Initial Experience with a Cone-beam Breast Computed Tomography-guided Biopsy System.

OBJECTIVE: To evaluate our initial experience with a cone-beam breast computed tomography (BCT)-guided breast biopsy system for lesion retrieval in phantom studies for use with a cone-beam BCT imaging system. MATERIALS AND METHODS: Under the Institutional Review Board approval, a phantom biopsy study was performed using a dedicated BCT-guided biopsy system. Fifteen biopsies were performed on each of the small, medium, and large anthropomorphic breast phantoms with both BCT and stereotactic guidance for comparison. Each set of the 45 phantoms contained masses and calcification clusters of varying sizes. Data included mass/calcium retrieval rate and dose and length of procedure time for phantom studies. RESULTS: Phantom mass and calcium retrieval rate were 100% for BCT and stereotactic biopsy. BCT dose for small and medium breast phantoms was found to be equivalent to or less than the corresponding stereotactic approach. Stereotactic-guided biopsy dose was 34.2 and 62.5 mGy for small and medium breast phantoms, respectively. BCT-guided biopsy dose was 15.4 and 30.0 mGy for small and medium breast phantoms, respectively. Both computed tomography biopsy and stereotactic biopsy study time ranged from 10 to 20 min. CONCLUSION: Initial experience with a BCT-guided biopsy system has shown to be comparable to stereotactic biopsy in phantom studies with equivalent or decreased dose.

Comparison of breast cancers diagnosed in screening patients in their 40s with and without family history of breast cancer in a community outpatient facility.

OBJECTIVE: The purpose of this study was to compare invasive breast cancer in patients in their 40s with and without a family history of breast cancer as well as the lymph node meta-static rate and mastectomy rate. MATERIALS AND METHODS: From 2000 to 2011, a total of 793,827 examinations were performed; 221,541 (28%) were women between 40 and 49 years old. A total of 6965 cancers were found in 6511 patients. Specifically, 1207 cancers (17.3%) were detected in 1162 patients in their 40s. Patients presenting for diagnostic evaluation and those with a personal history of breast cancer were excluded, leaving 388 cancers available for study; 238 (61%) cancers were in patients with no family history of breast cancer, and 150 (39%) were in patients with a family history of breast cancer. Pearson chi-square, Fisher exact, and Student t tests were used for between-group comparisons for qualitative data. A two-sided p value was reported for all tests. RESULTS: The difference in lesions detected by imaging was not statistically significant (p = 0.17); 65% (154/238) had invasive and 35% (84/238) noninvasive disease in the no family history of breast cancer group and 65% (98/150) and 35% (52/150), respectively, in the family history of breast cancer group (p = 0.90). The mastectomy rate was not statistically significantly different (p = 0.14). Fifteen percent (35/238) of the no family history of breast cancer patients and 12% (18/150) of the family history of breast cancer patients had positive lymph nodes (p = 0.45). CONCLUSION: In patients in their 40s with or without a family history of breast cancer, no differences were detected in the proportion of invasive versus noninvasive cancers diagnosed, lymph node metastases, or mastectomy rates. Screening mammography should be performed in this age group regardless of family history.

Management of patients diagnosed with lobular carcinoma in situ at needle core biopsy at a community-based outpatient facility.

