Use of ultrasound-guided percutaneous vacuum-assisted breast biopsy for selected difficult indications.

To assess ultrasound-guided vacuum-assisted biopsy (US-VAB) for selected problem cases and to report experiences with two different biopsy systems. Fifty-one lesions have been biopsied using the Mammotome (n = 24) or the Vacora (n = 27) system. Main indications: lesion in scarring (n = 5), complex cystic >or=8 mm (n = 7), increase in size (n = 10), architectural distortion (n = 4), uncharacteristic palpable abnormality (2), small size (n = 22), regional microcalcifications (n = 1). Results are verified by surgical excision (n = 10) or follow-up (n = 40). One patient was lost to follow-up. In four of the cases preceding core biopsy was inconclusive. four invasive carcinomas, two ductal carcinoma in situ (DCIS), three papillomas, six fibroadenomas, one adenosis tumor, one hamartoma, 10 complex cysts, 16 benign changes, three fat necroses, two granulomas, three unspecific inflammatory changes are verified. Surgery confirmed five malignancies, four benign changes, and converted one uncertain diagnosis (architectural distortion) from "inflammatory" to DCIS. Documented removal of all or most of the lesions correctly increased the level of confidence and open surgery could be avoided in 41/51 lesions. The two systems show different advantages and drawbacks. US-VAB may improve the level of confidence in selected difficult cases. Careful case selection and systematic retrospective correlation of imaging and histology remain crucial.

Reliability and validity of needle biopsy evaluation of breast-abnormalities using the B-categorization--design and objectives of the Diagnosis Optimisation Study (DIOS).

BACKGROUND: The planned nationwide implementation of mammography screening 2007 in Germany will increase the occurrence of mammographically detected breast abnormalities. These abnormalities are normally evaluated by minimal invasive core biopsy. To minimize false positive and false negative histological findings, quality assurance of the pathological evaluation of the biopsies is essential. Various guidelines for quality assurance in breast cancer diagnosis recommend applying the B-classification for histopathological categorization. However, to date there are only few studies that reported results about reliability and validity of B-classification. Therefore, objectives of our study are to determine the inter- and intraobserver variability (reliability study) and construct and predictive validity (validity study) of core biopsy evaluation of breast abnormalities. This paper describes the design and objectives of the DIOS Study. METHODS/DESIGN: All consecutive asymptomatic and symptomatic women with breast imaging abnormalities who are referred to the University Hospital of Halle for core breast biopsy over a period of 24 months are eligible. According to the sample size calculation we need 800 women for the study. All patients in the study population underwent clinical and radiological examination. Core biopsy is performed by stereotactic-, ultrasound- or magnetic resonance (MR) guided automated gun method or vacuum assisted method. The histopathologic agreement (intra- and interobserver) of pathologists and the histopathologic validity will be evaluated. Two reference standards are implemented, a reference pathologist and in case of suspicious or malignant findings the histopathologic result of excision biopsy. Furthermore, a self administrated questionnaire which contains questions about potential risk factors of breast cancer, is sent to the participants approximately two weeks after core biopsy. This enables us to run a case-control-analysis (woman with breast cancer histological verified after excision are defined as cases, woman without malignant breast lesions are defined as controls) to investigate the predictive values of various risk factors on breast cancer risk. CONCLUSION: The analysis of reliability and validity of the histopathological evaluation of core biopsy specimens of breast abnormalities is intended to provide important information needed for a high quality in breast cancer diagnostic and for planning of treatment strategies.

Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions.

BACKGROUND: The objective of this study was to determine the accuracy, reproducibility, and clinical value of magnetic resonance (MR)-guided, vacuum-assisted breast biopsy (MR-VAB) in a prospective, multicenter study. METHODS: In 5 European centers, MR-VAB was performed or attempted on 538 suspicious lesions that were visible or could targeted only by MR imaging (MRI). Verification of malignant or borderline lesions included reexcision of the biopsy cavity. Benign biopsy results were verified by retrospective correlation of histology with preinterventional and postinterventional MRI studies. Follow-up of 24-48 months (median, 32 months) was available for 491 of 538 patients. RESULTS: MR-VAB was unsuccessful or was not completed in 21 of 538 patients, for which an immediate repeat biopsy was recommended. Five hundred seventeen of 538 performed VAB procedures (96%) were successful. Histology yielded 138 (27%) malignancies, 17 (3%) atypical ductal hyperplasias, and 362 (70%) benign entities. No false-negative diagnoses occurred among the 517 successful MR-VAB procedures. The positive predictive value of VAB depended on patient preselection, which differed according to the indication for the initial MRI study. CONCLUSIONS: The results of this study indicated that MR-VAB offers excellent accuracy. Small lesion size did not prove to be a limitation.

MR-guided intervention in women at high hereditary risk of breast cancer due to both family and personal history of breast cancer.

The purpose of this study was to assess the value of magnetic resonance imaging (MRI)-guided intervention in women with a significant hereditary susceptibility to breast cancer due to both family and personal history of breast cancer (heterozygote risk >20%). Thirty women were referred for MR-guided intervention. MR examinations (1.0 T, T1-weighted 3D FLASH, 0.15 mmol Gd-DTPA/kg body weight, prone position) were performed using a system which allows vacuum-assisted breast biopsy or wire localization. Histologic findings in 41 procedures revealed six invasive carcinomas, eight ductal carcinomas in situ and two atypical ductal hyperplasias. Twenty-three benign histologic results were verified by an MR-guided intervention, retrospective correlation of imaging and histology and by subsequent follow-up. In two lesions the indication dropped as the enhancing lesion was no longer visible on the date of planned intervention. Absent enhancement was confirmed by short-term re-imaging of the non-compressed breast and by follow-up.

Spatial second-derivative image processing: an application to optical mammography to enhance the detection of breast tumors.

We present an image-processing method that enhances the detection of regions of higher absorbance in optical mammograms. At the heart of this method lies a second-derivative operator that is commonly employed in edge-detection algorithms. The resulting images possess a high contrast, an automatic display scale, and a greater sensitivity to smaller departures from the local background absorbance. Moreover, the images are free of artifacts near the breast edge. This second-derivative method enhances the display of structural information in optical mammograms and may be used to robustly select areas of interest to be further analyzed spectrally to determine the oxygenation level of breast lesions.

Suppression of unspecific enhancement on breast magnetic resonance imaging (MRI) by antiestrogen medication.

AIMS AND BACKGROUND: The value of breast MRI may be impaired by unspecific enhancement. This may leave patients with difficult-to-assess breast tissue with an uncertain diagnosis. We examined whether this unspecific enhancement (which is mostly due to proliferative or hyperplastic changes of benign breast tissue) may be suppressed by antiestrogen medication. METHODS: In a trial of treatment, 10 peri- or postmenopausal patients who exhibited diffuse and/or focal enhancement on breast MRI before tamoxifen medication agreed to undergo a short-term tamoxifen treatment. MRI monitoring was performed 2, 4 and 8 weeks after onset of antiestrogen therapy (tamoxifen, 30 mg per day). RESULTS: Six patients showed a significant decrease of enhancement. Unchanged (n = 3) or increased (n = 1) enhancement was seen in 4 patients. One of the three patients with unchanged enhancement proved to have diffuse lobular carcinoma in situ. CONCLUSIONS: Part of the unspecific enhancement seen on breast MRI can probably be suppressed by short-term antiestrogen medication.