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Vatteroni G, Pinna G, Trimboli RM, Levi R, Bolengo I, Patrone F, Volpe D, Fernandes B, Bernardi D. Role of ultrasound-guided vacuum-assisted breast biopsy in the management of radiologic-pathologic discordance: a retrospective single-centre study. LA RADIOLOGIA MEDICA 2024; 129:1454-1462. [PMID: 39102107 DOI: 10.1007/s11547-024-01864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE To evaluate the efficacy of US-guided vacuum-assisted biopsy (US-VAB) in radiologic-pathologic (rad-path) discordance in women with suspicious breast lesions. METHODS Two thousand three hundred and sixty patients with 2385 BI-RADS category 4 and 5 lesions underwent percutaneous US-guided CNB. Thirty-six lesions were classified as discordant benign and underwent second-line US-VAB. A 14-gauge needle was utilized for CNB and 10-gauge for US-VAB. Final pathology was the reference standard for women who underwent surgery, imaging follow-up in other cases. Rates of malignancy for US-VAB and subsequent surgery were evaluated. Lesions with upgrade and no upgrade to second-line VAB were compared in terms of patient's age, lesion type and characteristics, size and BI-RADS category. Positive predictive value (PPV), negative predictive value (NPV) for BI-RADS categories and diagnostic performance for second-line US-VAB were calculated. p value < 0.05 was considered statistically significant (t-test, Mann-Whitney, χ2). RESULTS US-VAB identified 10 B2, 9 B3 and 17 B5 lesions with upgrade to malignancy of 47.2% (17/36). There were 8 invasive no special type, 7 ductal in situ, 1 invasive lobular carcinoma and 1 angiosarcoma, and their distribution among BI-RADS categories was: 2/2 in BI-RADS 5 (100%), 12/18 in BI-RADS 4C (67%) and 3/16 in BI-RADS 4B lesions (19%) (p = 0.006). Of the remaining 19 lesions, 6 underwent surgery and 2 were upgraded to ductal carcinoma in situ; 13 underwent radiological follow-up and one resulted malignant. False-negative rate for US-VAB was 15.8% (3/19) with final upgrade to malignancy of 55% (20/36). The univariate analysis revealed mass shape (p = 0.008) and BI-RADS categories (p = 0.006) to be associated with upgrade to malignancy. Sensitivity, specificity, PPV, NPV and accuracy for US-VAB were 85, 100, 100, 84 and 92%, respectively. CONCLUSIONS US-VAB identified almost 50% of cancers missed by CNB, avoiding surgical biopsies and validating as an effective mini-invasive approach in rad-path discordance.
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Affiliation(s)
- Giulia Vatteroni
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Pinna
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rubina Manuela Trimboli
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Riccardo Levi
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Isabella Bolengo
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Patrone
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Daria Volpe
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Bethania Fernandes
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Daniela Bernardi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Kim BK, Ahn SG, Oh SJ, Kim H, Kang E, Jung Y, Do Byun K, Lee J, Sun WY. Survival Outcomes of Patients With Breast Cancer Diagnosed Using Vacuum-Assisted Biopsy: A Nationwide Study From the Korean Breast Cancer Society. J Breast Cancer 2022; 25:13-24. [PMID: 35133091 PMCID: PMC8876540 DOI: 10.4048/jbc.2022.25.e2] [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: 07/05/2021] [Revised: 10/09/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Breast cancer is mainly diagnosed using core needle biopsy (CNB), although other biopsy methods, including vacuum-assisted biopsy (VAB), may also be used. We compared differences in clinical characteristics and prognoses of patients with breast cancer according to biopsy methods used for diagnosis. METHODS A total of 98,457 patients who underwent various biopsy methods (CNB, fine-needle aspiration [FNA], VAB, and excisional biopsy) for diagnosing breast cancer were recruited. Using CNB as a reference, related clinicopathological factors and prognostic differences between biopsy methods were analyzed retrospectively using large-scale data from the Korean Breast Cancer Society Registration System. The associations between biopsy methods and clinicopathological factors were compared using multinomial logistic regression analysis, and the prognoses of patients undergoing the different biopsy methods, as breast cancer-specific survival (BCSS) and overall survival (OS), were compared using the Kaplan-Meier method and Cox proportional hazard model. RESULTS Univariate and multivariate analyses showed that unlike FNA, both VAB and excisional biopsy were significantly associated with tumor size, palpability, tumor stage, and histologic grade as relatively good prognostic factors compared to CNB. In particular, VAB showed lower odds ratios for these factors than excisional biopsy. In the univariate analysis, the prognosis of patients undergoing VAB was better than that of those undergoing CNB with respect to BCSS (hazard ratio [HR], 0.188, p < 0.001) and OS (HR, 0.359; p < 0.001). However, in the multivariate analysis, there were no significant prognostic differences from CNB in both BCSS and OS; differences were only evident for FNA. CONCLUSION In this study, we showed that the characteristics of breast cancer differed according to various biopsy methods. Although VAB is not a standard method for breast cancer diagnosis, it showed no prognostic differences to CNB.
