Stereotactic Biopsy Results of a Series of Patients with Nonpalpable Breast Lesions in Our Hospital

Yıl 2020, , 180 - 186, 29.10.2020

Nadir Adnan Hacım , Ahmet Akbaş

https://doi.org/10.21673/anadoluklin.683171

Cited By: 2

Öz

Aim: Although screening mammography has a high sensitivity in the clinical detection of nonpalpable breast cancer, most mammographically suspicious lesions referred to biopsy are seen to be benign. The rate of malignancy in such lesions that are biopsied with needle–wire localization ranges from 10 to 36%. In this study, we aimed to compare with the literature the pathological results and Breast Imaging Reporting and Data System (BI-RADS) scores of lesions subjected to mammography and excisional biopsy after ultrasonography-guided needle–wire localization and calculate a positive predictive value for each category.

Materials and Methods: By electronically reviewing patient files and using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified patients who underwent excisional biopsy after stereotactic marking at the General Surgery Clinic of the Istanbul Sisli Hamidiye Etfal Training and Research Hospital between January 2003 and March 2009. A total of 64 patients were included in the study, of whom 43 had benign and 21 had malignant lesions on postoperative histopathological examination. Data on patient demographic characteristics, indications for marking, and histopathological diagnoses were recorded. The patient BI-RADS scores were determined based on the mammography and breast ultrasonography reports. The BI-RADS classification and histopathological examination results were compared in percentages.

Results: The mean patient age was 48.9 (32–76) years. Based on the mammography reports, the most common indications for stereotactic marking and excisional biopsy were microcalcification cluster and spiculated mass. Histopathological examination results revealed malignancy in 8%, 51%, and 100% of the patients whose BI-RADS scores were mammographically determined to be BI-RADS 3, BI-RADS 4, and BI-RADS 5, respectively.

Discussion and Conclusion: The BI-RADS-based classification of lesions detected by mammography and ultrasonography can help in predicting malignancy. While BI-RADS 4 and BI-RADS 5 lesions are referred to biopsy primarily, short-term follow-up of BI-RADS 3 lesions as an alternative to biopsy could reduce unnecessary biopsies.

Anahtar Kelimeler

BI-RADS, Malignity, Mammography, Stereotactic techniques

Hastanemizde Nonpalpabl Meme Lezyonlu Bir Hasta Serisinde Stereotaktik Biyopsi Sonuçları

Öz

Amaç: Tarama mamografisi nonpalpabl meme kanserinin klinik tespitinde yüksek sensitivite göstermekle birlikte, mamografide saptanan ve biyopsi önerilen şüpheli lezyonların çoğunun benign olduğu görülmektedir. Tel lokalizasyonu ile biyopsi yapılan bu lezyonlarda malignite oranı %10–36 aralığında değişmektedir. Bu çalışmada mamografi ve ultrasonografi eşliğinde tel lokalizasyonu sonrasında eksizyonel biyopsi yapılan lezyonların patolojik sonuçlarının ve Meme Görüntüleme Raporlama ve Veri Sistemi (the Breast Imaging Reporting and Data System—BI-RADS) skorlarının literatür ile karşılaştırılması ve her kategori için pozitif öngörü değerinin hesaplanması amaçlanmıştır.

Gereç ve Yöntemler: Elektronik ortamda hasta dosyaları incelenerek ve Hastalıkların ve İlgili Sağlık Sorunlarının Uluslararası İstatistiksel Sınıflaması (ICD-10) kodları kullanılarak, Ocak 2003—Mart 2009 döneminde Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde stereotaktik işaretleme sonrasında eksizyonel biyopsi yapılan hastalar belirlendi. Toplamda (postoperatif histopatolojik inceleme sonucuna göre 43’ü benign, 21’i malign lezyonlu) 64 hasta çalışmaya dahil edildi. Hastaların demografik özelliklerine, işaretleme nedenlerine ve histopatolojik tanılara dair veriler kaydedildi. Mamografi ve meme ultrasonografi raporları incelenerek hastaların BI-RADS skorları belirlendi. BI-RADS sınıflaması ve histopatolojik inceleme sonuçları yüzde (%) üzerinden karşılaştırıldı.

Bulgular: Ortalama hasta yaşı 48,9 (32–76) yıldı. Mamografi raporlarına göre, stereotaktik işaretleme ve eksizyonel biyopsi için en sık neden mikrokalsifikasyon kümesi ve spiküler kitle idi. Histopatolojik inceleme sonuçlarına göre, BI-RADS skoru mamografide BI-RADS 3, BI-RADS 4 ve BI-RADS 5 olarak tespit edilen hastaların sırasıyla %8’inde, %51,8’inde ve %100’ünde malignite saptandı.

Tartışma ve Sonuç: Mamografi ve ultrasonografide saptanan lezyonların BI-RADS temelinde sınıflandırılması malignitenin öngörülmesine yardımcı olabilir. BI-RADS 4 ve BI-RADS 5 lezyonlarda ilk planda biyopsi yapılırken, BI-RADS 3 lezyonlarda biyopsiye alternatif olarak kısa dönem takip yapılması gereksiz biyopsileri azaltabilir.

Anahtar Kelimeler

BI-RADS, Malignite, Mammografi, Sterotaktik işaretleme

Kaynakça

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