Our Results of Stereotactic Vacuum Aspiration Biopsy Performed with Mammography on BIRADS 3 and 4 Lesions Detected in Mammography: Single Center Experience

Öz

Aim: To evaluate the effectiveness of stereotactic vacuum aspiration biopsy (SVAB) performed with mammography as an alternative to traditional biopsy methods or excisional biopsy for BI-RADS 3 and 4 category breast lesions.
Materials and Methods: Stereotactic vacuum aspiration biopsy (SVAB) was performed on patients who were detected to have BIRADS 3-4 lesions on mammography in our clinic. Pathology results of these patients were evaluated retrospectively. It was planned to evaluate the effectiveness of the SVAB method by comparing the SVAB pathology results with the surgical pathology results.
Results: With the evaluation of 1196 mammography examinations performed between May 2014 and May 2015 in our clinic, 53 of them which were SVAB performed and diagnosed with BI-RADS category 3 and 4 were included in our study. 9 of these cases were classified as BI-RADS 3 (17%), 33 of them as 4a (62%), 6 of them as 4b (11%) and 5 of them as 4c (9%). Four (12.1%) of the cases with pathological BI-RADS 4a and 2 (40%) of the BI-RADS 4c cases are compatible with premalignant / in situ lesions (Ductal carcinoma in situ, Atypical ductal hyperplasia). Microcalcification was present in 47 of the cases and nodular density in 11 of them. Procedure-related complications developed in only two cases (skin laceration / hemorrhage and vagal hypotension).
Conclusion: It is possible to obtain sufficient sample material with SVAB method. It is a successful alternative diagnostic method instead of traditional biopsy methods that can give insufficient material and false-negative results or invasive excisional biopsy.

Anahtar Kelimeler

• Mammography,BI-RADS 3 and 4 lesions,tereotactic Vacuum Aspiration Biopsy

Mamografide Tespit Edilen BIRADS 3 ve 4 Lezyonlara Yönelik Mamografi Eşliğinde Yapılan Stereotaktik Vakum Aspirasyon Biyopsi Sonuçlarımız: Tek Merkez Deneyimi

Öz

Amaç: Breast Imaging Reporting and Data System (BI-RADS) 3 ve 4 kategori içerisinde yer alan meme lezyonlarına yönelik, geleneksel biyopsi yöntemleri ya da eksizyonel biyopsiye alternatif olarak mamografi eşliğinde yapılan stereotaktik vakum aspirasyon biyopsi (SVAB) nin etkinliğini değerlendirmek.
Gereç ve Yöntemler: Kliniğimizde yapılan mamografilerde BIRADS 3-4 lezyon tespit edilen hastalardan, stereotaktik vakum aspirasyon biyopsisi (SVAB) yapılan hastaların patoloji sonuçları retrospektif olarak değerlendirildi. SVAB patoloji sonuçları ile cerrahi patoloji sonuçları arasında fark olup olmadığı incelenerek yöntemin etkinliğinin değerlendirilmesi planlandı.
Bulgular: Kliniğimizde Mayıs 2014 – Mayıs 2015 tarihleri arasında yapılan 1196 mamografi incelemesinin değerlendirilmesi ile BI-RADS kategori 3 ve 4 tanısı alan olguların, SVAB uygulanmış 53'ü çalışmamıza dahil edildi. Bu olguların 9'u BI-RADS 3 (%17), 33'ü 4a (%62), 6'sı 4b (%11) ve 5'i 4c (%9) olarak sınıflandırıldı. Patoloji sonucu BI-RADS 4a olan olguların 4 ü (%12.1), BI-RADS 4c olguların 2 si (%40) premalign / in situ lezyonlar (Duktal karsinoma in situ, Atipik duktal hiperplazi) ile uyumludur. Olguların 47'sinde mikrokalsifikasyon, 11'inde nodüler dansite mevcuttu. Olguların sadece iki tanesinde (ciltte laserasyon/hemoraji ile vagal hipotansiyon) işleme bağlı komplikasyon gelişmiştir.
Sonuç: SVAB yeteri kadar örnek materyal alma imkânı sunmaktadır. Yetersiz materyal ve yanlış negatif sonuçlar verebilen geleneksel biyopsi yöntemleri ya da invaziv eksizyonel biyopsi yerine başarılı, alternatif bir tanı yöntemidir.