OBJECTIVE: The objective of our study was to show the importance of surgical excision after the diagnosis of lobular carcinoma in situ (LCIS) based on needle core biopsy. MATERIALS AND METHODS: Retrospective evaluation of all cases of LCIS diagnosed at needle core biopsy from 2000 to 2011 was performed; 60 patients with 64 diagnoses of LCIS comprise the cohort. Data recorded included patient demographics, patient presentation, breast density, personal and family histories of breast cancer, lesion characteristics, biopsy method, and correlation of core results with surgical pathology or follow-up imaging. The pathology facility was recorded for all biopsies because the specimens from open surgical biopsy were frequently reviewed by a different laboratory. RESULTS: A total of 60 patients with 64 diagnoses of LCIS comprised the study cohort. The patients ranged in age from 36 to 93 years (average, 55 years). The lesions consisted of 39 calcifications, two masses with calcium, 10 masses, two asymmetries, two architectural distortions, two architectural distortions with calcifications, and seven MRI enhancements. Mammography detected lesions in 84% of the cases (n = 54) and 16% (n = 10) were not visualized. Sonography detected lesions in 30% of the cases (n = 19) and 70% (n = 45) were sonographically occult. Needle core biopsy was performed in all cases: 49 stereotactic biopsies (77%), 12 ultrasound-guided biopsies, and three MRI-guided biopsies. All but one case proceeded to surgery. Open surgical biopsy revealed 21 cancers (33%); of the remaining cases, 53% of the cases (n = 33) were atypical or high risk and 14% (n = 9) were benign. CONCLUSION: The diagnosis of LCIS at needle core biopsy, in this small study, revealed that 84% of lesions either were malignant or were atypical or high risk at surgery, of which 33% were found to be carcinoma. Our findings suggest that LCIS should be excised when noted at core biopsy.

Community-based practice experience of unsuspected breast magnetic resonance imaging abnormalities evaluated with second-look sonography.

OBJECTIVE: The purpose of this study was to assess the utility and efficacy of second-look breast sonography in the evaluation of abnormalities identified on presurgical breast magnetic resonance imaging (MRI) examinations. METHODS: A retrospective review was performed of 152 presurgical breast MRI examinations having 196 unsuspected abnormalities to identify findings that underwent subsequent breast sonography. Eligible examinations had a suspicious abnormality identified on presurgical MRI and documentation of the location and size of the finding on MRI and subsequent second-look sonography. Fourteen examinations not meeting the criteria were excluded, with 182 abnormalities remaining. Patient medical records were reviewed. RESULTS: Seventy percent (128 of 182) of breast MRI lesions were visible at second-look sonography; 30% (54 of 182) were sonographically occult. Ninety-five percent (121 of 128) of sonographically visible abnormalities underwent breast biopsy. Pathologic examinations of sampled sonographically visible lesions revealed 39 cancers, 9 high-risk lesions, 72 benign lesions, and 1 lesion not specified at surgery; 23% (9 of 128) of cancers were in the contralateral breast. Fifty-four lesions were sonographically occult. Needle biopsy was performed for 93% (50 of 54) of occult lesions, revealing 8 cancers, 1 high-risk lesion, and 41 benign lesions; 3 of the benign lesions did not have sufficient pathologic specimens but were benign at follow-up. Magnetic resonance imaging guidance was used in 86% (43 of 50) of these biopsies. One contralateral cancer was identified in the sonographically occult subset. Of the 182 lesions that underwent second-look sonography, 20% (36 of 182) had a change in management. CONCLUSIONS: Second-look sonography has value in the evaluation of abnormalities found on breast MRI. We found enhancements in 70% (128 of 182), yielding 39 cancers.

Anticoagulation and bleeding risk after core needle biopsy.

OBJECTIVE: The objective of our study was to compare the bleeding complication rates after core needle biopsy in patients receiving anticoagulation therapy and those who had not to assess the safety of performing core needle breast biopsy in anticoagulated patients. MATERIALS AND METHODS: Core needle biopsy was performed at 1,144 sites in 1,055 women from August 2004 to May 2007. A retrospective study of these cases was performed. The patient group was composed of 200 women (220 biopsy sites) who were taking anticoagulant therapy daily (180 patients, aspirin; 16 patients, warfarin; and four patients, Excedrin), and the control group was composed of 855 women (924 biopsy sites) who were not receiving daily anticoagulant therapy. Any adverse reactions after core needle biopsy, including the presence and size of bruises or lumps (hematomas), were recorded. RESULTS: There was a statistically significant difference (p = 0.035) in the percentage of bruises between patients receiving anticoagulation therapy and those who were not. Bruising occurred in 68 of the 200 (34%) women in the patient group (anticoagulated), whereas bruising occurred in 227 of the 855 (26.5%) women in the control group (nonanticoagulated). The differences were not statistically significant for hematoma formation (p = 0.274) or bruising with hematoma formation (p = 0.413). Hematoma occurred in 12 of the 200 (6%) anticoagulated patients versus 36 of the 855 (4.2%) patients in the control group. Patients reporting a bruise and lump (hematoma) numbered 10 of 200 (5%) for the anticoagulated group and 32 of 855 (3.7%) for the control group. CONCLUSION: No patients undergoing core needle biopsy reported any clinically important complications. The results of this study confirm that performing core needle biopsy in patients on anticoagulation therapy is safe.

