calcification cases. Histologic underestimation is unavoidable; still, Wi-UVAB is safe and accurate to diagnose a malignancy.
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Affiliation(s)
- E-Ryung Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chopier J, Roedlich M, Mathelin C. Imagerie mammaire du syndrome de masse, distorsion architecturale et asymétrie : recommandations pour la pratique clinique. ACTA ACUST UNITED AC 2015; 44:947-59. [DOI: 10.1016/j.jgyn.2015.09.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/15/2022]
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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.
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Park AY, Son EJ, Kim JA, Han K, Youk JH. Lesion stiffness measured by shear-wave elastography: Preoperative predictor of the histologic underestimation of US-guided core needle breast biopsy. Eur J Radiol 2015; 84:2509-14. [PMID: 26467705 DOI: 10.1016/j.ejrad.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether lesion stiffness measured by shear-wave elastography (SWE) can be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses. METHODS This retrospective study enrolled 99 breast masses from 93 patients, including 40 high-risk lesions and 59 ductal carcinoma in situ (DCIS), which were diagnosed by US-guided 14-gauge CNB. SWE was performed for all breast masses to measure quantitative elasticity values before US-guided CNB. To identify the preoperative factors associated with histologic underestimation, patients' age, symptoms, lesion size, B-mode US findings, and quantitative SWE parameters were compared according to the histologic upgrade after surgery using the chi-square test, Fisher's exact test, or independent t-test. The independent factors for predicting histologic upgrade were evaluated using multivariate logistic regression analysis. RESULTS The underestimation rate was 28.3% (28/99) in total, 25.0% (10/40) in high-risk lesions, and 30.5% (18/59) in DCIS. All elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (P<0.001). On multivariate analysis, the mean (Odds ratio [OR]=1.021, P=0.001), maximum (OR=1.015, P=0.008), and minimum (OR=1.028, P=0.001) elasticity values were independently associated with histologic underestimation. The patients' age, lesion size, and final assessment category on US of the upgrade group were higher than those of the non-upgrade group (P=0.046 for age; P=0.021 for lesion size; P=0.030 for US category), but these were not independent predictors of histologic underestimation on multivariate analysis. CONCLUSION Breast lesion stiffness quantitatively measured by SWE could be helpful to predict the underestimation of malignancy in US-guided 14-gauge CNB.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan city, Gyeonggi-do 15355, Republic of Korea; Kangwon National University Graduate School, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do 24341, Republic of Korea.
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.
| | - Kyunghwa Han
- Yonsei Biomedical Research Institute, Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.
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Risks of Being Malignant or High Risk and Their Characteristics in Breast Lesions 20 mm or Larger After Benign Results on Ultrasonography-Guided 14-Gauge Core Needle Biopsy. Ultrasound Q 2015; 32:157-63. [PMID: 26441382 DOI: 10.1097/ruq.0000000000000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The malignancy risk, risk of being high-risk lesions after benign results on ultrasonography-guided 14-gauge core needle biopsies (US-CNBs), and their characteristics in breast lesions of 20 mm or greater were investigated. METHODS Eight hundred forty-seven breast lesions with benign results on US-CNB were classified as benign, high risk, and malignant through excision and clinical follow-up. The risks of being malignant or high risk were analyzed in all lesions, lesions 20 to 29 mm, and lesions 30 mm or greater. Their clinicopathological characteristics were evaluated. RESULTS Of 847, 18 (2.1%) were malignant, 53 (6.3%) were high-risk lesions, and 776 (91.6%) were benign. Of 18 malignancies, 6 (33.3%) were malignant phyllodes tumors and 12 (66.7%) were carcinomas. In benign lesions 20 to 29 mm, risks of being malignant or high risk were 1.6% (9 of 566) and 4.4% (25 of 566). In 281 lesions 30 mm or greater, the risks of being malignant or high risk were 3.2% and 10%. The risk of being high risk in lesions 30 mm or greater was 10%, significantly higher than 4.4% of lesions 20 to 29 mm (P = 0.002). CONCLUSIONS Excision can be considered in lesions measuring 20 mm or larger because of the 2.1% malignancy risk and the 6.3% risk of being high-risk lesions despite benign results on US-CNB. Excision should be considered in lesions measuring 30 mm or larger because of the 3.2% malignancy risk and the 10% risk of being high-risk lesions.
