Comparison of prone and upright, stereotactic, and tomosynthesis-guided biopsies with secondary analysis of ultrasound-occult architectural distortions

Suspicious Ultrasound-Occult Non-Calcified Mammographic Masses, Asymmetries, and Architectural Distortions Are Moderate Probability for Malignancy

“…This sub-analysis of 302 cases of ultrasound-occult AD represents the largest sample size reported to date, and the calculated likelihood of malignancy in this retrospective review was 25.5%. Again, this is lower than the studies mentioned above which did not distinguish between AD visible at ultrasound and AD occult at ultrasound, yet it is very much in line with more recent reports that have found a 13-29% likelihood of malignancy for AD without a definite ultrasound correlate [14][15][16][17][18][19][20]26,27]. These, and our data confirm the moderate probability BI-RADS assessment category 4b for suspicious, ultrasound-occult AD.…”

“…Note that the study populations from two prior publications were included in their entirety within this study's population. The first evaluated how the needle approach for prone DBT-guided biopsy affected hematoma formation and clip migration [21], and the second directly compared procedural details for prone and upright, stereotactic, and DBT-guided breast biopsies [19]. The study population from a third prior publication evaluating DBT screening in women with breast implants partially overlapped with this current study population [22].…”

“…DBT-guided breast biopsy was not available at all facilities throughout the entire study period, but it was available at most, so patients in need of a DBT-guided biopsy were scheduled at a facility with that capability. The biopsy procedures and equipment have also been previously described in detail [19,21].…”

“…Among those prior studies, many have compared AD with a correlation on ultrasounds to AD without. In general, suspicious AD with an ultrasound correlate has a high level of suspicion for malignancy (BI-RADS assessment category 4c), whereas suspicious AD without an ultrasound correlate has a moderate level of suspicion for malignancy (BI-RADS assessment category 4b) [5,[13][14][15][16][17][18][19][20]. However, the studies evaluating AD without an ultrasound correlation are of limited sample size, and no prior study has also included ultrasound-occult masses or asymmetries.…”