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Affiliation(s)
- Bong Kyun Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Jeong Oh
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hakyoung Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yongsik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Do Byun
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Jina Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Young Sun
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Song RF, Jiang YX, Cui JC, Yu XW, Gao Y, Li L, Pei XH. Horizontal Rotary Cutting Technique for Skin Injury Avoidance in Superficial Benign Breast Masses. Int J Gen Med 2021; 14:1379-1387. [PMID: 33907442 PMCID: PMC8064672 DOI: 10.2147/ijgm.s303183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 12/26/2022] Open
Abstract
Objective This study aims to investigate the feasibility of the horizontal rotary-cut technique in the removal of superficial benign breast tumors with a ≤1.0 cm distance between the upper margin of the tumor and the skin. Patients and Methods A total of 69 patients with superficial benign breast tumors received horizontal rotary-cut surgery between July 2018 and June 2019 (horizontal group). The rotary cutter groove was in the true lateral position of the tumor and the ultrasonic probe was vertical to the rotary cutter groove. The patients were compared with 33 patients who underwent the traditional vertical rotary-cut surgery between July 2017 and June 2018 (traditional group) regarding the aspects of operation time, intraoperative bleeding volume, postoperative skin ecchymosis, skin damage, and tumor residue. The rotary cutter groove was directly below the tumor and the ultrasonic probe was parallel to the rotary cutter groove in the traditional vertical rotary-cut surgery. Results The operation time in the horizontal group was significantly shorter than in the traditional group (7.7 ± 1.1 minutes vs 9.5 ± 1.3 minutes, with t = -7.458 and p = 0.000) and there was significantly less skin damage in the horizontal group than in the traditional group (0 cases vs 3 cases, with p = 0.032). The differences in intraoperative bleeding and postoperative skin ecchymosis between the two groups were not statistically significant (6.0 ± 1.3 mL vs 6.5 ± 1.5 mL, with t = -1.853 and p = 0.067; 4 cases vs 2 cases, with χ 2 = 0.003 and p = 0.958). Ninety-seven patients attended follow-ups for 6-30 (16.5 ± 4.5) months. No residues or recurrences were observed under ultrasound reviews in either group. Conclusion In superficial benign breast tumor removal, the horizontal rotary-cut breast technique can help avoid skin injury, shorten the operation time, and reduce tumor residue more effectively compared with the traditional vertical rotary-cut technique. It has certain popularization and application values.
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Affiliation(s)
- Ren-Feng Song
- Department of General Surgery, The First People's Hospital of Huangzhong District, Xining, 811600, People's Republic of China
| | - Yu-Xia Jiang
- Department of Thyroid and Breast Surgery, The Chinese Medicine Hospital of Shexian, Handan, 056400, People's Republic of China
| | - Jian-Chun Cui
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University (Liaoning Provincial People's Hospital), Shenyang, 110015, People's Republic of China
| | - Xue-Wei Yu
- Department of General Surgery, The First People's Hospital of Huangzhong District, Xining, 811600, People's Republic of China
| | - Yang Gao
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University (Liaoning Provincial People's Hospital), Shenyang, 110015, People's Republic of China
| | - Li Li
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University (Liaoning Provincial People's Hospital), Shenyang, 110015, People's Republic of China
| | - Xiao-Hua Pei
- Department of General Surgery, Xiamen Hospital of Beijing University of Traditional Chinese Medicine, Xiamen, 361001, People's Republic of China
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Discrepancies between radiological and histological findings in preoperative core needle (CNB) and vacuum-assisted (VAB) breast biopsies. J Cancer Res Clin Oncol 2020; 147:749-754. [PMID: 33284380 PMCID: PMC7873108 DOI: 10.1007/s00432-020-03481-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/22/2020] [Indexed: 11/25/2022]
Abstract
Background Ultrasound (US)-guided breast biopsy is a routine diagnostic method used to correlate imaging finding to a histological diagnosis which is still the gold standard in preoperative diagnostics. The accuracy of US-guided breast biopsies relies on a precise radiologic-histopathologic correlation, which is discussed amongst an interdisciplinary team of gynecologists, radiologists and pathologists. However, false-negative or non-diagnostic biopsy results occur. Hence, a thorough and honest discussion to clarify the reason for discrepancies and to decide the next diagnostic step between specialists of the different disciplines is warranted. In this retrospective study, we analyzed discrepant findings between imaging and pathology results on preoperative breast biopsies. Methods Core and vacuum-assisted breast biopsies from 232 patients were included in this study. Inclusion criteria were (1) non-diagnostic (B1) category on histology independent from imaging category and (2) histological benign (B2) category with a BIRADS 5 (Breast Imaging Reporting and Data System) rating on imaging. Histological diagnoses were retrieved from all cases. Follow-up data were available in most cases. Results 138 biopsies were classified as B1, 94 biopsies as B2 category. 51 of 138 B1 cases (37%) underwent re-biopsy. Re-biopsy found malignancy (B5) in 19 of 51 cases, and B3/4 (premalignant) lesions in 3 of 51 cases. All B2 cases underwent second-look imaging-diagnosis, in 57 of 94 cases (66%) consecutive direct surgery or re-biopsy. Of these, malignancy was diagnosed histologically in 26 of 57 cases (45.6%). Conclusion Determining imaging-pathology concordance after US-guided breast biopsy is essential. Discrepant cases and further diagnostic steps need to be discussed with an interdisciplinary approach.
