Predictive value of specimen radiography for core needle biopsy of noncalcified breast masses.

Berg, Wendie A.; Jaeger, Barbara; Campassi, C; Kumar, Dhiren

doi:10.2214/ajr.171.6.9843311

Cited by 23 publications

(11 citation statements)

References 25 publications

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“…When microcalcifications detected in mammography are sampled, specimen radiography can ensure that sufficient amounts of microcalcification have been removed via cutting needle biopsy or vacuum biopsy; however, in US-guided biopsy, it is more difficult to demonstrate that the sample is sufficient [13,14]. US-guided biopsy is a technically easy procedure, and generally provides reliable sampling.…”

Section: Discussionmentioning

confidence: 99%

“…However, especially in non-solid masses and small lesions, demonstrating whether or not a sufficient sample has been obtained is not easy. If a lesion is easily seen on mammography, post-biopsy mammography control is capable of demonstrating that the sample has been obtained from the right region [13,14]. However, in 14-gauge needle biopsies, changes are generally not sufficient to yield marked findings in mammography relating to the breast tissue and the non-calcified lesion.…”

Section: Discussionmentioning

confidence: 99%

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Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

2014

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Background: The objectives of this study were to determine the frequency of imaging-histological discordance and to compare the frequency of carcinoma between discordant lesions at ultrasound (US)-guided core needle biopsy. Materials and Methods: From November 2009 to June 2012, we performed US-guided 14-gauge core needle biopsies on 989 breast lesions in 961 women. We reviewed 58 (5.8%) cases that had imaging-histological discordance after percutaneous breast biopsy and underwent subsequent excisional biopsy. The clinical, radiological, and histological findings were reviewed for those 58 cases. Results: Among the 58 cases, subsequent excisions revealed 16 (27.5%) malignancies, which were categorized as 9 (15.5%) invasive ductal carcinomas, 4 (6.9%) malignant phyllodes tumors, and 3 (5.1%) ductal carcinomas in situ. Conclusion: The malignancy rate of 27.5% suggests that surgical excision should be performed in those cases presenting with imaging-histological discordance after US-guided core biopsy. Careful correlation of clinical, radiological, and histological results as well as appropriate follow-up are essential.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

2014

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“…15,16 Specimen radiography can provide evidence that tissue was retrieved from the appropriate site during percutaneous biopsy of calcification lesions 17,18 but is less helpful for masses. 19 Postbiopsy mammography may reveal changes at the biopsy site, 20,21 but there is often no substantial alteration in the target lesion, particularly if the biopsy is performed with a smaller tissue acquisition device such as the 14-gauge automated needle. 22 Imaging-histologic correlation, therefore, plays an important role in percutaneous breast biopsy because of the limitations of other methods of confirming lesion sampling.…”

Section: Discussionmentioning

confidence: 99%

Imaging–histologic discordance at percutaneous breast biopsy

Liberman

Drotman

Morris

et al. 2000

Cancer

175

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“…Indeed, Venta et al (29) describe focal fibrosis as typically manifesting as a circumscribed mass: marginal spiculation should be considered discordant with a diagnosis of fibrosis on the basis of findings of core-needle biopsy. Further, Berg et al (30) reported that 22 (32%) of 68 core specimens showing only focal fibrosis had actually missed the lesion and that such a result was particularly problematic in dense breast tissue. As such, this patient chose bilateral mastectomy out of her understanding of the limitations of imaging and even core-needle biopsy in depicting both current and any subsequent disease.…”

Section: Discussionmentioning

confidence: 99%

Case 39: Invasive Lobular Carcinoma

Gill¹,

Berg²

2001

Radiology

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The patient was a 43-year-old woman, otherwise healthy, who presented with a palpable mass in the entire upper right breast, centered at the 12-o'clock position. She also had vague thickening of the upper left breast at the radiologist's clinical examination. IMAGING FINDINGSPreliminary clinical examination findings demonstrated a broad, approximately 7 ϫ 8-cm area of palpable thickening in the upper right breast extending from the 9-through the 3-o'clock position. Bilateral mediolateral oblique and craniocaudal mammograms (Fig 1a, 1b) and spot compression of the palpable area in the right breast (Fig 1c) showed dense tissue with no discrete abnormalities. Sonography of the upper right breast revealed numerous irregular hypoechoic masses from the 11-to the 3-o'clock position that were not discrete and demonstrated moderate posterior acoustic shadowing suggestive of invasive lobular carcinoma (ILC) (Fig 2a). Sonography of the left breast was also performed in a region of mildly palpable thickening felt by the radiologist at the 12-o'clock position, and the findings included an indistinct, approximately 17-mm focus of decreased echogenicity with moderate posterior acoustic shadowing (Fig 2b) that was also considered suspicious for cancer.Sonographically guided core-needle biopsy of the suspicious mass at the 12-o'clock position in the right breast with a 14-gauge automated biopsy gun revealed ILC. Sonographically guided core-needle biopsy of the suspicious area in the left breast, which revealed fibrosis, was also performed with a 14-gauge automated gun.A contrast material-enhanced magnetic resonance (MR) imaging examination was performed 42 days after the biopsy to evaluate the extent of disease and to plan treatment. Findings of MR imaging examination showed lobulated marked early enhancement of nearly the entire upper right breast that measured 7.3 ϫ 5.5 ϫ 5.0 cm and extended below the level of the nipple (Fig 3), which was compatible with cancer. The area in question in the left breast showed negligible enhancement, concordant with the core-needle biopsy finding of fibrosis. (2) that are loosely dispersed, whereas invasive ductal carcinoma (IDC) is more typically a discrete mass. ILC frequently invades the normal tissues without invoking the vigorous desmoplastic response that usually accompanies IDC. Cells of ILC often encircle ducts, thus preserving the architecture of the ducts (3). These histopathologic features tend to produce more subtle imaging findings with ILC than with IDC. DISCUSSION Infiltrating or invasive lobular carcinoma is the diagnosis in 7%-10% of all breast cancer (1-3). ILC is characterized microscopically by similar cells forming linear invasive columnsMammographically, as in our patient, often no focal mass or clustered microcalcifications are evident, particularly in dense parenchyma. As a result, ILC tends to be larger than IDC at diagnosis, with an average size of 29 mm compared with 23 mm for IDC in one series (4). Hilleren et al (5) retrospectively reviewed 137 cases of ILC and found...

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Predictive value of specimen radiography for core needle biopsy of noncalcified breast masses.

Cited by 23 publications

References 25 publications

Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

Imaging–histologic discordance at percutaneous breast biopsy

Case 39: Invasive Lobular Carcinoma

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