Predictive factors for breast lesion excision system (BLES) accuracy and safety in stereotactic biopsy of suspicious calcifications

Abstract

Aim To retrospectively assess the effectiveness and safety of BLES stereotactic biopsy of suspicious calcifications and investigate possible predictive factors for underestimation. Methods and materials Between January 2014 and January 2016, 400 biopsies of suspicious calcifications were performed in our Department using the BLES stereotactic device. The mean age of our population was 58.5 years (range 39‐78 years). The final surgical results were used as gold standard. The effectiveness of the method was statistically evaluated. Mammographic size, grade, molecular type, and presence of comedo type/necrosis were assessed as predictive factors. Results 90/400 (22.5%) cases were cancers (20% invasive cancers, 80% non‐invasive cancers). 38/400 cases were atypical lesions (9.5%). No underestimation was found in atypical lesions that underwent surgery (29/38 cases). Downgrade was achieved in 45.5% of cases (with complete removal in 34.4%), concordance in 43.3%, and upgrade was found in 15.5% of the cases; the initial mammographic size and the grade of the cancers were found to be statistically significant predictive factors. The total complication rate was 8.75%. Conclusions Breast lesion excision system is a highly accurate and safe stereotactic biopsy technique of suspicious calcifications with low underestimations and high downgrade/removal rates with the potential to alter the final surgical decision in selected cases.

Criteria for Excision of Suspicious Calcifications Using the Breast Lesion Excision System (BLES)

“…The main criteria for avoiding a BLES biopsy have been previously reported in papers from our unit, with the lesion positioning and the thickness of 14,15 the breast being the most frequent ones.…”

“…The procedure has been previously described in 14,15 reports from our department. Briefly, after careful stereotactic localization of the targeted area in order to be centrally positioned, 20 ml of local anesthetic (lidocaine 2%) is applied around the area (12, 3, 6 and 9 o'clock positions).…”