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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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Liu S, Zou JL, Zhou FL, Fang YM. [Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for management of benign breast diseases: analysis of 1267 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1121-1125. [PMID: 28801296 PMCID: PMC6765730 DOI: 10.3969/j.issn.1673-4254.2017.08.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the clinical value of ultrasound-guided vacuum-assisted Mammotome (MMT) system for surgical resection of benign breast disease. METHODS This retrospective study was conducted among 1267 patients who underwent minimally invasive surgery with ultrasound-guided MMT system for benign breast disease at our center between January, 2009 and January, 2014. The resection rate, incidence of complication, recurrence rate, patients' satisfaction, clinical follow-up results and risk factors were analyzed. The patients were followed up at 1 month, 6 months and every 6 months thereafter for up to 2 years with a median follow-up of 22 months. RESULTS Of the total of 1267 patients, 1259 (99.36%) had complete resection of the breast lesions, and residual lesions were found in 8 cases 1 month after the operation. The resection rate was significantly associated with lesion size (P=0.003) but not with the patients'age, pathology, BI-RADS classification, or the number or location of the lesions (P>0.05). Eighty-nine (7.02%) patients showed postoperative complications, and hematoma occurred in 70 (5.52%) patients after the operation. The complication rate was significantly associated with the number and location of lesions (P=0.000) but not with age, pathology, BI-RADS classification or the lesion size (P>0.05). A total of 193 (15.23%) patients had recurrence after the operation, including 65 (5.13%) with in situ recurrence and 128 (10.1%) with new lesions. The recurrence rate was significantly associated with the number and size of lesions (P=0.000) but not with age, pathology, BI-RADS classification or location of lesions(P>0.05). Six patients were not satisfied with the appearance of the incision, and the overall satisfaction rate of the patients was 99.52%. CONCLUSION s Ultrasound-guided vacuum-assisted MMT excision is a safe and effective procedure for benign breast disease with a low surgical complication rate, a high resection rate and a low recurrence rate. This technique results in good postoperative appearance for treatment of benign and high-risk breast lesions, especially multiple benign breast lesions.
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Affiliation(s)
- Shu Liu
- Department of Breast Surgery, Guiyang Maternal and Child Healthcare Hospital/Guiyang Minimally Invasive Breast Center, Guiyang 550003, China. E-mail:
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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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Park VY, Kim EK, Kim MJ, Yoon JH, Moon HJ. Mammographically Occult Asymptomatic Radial Scars/Complex Sclerosing Lesions at Ultrasonography-Guided Core Needle Biopsy: Follow-Up Can Be Recommended. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2367-2371. [PMID: 27444865 DOI: 10.1016/j.ultrasmedbio.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
An increasing number of radial scars are detected by ultrasound (US), but their management is controversial. This study investigated the upgrade rate in mammographically occult radial scars/complex sclerosing lesions without epithelial atypia at US-guided 14-gauge core needle biopsy in asymptomatic patients. Nineteen mammographically occult benign radial scars/complex sclerosing lesions (median size, 7 mm; range, 3-23 mm) were included. Patients underwent surgical excision (n = 10) or vacuum-assisted excision, with follow-up US at least 6 mo after benign vacuum-assisted excision results (n = 8), or underwent US follow-up for 2 y after core needle biopsy (n = 1). Any cases with change in diagnosis to high-risk lesions or malignancy at excision were considered upgrades. The upgrade rate was 0.0%. Based on US findings, 15.8% (3/19) were Breast Imaging Reporting and Data System (BI-RADS) category 3, 68.4% (13/19) were BI-RADS category 4a and 15.8% (3/19) were BI-RADS category 4b. Follow-up with US can be considered for mammographically occult benign radial scar/complex sclerosing lesions diagnosed by US core needle biopsy in asymptomatic patients.
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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
| | - Min Jung Kim
- 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
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Gestion d’un résultat bénin après prélèvement mammaire. Recommandations et conduite à tenir. IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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A framework for the role of acute inflammation in tumor progression. Breast Cancer Res Treat 2015; 151:235-8. [DOI: 10.1007/s10549-015-3392-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/15/2015] [Indexed: 01/21/2023]
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