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Moon HJ, Jung I, Youk JH, Kim MJ, Kim EK. Short-term follow-up in 6 months is unnecessary for asymptomatic breast lesions with benign concordant results obtained at ultrasonography-guided 14-gauge core needle biopsy. Am J Surg 2015; 211:152-8. [PMID: 26381659 DOI: 10.1016/j.amjsurg.2015.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/10/2015] [Accepted: 03/31/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated whether short-term follow-up in 6 months was appropriate for asymptomatic benign concordant lesions on ultrasonography-guided core needle biopsy (ultrasonography-guided CNB). METHODS Of 1,111 lesions, 944 underwent follow-up within 4 to 9 months after CNB, and 359 of 944 underwent a 2nd follow-up within 9 to 15 months. One hundred sixty-seven underwent a 1st follow-up within 9 to 15 months. Follow-up intervals were classified according to an interval of 6 and 12 months with 2 different methods. First, 944 and 167 lesions were classified into the 6- and 12-month groups. Second, 944 and 526 lesions (sum of 167 and 359 lesions) were classified into the 6- and 12-month groups. Clinicopathologic factors were compared between the 2 groups. RESULTS None of the benign concordant lesions were malignant; 1.4% of the lesions showed progression in the 6-month group, not significantly different from 1.2% and .8% of the 12-month group. Mean age, mean lesion size, final assessments, and specific or nonspecific pathologies were not different between the 2 groups. CONCLUSIONS Short-term follow-up in 6 months is unnecessary for asymptomatic benign concordant breast lesions at ultrasonography-guided CNB.
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Affiliation(s)
- Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
| | - Inkyung Jung
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Youk
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
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Ferré R, Kao E, Mesurolle B. High-Risk Lesions Detected at Second-Look US for Breast Lesions Identified at MR Imaging. Radiology 2015; 276:615-6. [DOI: 10.1148/radiol.2015150121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Western C, Hristov D, Schlosser J. Ultrasound Imaging in Radiation Therapy: From Interfractional to Intrafractional Guidance. Cureus 2015; 7:e280. [PMID: 26180704 PMCID: PMC4494460 DOI: 10.7759/cureus.280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 11/05/2022] Open
Abstract
External beam radiation therapy (EBRT) is included in the treatment regimen of the majority of cancer patients. With the proliferation of hypofractionated radiotherapy treatment regimens, such as stereotactic body radiation therapy (SBRT), interfractional and intrafractional imaging technologies are becoming increasingly critical to ensure safe and effective treatment delivery. Ultrasound (US)-based image guidance systems offer real-time, markerless, volumetric imaging with excellent soft tissue contrast, overcoming the limitations of traditional X-ray or computed tomography (CT)-based guidance for abdominal and pelvic cancer sites, such as the liver and prostate. Interfractional US guidance systems have been commercially adopted for patient positioning but suffer from systematic positioning errors induced by probe pressure. More recently, several research groups have introduced concepts for intrafractional US guidance systems leveraging robotic probe placement technology and real-time soft tissue tracking software. This paper reviews various commercial and research-level US guidance systems used in radiation therapy, with an emphasis on hardware and software technologies that enable the deployment of US imaging within the radiotherapy environment and workflow. Previously unpublished material on tissue tracking systems and robotic probe manipulators under development by our group is also included.
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Affiliation(s)
- Craig Western
- Department of Mechanical Engineering, Stanford University
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Yu CC, Ueng SH, Cheung YC, Shen SC, Kuo WL, Tsai HP, Lo YF, Chen SC. Predictors of Underestimation of Malignancy after Image-Guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia. Breast J 2015; 21:224-32. [DOI: 10.1111/tbj.12389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Chi-Chang Yu
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Yun-Chung Cheung
- Department of Diagnostic Radiology; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shih-Che Shen
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Wen-Lin Kuo
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Hsiu-Pei Tsai
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Yung-Feng Lo
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shin-Cheh Chen
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
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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.
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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.)
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Interventional radiology in the diagnosis and treatment of diseases of the breast: a historical review and future perspective based on currently available techniques. AJR Am J Roentgenol 2014; 203:725-33. [PMID: 25247936 DOI: 10.2214/ajr.14.12994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The topic of imaging-guided breast interventions spans more than 30 years. Radiologists pioneered procedures such as needle or wire localization and ultrasound and stereotactic-guided biopsy. Using recently developed devices and technology, the opportunity exists to treat lesions of the breast with minimally invasive imaging-guided techniques. CONCLUSION Breast imagers and interventional radiologists, along with our surgical and oncologic colleagues, are best qualified to participate together in the research and development of these procedures.
