Cancelled stereotactic biopsy of calcifications not seen using the stereotactic technique: do we still need to biopsy?

Eur Radiol. 2014 Apr;24(4):907-12. doi: 10.1007/s00330-013-3055-z. Epub 2013 Nov 12.

Abstract

Objective: To determine the frequency of cancelled stereotactic biopsy due to non-visualisation of calcifications, and assess associated features and outcome data.

Methods: A retrospective review was performed on 1,874 patients scheduled for stereotactic-guided breast biopsy from 2009 to 2011. Medical records and imaging studies were reviewed.

Results: Of 1,874 stereotactic biopsies, 76 (4 %) were cancelled because of non-visualisation of calcifications. Prompt histological confirmation was obtained in 42/76 (55 %). In 28/76 (37 %) follow-up mammography was performed, and 7/28 subsequently underwent biopsy. Of 27 without biopsy, 21 (78 %) had follow-up. Nine cancers (9/49, 18 %) were found: 6 ductal carcinoma in situ (DCIS), 3 infiltrating ductal carcinoma (IDC). Of 54 patients with either biopsy or at least 2 years' follow-up, 9 (17 %) had cancer (95 % CI 8-29). Cancer was present in 7/42 (17 %, 95 % CI 7-31 %) lesions that had prompt histological confirmation (DCIS = 5, IDC = 2) and in 2/28 (7 %, 95 % CI 0.8-24 %) lesions referred for follow-up (DCIS = 1, IDC = 1). Neither calcification morphology (P = 0.2), patient age (P = 0.7), breast density (P = 1.0), personal history (P = 1.0) nor family history of breast cancer (P = 0.5) had a significant association with cancer.

Conclusion: Calcifications not visualised on the stereotactic unit are not definitely benign and require surgical biopsy or follow-up. No patient or morphological features were predictive of cancer.

Key points: • Half of cancelled stereotactic biopsies were due to non-visualisation of calcified foci. • This reflects the improved detection of calcifications by digital mammography. • Calcifications too faint for the stereotactic technique require alternative biopsy or follow-up • 17 % of patients with biopsy or at least 2 years' follow-up had cancer. • No patient/morphological features were found to aid selection for re-biopsy vs. follow-up.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy / methods
  • Breast / pathology
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Calcinosis / diagnostic imaging*
  • Carcinoma, Ductal, Breast / diagnostic imaging*
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Intraductal, Noninfiltrating / diagnostic imaging*
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Female
  • Humans
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Retrospective Studies
  • Stereotaxic Techniques