ABSTRACT
PURPOSE: To determine whether it is appropriate to routinely undertake surgery if flat epithelial atypia (FEA) or pure flat epithelial atypia (pFEA) is found on large-core biopsy. PATIENTS AND METHODS: Between 2005 and 2010, 1678 large-core biopsy procedures were carried out, which led to 136 FEA sites being identified, 63 of which across 59 patients were pFEA (four patients had two sites of pFEA each). Forty-eight patients underwent further surgical excision, equating to 52 excised sites of pFEA. RESULTS: Of the 52 operated sites, there were 20 benign lesions (38%), 26 borderline lesions (56%), and three ductal carcinomas in situ (6%). The rate of histologic underestimation was put at 3.8%. Of the three cases that were underestimated, one was discarded because the definitive histology was not representative of the site from which microcalcifications had initially been taken. The other two cases that were underestimated were found in patients with an increased individual risk of breast cancer. CONCLUSION: In patients with no personal or first-degree family history of breast cancer, after complete or subtotal excision under radiology of the radiological lesion, and while excluding images fitting BI-RADS 5, annual monitoring may be offered as an alternative to surgical excision in view of the absence of underestimation found in our study.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma in Situ/pathology , Carcinoma in Situ/surgery , Mammography , Precancerous Conditions/pathology , Precancerous Conditions/surgery , Adult , Aged , Biopsy, Large-Core Needle , Breast/pathology , Breast Neoplasms/genetics , Calcinosis/pathology , Calcinosis/surgery , Carcinoma in Situ/genetics , Carcinoma, Intraductal, Noninfiltrating/genetics , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/surgery , Diagnosis, Differential , Epithelial Cells/pathology , Female , Follow-Up Studies , Genetic Predisposition to Disease/genetics , Humans , Male , Mastectomy, Segmental , Middle Aged , Precancerous Conditions/genetics , PrognosisABSTRACT
PURPOSE: With the advent of digital mammography with electronic zoom capabilities, we have sought to determine the need for geometric magnification for the evaluation of clusters of microcalcifications. PATIENTS AND METHODS: Eighty-eight clusters of microcalcifications were reviewed by two experienced radiologists using electronic zoom (ZOOM) and geometric magnification (MAG). The following criteria were evaluated: image quality, shape and number of microcalcifications, size and shape of the clusters. The clusters were classified based on malignancy risk using the BI-RADS criteria. Histological results from macrobiopsy or surgery as well as 2 year follow-up were used as reference for statistical analysis. RESULTS: Sensitivity (100% for MAG and 90% for ZOOM), specificity (52% versus 39%), positive predictive value (51% versus 44%) and negative predictive value (100% versus 88%) were superior for geometric magnification compared to electronic zoom irrespective of the reviewer but without reaching statistical significance. However, image quality was significantly superior with geometric magnification (p<<0.05). In addition, reviewers were more confident in their interpretation of geometric magnification images. CONCLUSION: Geometric magnification remains necessary in routine clinical practice for the characterization of microcalcifications and BI-RADS classification.
Subject(s)
Breast Neoplasms/diagnostic imaging , Calcinosis/diagnostic imaging , Image Processing, Computer-Assisted , Mammography/methods , Radiographic Image Enhancement/methods , Radiographic Magnification/methods , Biopsy , Breast/pathology , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Calcinosis/pathology , Calcinosis/surgery , Female , Follow-Up Studies , Humans , Observer Variation , Sensitivity and Specificity , SoftwareABSTRACT
PURPOSE: Clip migration occurs frequently in clinical practice (13-20%), irrespective of the approach. The purpose of this article is to suggest tricks in order to decrease clip migration and optimize presurgical localization. MATERIALS AND METHODS: Retrospective study of breast macrobiopsy from a lateral approach performed between March 2003 and June 2004: 447 clips were placed. Sixty clips showed migration>20 mm, due to the accordion effect in 59 cases (98.4%). These 59 procedures were analyzed to try and understand the underlying mechanisms of clip migration. RESULTS: From these 59 clips, more migrations were noted on CC compression (16.6%) compared to MLO compression (5.2%). This difference was statistically significant. Therefore, we promote the use of MLO compression. This incidence also allows optimal presurgical localization in case of clip migration, by placing the patient in the same position while modulating depth based on the extent of clip displacement. CONCLUSION: For quality purposes, it is imperative to know the clip position relative to the initial target. By using MLO compression from a lateral approach, it is possible to reduce clip migration and optimize future presurgical localization.
Subject(s)
Biopsy/instrumentation , Biopsy/methods , Breast/pathology , Foreign-Body Migration , Radiology, Interventional , Stereotaxic Techniques , Surgical Instruments , Adult , Aged , Aged, 80 and over , Breast/surgery , Chi-Square Distribution , Female , Humans , Mammography , Middle AgedABSTRACT
The role of MRI for presurgical local staging of breast cancers amenable to conservative treatment has been the subject of multiple publications and tends to become a "validated" indication in routine practice. The purpose of the paper is to review the advantages and limitations of this imaging modality that is part of a comprehensive management that must be validated by clinical data especially with regards to local recurrence and survival. Knowledge of these elements combined with more precise indications should result in improved patient management while avoiding overtreatment or unnecessary anxiety-producing examinations.
