Pure flat epithelial atypia: is there a place for routine surgery?

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.

[Comparison between electronic zoom and geometric magnification of clusters of microcalcifications on digital mammography]. / Comparaison entre le zoom numérique et l'agrandissement géométrique dans l'étude des foyers de microcalcifications en mammographie numérique.

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.

[Clip migration after stereotactic macrobiopsy and presurgical localization: technical considerations and tricks]. / Déplacement de clip post-macrobiopsie sous guidage stéréotaxique et repérage préopératoire: trucs et astuces.

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.

[Role of MRI in the presurgical work-up of breast cancer: appropriate utilization of MRI as a complement to mammography and ultrasound]. / Place de l'IRM dans le bilan préchirurgical du cancer du sein: pour une utilisation raisonnée de cet examen complémentaire du bilan mammo-échographique.

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.

Stereotactic vacuum biopsy of calcifications with a handheld portable biopsy system: a validation study.

To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.