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Zhang YJ, Wei L, Li J, Zheng YQ, Li XR. Status quo and development trend of breast biopsy technology. Gland Surg 2014; 2:15-24. [PMID: 25083451 DOI: 10.3978/j.issn.2227-684x.2013.02.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/18/2013] [Indexed: 11/14/2022]
Abstract
Triple assessment is a standard method for assessment of breast diseases, which includes clinical evaluation, radiographic assessment and pathological assessment. Biopsy for breast disease is the gold standard for pathological assessment, including incisional biopsy, excisional biopsy, core needle biopsy, vacuum-assisted biopsy and bite biopsy. With the continuous advancement of diagnostic and treatment technology for breast cancer, collection of diseased tissue has also undergone a gradual transition from traditional open surgery to biopsy. This review summarizes the current situation and development of breast biopsy technology to provide an insight into the latest details such as the safety and reliability as the basis for selection of the most appropriate techniques for specific settings.
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Affiliation(s)
- Yan-Jun Zhang
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lichun Wei
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jie Li
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yi-Qiong Zheng
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xi-Ru Li
- 1 Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, China ; 2 Department of radiation oncology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol 2014; 202:1389-94. [PMID: 24848840 DOI: 10.2214/ajr.13.10864] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this article were to review the mammographic and sonographic features of breast masses yielding atypical ductal hyperplasia (ADH) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine whether clinical or imaging features can be used to predict upgrade to malignancy. MATERIALS AND METHODS Among 6325 sonographically guided biopsies (2003- 2010) (14-gauge cores), 56 yielded the diagnosis of ADH (0.9%). Six patients were excluded (lost to follow-up). Fifty lesions were surgically excised in 45 patients. Mammographic and sonographic features were analyzed in consensus by two radiologists using the BI-RADS lexicon. RESULTS Forty-five patients (mean age, 56 years; 12 < 50 years; six with synchronous breast carcinoma) had 50 ADH lesions (median size, 0.6 cm). Surgical excision yielded malignancy in 28 cases (56% underestimation rate). Among 42 mammograms (47 lesions), 30 lesions were identified (30/47, 64%) as masses (12/30, 40%), asymmetric densities (10/30, 33%), microcalcifications (4/30, 13%), and architectural distortions (4/30, 13%). Sonographically, most lesions appeared as hypoechoic masses (64%, 30/47) with irregular shape (51%, 24/47), microlobulated margins (49%, 23/47), no posterior acoustic feature (25/47, 53%), abrupt interface (70%, 33/47), and parallel orientation (57%, 27/47). No mammographic and sonographic features were associated with malignant outcome, whereas age less than 50 years (p = 0.03) and synchronous malignancy (p = 0.03) were associated with malignant outcome. CONCLUSION ADH diagnosed at sonographically guided 14-gauge core needle biopsy shows a high underestimation rate. Synchronous carcinoma or age less than 50 years is associated with malignant outcome.
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Lee SH, Kim EK, Kim MJ, Moon HJ, Yoon JH. Vacuum-assisted breast biopsy under ultrasonographic guidance: analysis of a 10-year experience. Ultrasonography 2014; 33:259-66. [PMID: 25036755 PMCID: PMC4176113 DOI: 10.14366/usg.14020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/09/2014] [Accepted: 05/21/2014] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To determine the indications and the diagnostic accuracy of vacuum-assisted breast biopsy (VABB) under ultrasonographic (US) guidance based on a 10-year period of clinical use. METHODS This was a retrospective analysis of 2,920 breast lesions in 2,477 consecutive patients who underwent US-guided VABB between February 2002 and December 2011. The proportions of each indication for VABB were analyzed as well as the trend of its use over divided time periods. Histopathological diagnosis and the malignancy rate of the lesions with VABB were analyzed. A comparison of the pathological diagnosis of VABB and the gold standard diagnosis revealed the false negative rate, the underestimation rate, and the agreement rate. RESULTS Palpable lesions (44.4%), low-suspicion lesions (15.7%), high-risk lesions (12.4%), and calcifications (10.3%) were the most common indications for US-guided VABB. The malignancy rate of lesions submitted to VABB was 5.4%. The false negative rate was only 0.1%, while the underestimation rate of high-risk lesions and ductal carcinoma in situ was 3.1% and 13.8%, respectively, with a 98.7% agreement rate. Among 1,512 therapeutic VABB cases, 84.9% showed no residual or recurrent lesions on long term follow-up US for more than a year. Complications occurred in 1% of the patients without need for surgical intervention. CONCLUSION US-guided VABB is an accurate and safe method that can help decision-making in the diagnostic process and can be an alternative for excisional surgery in some therapeutic circumstances.
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Affiliation(s)
- Seung Hyun Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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