Korean J Radiol.  2015 Oct;16(5):996-1005. 10.3348/kjr.2015.16.5.996.

Breast Microcalcifications: Diagnostic Outcomes According to Image-Guided Biopsy Method

• Bae S
• Yoon JH
• Moon HJ
• Kim MJ
• Kim EK

• KMID: 2160766
• DOI: http://doi.org/10.3348/kjr.2015.16.5.996

Abstract

OBJECTIVE
To evaluate the diagnostic outcomes of ultrasonography-guided core needle biopsy (US-CNB), US-guided vacuum-assisted biopsy (US-VAB), and stereotactic-guided vacuum-assisted biopsy (S-VAB) for diagnosing suspicious breast microcalcification.
MATERIALS AND METHODS
We retrospectively reviewed 336 cases of suspicious breast microcalcification in patients who subsequently underwent image-guided biopsy. US-CNB was performed for US-visible microcalcifications associated with a mass (n = 28), US-VAB for US-visible microcalcifications without an associated mass (n = 59), and S-VAB for mammogram-only visible lesions (n = 249). Mammographic findings, biopsy failure rate, false-negative rate, and underestimation rate were analyzed. Histological diagnoses and the Breast Imaging Reporting and Data System (BI-RADS) categories were reported.
RESULTS
Biopsy failure rates for US-CNB, US-VAB, and S-VAB were 7.1% (2/28), 0% (0/59), and 2.8% (7/249), respectively. Three false-negative cases were detected for US-CNB and two for S-VAB. The rates of biopsy-diagnosed ductal carcinoma in situ that were upgraded to invasive cancer at surgery were 41.7% (5/12), 12.9% (4/31), and 8.6% (3/35) for US-CNB, US-VAB, and S-VAB, respectively. Sonographically visible lesions were more likely to be malignant (66.2% [51/77] vs. 23.2% [46/198]; p < 0.001) or of higher BI-RADS category (61.0% [47/77] vs. 22.2% [44/198]; p < 0.001) than sonographically invisible lesions.
CONCLUSION
Ultrasonography-guided vacuum-assisted biopsy is more accurate than US-CNB when suspicious microcalcifications are detected on US. Calcifications with malignant pathology are significantly more visible on US than benign lesions.

Keyword

Mammography; Calcification; Ultrasonography; Core needle biopsy; Image-guided biopsy

MeSH Terms

Adult
Aged
Biopsy, Large-Core Needle
Breast/*pathology
Breast Neoplasms/*pathology/ultrasonography
Carcinoma, Intraductal, Noninfiltrating/pathology
False Negative Reactions
Female
Humans
Image-Guided Biopsy
Imaging, Three-Dimensional
Middle Aged
Retrospective Studies
Ultrasonography, Mammary

Figure

• 

  Fig. 1 Study population. BI-RADS = Breast Imaging Reporting and Data System, S-VAB = stereotactic-guided vacuum assisted biopsy, US-CNB = ultrasonography-guided core needle biopsy, US-VAB = ultrasonography-guided vacuum assisted biopsy

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  Fig. 2 68-year-old female patient with complaint of bloody nipple discharge from left breast. A. Magnified mammogram of left breast reveals suspicious segmental coarse heterogeneous microcalcifications. B. Ultrasonogram of left breast shows hypoechoic mass with internal hyperechoic foci in upper outer aspect of left breast. 14-gauge ultrasonography-guided core needle biopsy was performed on mass, and final diagnosis was invasive ductal carcinoma.

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  Fig. 3 54-year-old female patient who underwent screening mammography. A. Magnified mammogram of left breast reveals suspicious segmental coarse heterogeneous microcalcifications. B. Ultrasonogram of left breast shows microcalcifications (arrows) at corresponding area of microcalcifications observed on mammography. C. Radio-opaque marker was placed on skin over lesion for confirmation, and left breast view was magnified. Ultrasonography (US)-visible microcalcifications are correlated with mammographically visualized microcalcifications. D. 11-gauge US-guided vacuum-assisted biopsy is performed. E. Specimen mammography confirms retrieval of microcalcifications. Diagnosis was ductal carcinoma in situ, which was also confirmed by post-partial mastectomy pathology.

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  Fig. 4 47-year-old female patient who underwent screening mammography. A. Magnified mammogram of left breast reveals suspicious grouped fine pleomorphic microcalcifications (arrow). B. Ultrasonogram of left breast shows hypoechoic mass with internal hyperechoic foci (arrows) in upper central aspect of left breast. 14-gauge ultrasonography-guided core needle biopsy was performed on mass, and calcifications were not retrieved per specimen mammography. Diagnosis was stromal fibrosis, which was thought to be discordant with imaging findings. Patient underwent excisional biopsy under wire localization, and final diagnosis was ductal carcinoma in situ.

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