STEREOTACTIC BREAST BIOPSY: CORRELATION WITH HISTOLOGY
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1 3-rd Baltic Congress of Radiology, October 8-9, 2010 Riga Rūta Briedienė, Rūta Grigienė, Raimundas Meškauskas Institute of Oncology Vilnius University, National Centre of Pathology STEREOTACTIC BREAST BIOPSY: CORRELATION WITH HISTOLOGY
2 Breast Cancer in Lithuania The most common cancer among women About 1400 new cases every year cases / inhabitants cases / inhabitants Screening started in 2005
3 Breast cancer screening and better diagnostic techniques have resulted in: Significant decrease in size of suspicious lesions detected on imaging studies Shift from open surgical to percutaneous image guided biopsy
4 Majority of detected breast cancers are < 15mm Minimally invasive percutaneous biopsy techniques are now used to diagnose the vast majority of breast cancers These smaller impalpable cancers are not typically grossly visible to the Surgeon
5 BIRADS (breast imaging and detection system) Category Assessment Cancer probability Recommendation 1 Normal 0% Screening in 2 years 2 Benign 0% Screening in 2 years 3 Probably bening <2% Follow up 0 Additional investigation needed 4 Probably malignant 2 95% Biopsy 5 Malignant >95% Biopsy 6 Known malignancy ACR (American College of Radiology)
6 Indications for Breast Biopsy BIRADS 3 Probably Benign Finding BIRADS 4 Suspicious Abnormality BIRADS 5 Highly Suggestive of Malignancy Anxious patient Family history of breast cancer To confirm diagnosis To diferentiate bening from malignant lesions To confirm diagnosis To plan surgery To plan therapy
7 Biopsies Surgical biopsy Blind biopsy US guided Stereo guided MR guided FNA CNB Vacuum biopsy
8 Indicated Targets for SBB Mammographic Abnormalities BIRADS 4 and 5 including Solid, spiculated, nonpalpable Mass Suspicious Micro calcifications Architectural distortion Asymmetry
9
10 Accuracy means correlation with surgical biopsy and depends on several issues: Sampling localization accuracy Samplevolumesize Typeofcancer
11 Accuracy Desired goal is 25 40% of recommended biopsies be malignant Wallace Gur. D. et al. Radiology 2005;235:
12 Results Institute of Oncology, Vilnius University Since 2009 SBB Lorad Multicare prone biopsy table 14G CNB (Bard) 6 10 samples
13 Prone SBB No vasovagal episodes More comfort for patient Expensive Separate room
14 Results 178 SBB 65 operations 47 cancer cases (26%) Sensitivity 83% 11 non correlating results 8 False Negative 3 not found at final histology 133 microcalcifications 30 architecture distortion 12 mass 4 mass + microc
15 Results BIRADS category Surgical category 3 (11 cases) 4 (158 cases) 5 (9 cases) CNB benign benign 14 1 malignant 7 1 CNB malignant benign 3 malignant 36 3 No operation 1 3
16 8 False negative cases 2 architectural distortion 6 mcc 4,3 specimens per case (average 5,1) 2,2cm average specimen lengh (average 1,5cm) 1 case of subcutaneous tissue 1 case of atypic hyperplasia 6 cases proliferative disorders
17
18 CNB: subcutaneous tissue
19 Postoperative histology: LCIS
20
21 CNB: mcc in breast tissue
22 Postoperative histology: DCIS
23
24 CNB: atypic hyperplasia
25 Sectoral resection Mastectomy Multicentric DCIS, LCIS
26 I CNB: Adenosis
27 II CNB: Adenosis
28 Postoperative histology: inasive ductal carcinoma 6 mm G1
29 Breast Biopsy DCIS Final hystology no cancer 3 cases Microcalcifications DCIS
30
31 CNB: High grade DCIS Postoperative histology: ductal epithelium hyperplasia
32 Right breast February 2009 October 2009
33 Left breast
34 Right breast SBB: low grade DCIS Left breast SBB: low grade DCIS
35 Postoperative histology: benign fibrocystic changes, ductal epitelium hyperplasia Subcutaneous mastectomy? 3 months after surgery
36
37 CNB: low grade DCIS Postoperative histology: fibrocystic changes
38 Factors that may influence False negative biopsy results: Histologic heterogenity of the focus Multifocal, multicentral cancer Sampling problems The wrong biopsy place The wrong sample size Cancer may grow in neighbour regions with benign lesions
39
40 Recommendation A determination of concordance of pathology results with imaging findings
41 Conclusions Sensitivity of Stereotactic Breast Biopsy was 83% 26% Cancer cases from recommended biopsies (target 25 40%)
42 Bruening W et al. Systematic Review: Comparative Effectiveness of Core Needle and Open Surgical Biopsy to Diagnose Breast Lesions. Annals of Internal Medicine. 2010; 4: All studies in MEDLINE and EMBASE from 1990 to analysed: 33 studies with SCNB 22 studies with vacuum SB 16 studies with US CNB 7 studies with UG vacuum biopsy 5 studies with blind CNB
43 Summary of Key Accuracy Findings.
44 Recommendations A determination of concordance of pathology results with imaging findings 11 G Vacuum biopsy more accurate than CNB Lesion clip marking after biopsy Preoperative lesion marking Specimens radiography Surgical biopsy recommended in case of the lesion close to the skin, chest wall, the nipple; small breast
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