Bridiene Breast Biopsy BCR10

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STEREOTACTIC BREASTBIOPSY: CORRELATION WITH

HISTOLOGY

Rta Briedien, Rta Grigien, Raimundas MekauskasInstitute of Oncology Vilnius University, National Centre of

Pathology

3-rd Baltic Congress of Radiology, October 8-9, 2010 Riga


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BreastCancerinLithuania Themostcommoncanceramongwomen

About1400

new

cases

every

year

2009 83cases/100000inhabitants

2001 62

cases

/100

000

inhabitants

Screening

started

in

2005


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Breast cancerscreeningandbetterdiagnostictechniqueshave resulted in:

Significantdecreaseinsizeofsuspicious

lesions detected

on

imaging

studies

Shiftfromopensurgicaltopercutaneous

image guidedbiopsy


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Majorityofdetectedbreastcancers are


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BIRADS(breast imaging anddetection system)Category Assessment Cancer

probabilityRecommendation

1 Normal 0% Screeningin2years

2 Benign 0% Screeningin2years

3 Probably bening 95% Biopsy

6 KnownmalignancyACR (American College of Radiology)


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IndicationsforBreastBiopsyBIRADS3

Probably

Benign Finding

BIRADS 4

Suspicious

Abnormality

BIRADS 5

Highly Suggestive of

Malignancy

Anxious patient

Family history ofbreast cancer

Toconfirmdiagnosis

Todiferentiatebening from

malignantlesions

Toconfirm diagnosis

ToplansurgeryToplantherapy


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Biopsies

Surgicalbiopsy

Blindbiopsy

USguided

Stereoguided

MRguided

FNA

CNB

Vacuumbiopsy


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IndicatedTargetsforSBBMammographicAbnormalitiesBIRADS4and5

including Solid,spiculated,nonpalpableMass

Suspicious

Micro

calcifications Architecturaldistortion

Asymmetry


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Accuracymeans correlation with surgical biopsy and

depends on several issues:

Sampling localization accuracy Sample volume size

Type of cancer


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Accuracy

Desiredgoalis2540%ofrecommended

biopsiesbe

malignant

WallaceGur.D.etal.Radiology

2005;235:396401


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Results

InstituteofOncology,VilniusUniversity

Since2009SBB

LoradMulticareprone

biopsytable

14G

CNB

(Bard)

610samples


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ProneSBB Novasovagalepisodes

More

comfort

for

patient

Expensive

Separateroom


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Results

178 SBB

65 operations 47 cancercases(26%) Sensitivity

83% 133 microcalcifications

30

architecture

distortion

12 mass

4 mass+microc

11noncorrelatingresults 8FalseNegative

3notfoundatfinalhistology


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ResultsBIRADScategory

Surgical

category

3 (11cases) 4(158cases) 5 (9cases)

CNB benign

benign

14 1

malignant 7 1

CNBmalignant

benign 3

malignant 36 3

Nooperation 1 3


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8Falsenegativecases 2 architectural

distortion

6 mcc

4,3specimenspercase

(average5,1)

2,2cm averagespecimenlengh (average1,5cm)

1caseofsubcutaneous

tissue

1case

of

atypic hyperplasia

6cases proliferative

disorders


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CNB: subcutaneous tissue


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Postoperative histology: LCIS


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CNB: mcc in breast tissue

P t ti hi t l DCIS


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Postoperative histology: DCIS


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CNB: atypic hyperplasia


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Sectoral resection

Mastectomy

Multicentric DCIS, LCIS


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I CNB: Adenosis


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II CNB: Adenosis


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Postoperative histology:

inasive ductal carcinoma 6

mm G1


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BreastBiopsy DCISFinalhystology nocancer

3

cases

Microcalcifications

DCIS


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CNB: High grade DCISPostoperative histology: ductal epithelium hyperplasia

Right breast


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February 2009 October 2009

Right breast


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Left breast


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Right breast SBB: low grade DCIS Left breast SBB: low grade DCIS


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Postoperative

histology: benignfibrocystic changes,

ductal epitelium

hyperplasia

3 months after surgery

Subcutaneousmastectomy ?


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CNB: low grade DCISPostoperative histology: fibrocystic changes


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Factors that may influence

False negative biopsy results:

Histologicheterogenity

of

the

focus

Multifocal,multicentralcancer

Sampling

problems Thewrongbiopsyplace

Thewrongsamplesize

Cancermay

grow

in

neighbour

regions

with

benignlesions


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Recommendation

Adeterminationofconcordanceofpathologyresults

with

imaging

findings


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Conclusions

SensitivityofStereotacticBreastBiopsywas

83% 26%Cancercasesfromrecommended

biopsies

(target

25

40%)


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Bruening Wetal.Systematic Review:

Comparative Effectiveness of Core

Needleand Open Surgical Biopsy toDiagnose

Breast Lesions.AnnalsofInternal

Medicine.

2010;4:238

246

AllstudiesinMEDLINEand EMBASE from

1990to 2009 09 analysed:

33studieswithSCNB

22studies

with

vacuum

SB

16studieswithUSCNB

7studieswithUGvacuum biopsy

5studies

with

blind

CNB


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Summary of Key Accuracy Findings.

-


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Recommendations

Adeterminationofconcordanceofpathology

resultswith

imaging

findings

11GVacuumbiopsymoreaccuratethanCNB

Lesion

clip

marking

after

biopsy

Preoperativelesionmarking

Specimensradiography

Surgicalbiopsy

recommended

in

case

of

the

lesionclosetotheskin,chestwall,thenipple;

small

breast

Documents

Bridiene Breast Biopsy BCR10