Full-field digital mammography on LCD versus CRT monitors.

OBJECTIVE: Our purpose was to determine if the display of full-field digital mammograms on a 5-megapixel liquid crystal display (LCD) monitor is at least equivalent to the display of the same on a 5-megapixel cathode ray tube (CRT) monitor. MATERIALS AND METHODS: Five radiologists evaluated normal anatomy and features of 61 abnormalities in 48 full-field digital mammograms. A 9-point Likert scale was used to compare images on two identical soft-copy review workstations, one equipped with two 5-megapixel CRTs and the other with two 5-megapixel LCDs. Outcomes were evaluated using a random-effects analysis of variance model. Means and SEs were reported. Ninety-five percent confidence intervals and p values were calculated. RESULTS: The two systems were equivalent for most features. The LCDs were rated better for the sharpness of mass margins (p = 0.011) and mass conspicuity (p = 0.050). For calcium features, the LCDs were rated better than the CRTs for lesion conspicuity (p = 0.010) and number of calcifications (p = 0.043). For architectural distortions, there was no statistically significant difference between the monitors in any of the features evaluated. For display characteristics, the LCDs were better for luminance (p = 0.021). The CRTs were significantly better for image noise (p = 0.001). In the overall ratings, there was no statistically significant difference between the two displays. CONCLUSION: The 5-megapixel monochrome active-matrix LCD is equivalent to and in some respects better than the 5-megapixel CRT display for full-field digital mammograms over a range of normal and abnormal findings.

Periareolar injection for localization of sentinel nodes in breast cancer patients.

The goal of this study was to evaluate the periareolar injection of technetium 99m sulfur colloid to identify axillary sentinel nodes and compare the number of sentinel lymph nodes identified with preoperative lymphoscintigraphy to intraoperative biopsy using a handheld gamma probe. A total of 104 consecutive patients diagnosed with invasive breast cancer participated in this prospective study, with 81 patients receiving an intradermal periareolar injection and 23 patients receiving an intradermal peritumoral injection of filtered technetium 99m sulfur colloid. Preoperative lymphoscintigraphy was performed for sentinel node mapping and localization. In addition to selective sentinel node biopsy, axillary dissection was performed on all patients to determine false-negative rates. Routine histologic staining was performed on all identified nodes, along with immunohistochemical staining of sentinel nodes negative on initial routine staining. With an intradermal periareolar injection, the sentinel node identification rate was 91.4% (74/81), axillary metastatic rate 35.1% (26/74), sentinel node positive only 61.5% (16/26), and false negative 3.8% (1/26). With an intradermal peritumoral injection, the sentinel node identification rate was 91.3% (21/23), axillary metastatic rate 42.9% (9/21), sentinel node positive only 88.9% (8/9), and false negative 0% (0/9). A total of 241 sentinel nodes were identified with biplanar lymphoscintigraphy and 173 sentinel nodes were harvested during surgery, yielding a 28.2% increase in sentinel nodes identified with lymphoscintigraphy. This study demonstrates that intradermal periareolar injection of filtered technetium 99m sulfur colloid is successful in identifying axillary sentinel nodes with a low false-negative rate. Preoperative lymphoscintigraphy aids in the identification and surgical planning of sentinel node biopsy and provides an objective measure of surgical performance.