Anahtar Kelimeler

• Mamografi,BI-RADS 3 ve 4 lezyonlar,Stereotaktik Vakum Aspirasyon Biopsisi

Kaynakça

1. 1. Pickles MD, Lowry M, Manton DJ, Gibbs P, Turnbull LW. Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy. Breast Cancer Res Treat. 2005;91(1):1-10. DOI: 10.1007/s10549-004-5819-2
2. 2. Winchester DP. Breast cancer in young women. Surg Clin North Am. 1996;76(2):279-87. DOI: 10.1016/s0039-6109(05)70439-4
3. 3. Hortobagyi GN, de la Garza Salazar J, Pritchard K, Amadori D, Haidinger R, Hudis CA, et al. The global breast cancer burden: variations in epidemiology and survival. Clin Breast Cancer. 2005;6(5):391-401. DOI: 10.3816/cbc.2005.n.043
4. 4. Kopans DB. The positive predictive value of mammography. AJR Am J Roentgenol. 1992;158(3):521-6. DOI: 10.2214/ajr.158.3.1310825
5. 5. Burbank F. Mammographic findings after 14-gauge automated needle and 14-gauge directional, vacuum-assisted stereotactic breast biopsies. Radiology. 1997;204(1):153-6. DOI: 10.1148/radiology.204.1.9205238
6. 6. Ayşenur Oktay. Meme Hastalıklarında Görüntüleme.Rota Tıp Kitabevi. 2014; 237-239.
7. 7. O'Flynn EA, Wilson AR, Michell MJ. Image-guided breast biopsy: state-of-the-art. Clin Radiol. 2010;65(4):259-70. DOI: 10.1016/j.crad.2010.01.008
8. 8. Parker SH, Jobe WE, Dennis MA, Stavros AT, Johnson KK, Yakes WF, et al. US-guided automated large-core breast biopsy. Radiology. 1993;187(2):507-11. DOI: 10.1148/radiology.187.2.8475299

9. 9. Sauer G, Deissler H, Strunz K, Helms G, Remmel E, Koretz K, et al. Ultrasound-guided large-core needle biopsies of breast lesions: analysis of 962 cases to determine the number of samples for reliable tumour classification. Br J Cancer. 2005;92(2):231-5. DOI: 10.1038/sj.bjc.6602303
10. 10. Grady I, Gorsuch H, Wilburn-Bailey S. Long-term outcome of benign fibroadenomas treated by ultrasound-guided percutaneous excision. Breast J. 2008;14(3):275-8. DOI: 10.1111/j.1524-4741.2008.00574.x
11. 11. Hui JY, Chan LK, Chan RL, Lau AW, Lo J, Chan JC, et al. Prone table stereotactic breast biopsy. Hong Kong Med J. 2002;8(6):447-51.
12. 12. Yıldız, Veysel Atilla. Pron masada stereotaktik vakumlu biyopsi yapılan mikrokalsifikasyonların mamografik özelliklerinin patoloji bulgularıyla karşılaştırılması. Uzmanlık tezi, 2014. Ankara.
13. 13. Memarsadeghi M, Pfarl G, Riedl C, Wagner T, Rudas M, Helbich TH. Value of 14-gauge ultrasound-guided large-core needle biopsy of breast lesions: own results in comparison with the literature. Rofo. 2003;175(3):374-80. DOI: 10.1055/s-2003-37822
14. 14. Jackman RJ, Burbank F, Parker SH, Evans WP, Lechner MC, Richardson TR, et al. Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 2001;218(2):497-502. DOI: 10.1148/radiology.218.2.r01fe35497
15. 15. Liberman L. Percutaneous image-guided core breast biopsy. Radiol Clin North Am. 2002;40(3):483-500. DOI: 10.1016/s0033-8389(01)00011-2
16. 16. American College of Radiology. ACR breast imaging reporting and data system (BI-RADS): breast imaging atlas. Reston, Va: American College of Radiology, 2003.
17. 17. Vizcaíno I, Gadea L, Andreo L, Salas D, Ruiz-Perales F, Cuevas D, et al. Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 2001;219(2):475-83. DOI: 10.1148/radiology.219.2.r01ma11475
18. 18. Liberman L, Gougoutas CA, Zakowski MF, LaTrenta LR, Abramson AF, Morris EA, et al. Calcifications highly suggestive of malignancy: comparison of breast biopsy methods. Am J Roentgenol 2001;177:165-72. DOI: 10.2214/ajr.177.1.1770165
19. 19. Kettritz U, Rotter K, Schreer I, Murauer M, Schulz‐Wendtland R, Peter D, et al. Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer 2004;100:245-51. DOI: 10.1002/cncr.11887
20. 20. Liberman L, Sama MP. Cost-effectiveness of stereotactic 11-gauge directional vacuum-assisted breast biopsy. Am J Roentgenol 2000;175:53-8. DOI: 10.2214/ajr.175.1.1750053
21. 21. Uematsu T, Kasami M, Yuen S. Usefulness and limitations of the Japan Mammography Guidelines for the categorization of microcalcifications. Breast Cancer. 2008;15(4):291-7. DOI: 10.1007/s12282-008-0033-4
22. 22. Shah AK, Girishkumar HT, Parithivel VS. Stereotactic needle bre¬ast biopsy: a review of current status and practice. Prim Care Update Ob Gyns 1999;6:147-52.
23. 23. Salem C, Sakr R, Chopier J, Antoine M, Uzan S, Daraï, E. Pain and complications of directional vacuum-assisted stereotactic biopsy: comparison of the Mammotome and Vacora techniques. Eur J Radiol 2009;72:295-9. DOI: 10.1016/j.ejrad.2008.07.015