Ultrasonography Findings of Breast Microcalcifications without Accompanying Mass and Evaluation of Ultrasound-Guided Biopsy Results

Objective: Ultrasonography guided core needle biopsy is a real-time, inexpensive method with higher patient comfort. The aim of this study was to evaluate ultrasonography findings of microcalcifications without accompanying mass and also to investigate the accuracy of ultrasonography guided core needle biopsy results. Materials and Methods: The study included a total of 54 patients, with microcalcifications observed on mammography and no accompanying mass, who underwent ultrasonography guided core needle biopsy and surgical excision. Core needle biopsy specimen x-rays were obtained from 23 patients. In 11 patients, the location of microcalcification was confirmed by mammography following the administration of contrast agent under ultrasonography guidance. Ultrasonography findings of microcalcifications were identified. The results of ultrasonography guided core needle biopsy were compared with the excisional pathology results. Results: The microcalcifications without accompanying mass were presented with punctate echogenous foci, hypoechoic area, small distortion, ductal abnormality or fibrocystic changes on ultrasonography. Hypoechoic area and distortion were seen more in malignant lesions, and fibrocystic changes and ductal abnormalities in benign lesions but the difference was not statistically significant. The agreement between ultrasonography guided core needle biopsy and the excisional pathology results was high (Kappa = 0.781). When a specimen x-ray was obtained or core needle biopsy was performed after confirming the location of the microcalcifications with the use of contrast agent, Kappa values were even higher (0.87 and 1, respectively). Conclusions: Microcalcifications can be seen with targeted ultrasonography imaging and ultrasonography guided core needle biopsy has high accuracy. Taking a specimen x-ray, or biopsy performed after identifying of the location of microcalcifications with a trace amount of contrast agent, can increase the accuracy of ultrasonography guided core needle biopsy.

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Management of Benign Papilloma Without Atypia Diagnosed at US-Guided 14-Gauge Core Needle Biopsy: US-Guided Vacuum-Assisted Percutaneous Excision as an Alternative to Surgical Excision

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2011.05.427 ◽

2011 ◽

Vol 37 (8) ◽

pp. S96

Author(s):

J.H. Youk ◽

M.J. Kim ◽

E.J. Son ◽

J.Y. Kwak ◽

E. Kim

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Surgical Excision ◽

Core Needle ◽

Benign Papilloma

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Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary?

Academic Radiology ◽

10.1016/j.acra.2018.08.014 ◽

2019 ◽

Vol 26 (7) ◽

pp. 909-914 ◽

Cited By ~ 1

Author(s):

Sean D. Raj ◽

Jordana Phillips ◽

Tejas S. Mehta ◽

Liza M. Quintana ◽

Michael D. Fishman ◽

...

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Surgical Excision ◽

Ultrasound Guided ◽

Core Needle

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Agreement between core needle biopsy and surgical excision product: the importance of the invasive breast carcinoma grading system

Virchows Archiv ◽

10.1007/s00428-021-03246-8 ◽

2021 ◽

Author(s):

Rodrigo Justi Nogueira ◽

Thales Müller Silvério Alves ◽

Mário Jefferson Quirino Louzada ◽

Deolino João Camilo-Júnior ◽

José Cândido Caldeira Xavier-Júnior

Keyword(s):

Breast Carcinoma ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Surgical Excision ◽

Invasive Breast Carcinoma ◽

Grading System ◽

Core Needle

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Abstract P3-02-01: Impact of prognoses on the discrepancies in histological grade of breast cancer between core needle biopsy and surgical excision specimen

10.1158/1538-7445.sabcs17-p3-02-01 ◽

2018 ◽

Author(s):

R Nakamura ◽

N Yamamoto ◽

T Miyaki ◽

R Teranaka ◽

M Itami

Keyword(s):

Breast Cancer ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Histological Grade ◽

Surgical Excision ◽

Core Needle

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Flat Epithelial Atypia of the Breast on Core Needle Biopsy: An Indication for Surgical Excision

Military Medicine ◽

10.7205/milmed-d-11-00088 ◽

2011 ◽

Vol 176 (11) ◽

pp. 1347-1350 ◽

Cited By ~ 13

Author(s):

Vance Sohn ◽

Rees Porta ◽

Tommy Brown

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Surgical Excision ◽

Flat Epithelial Atypia ◽

Core Needle ◽

Epithelial Atypia

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Benign breast papillomas without atypia diagnosed with core needle biopsy: Outcome of surgical excision and imaging follow-up

European Journal of Radiology ◽

10.1016/j.ejrad.2020.109237 ◽

2020 ◽

Vol 131 ◽

pp. 109237

Author(s):

Dogan S. Polat ◽

Emily E. Knippa ◽

Ramapriya Ganti ◽

Stephen J. Seiler ◽

Sally H. Goudreau

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Surgical Excision ◽

Core Needle

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LCIS Found at Core Needle Biopsy May Not Need Surgical Excision

American Journal of Roentgenology ◽

10.2214/ajr.07.3984 ◽

2008 ◽

Vol 191 (3) ◽

pp. W152-W152 ◽

Cited By ~ 4

Author(s):

Daniel B. Kopans

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Surgical Excision ◽

Core Needle

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Papillary lesions of the breast: Can larger core needle biopsy samples identify patients who may avoid surgical excision?

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.44 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 44-44

Author(s):

Alice P. Chung ◽

Kelly T. Huynh ◽

Jaime Shamonki ◽

Myung-Shin Sim ◽

Camelia Lawrence ◽

...

Keyword(s):

Core Needle Biopsy ◽

Predictive Value ◽

Needle Biopsy ◽

Surgical Excision ◽

Tissue Samples ◽

Core Needle ◽

Ductal Hyperplasia ◽

Benign Histology ◽

Papillary Lesions ◽

Malignant Lesions

44 Background: Papillary lesions of the breast are frequently diagnosed on core needle biopsy (CNB). The ability to distinguish benign from atypical/malignant papillary lesions is limited by the representative nature of the biopsy method; thus follow-up excision is usually recommended. We aimed to determine if larger CNB samples can more reliably predict the true benign nature of a papillary lesion, thereby sparing certain patients a formal surgical excision. Methods: We reviewed medical records of 53 female patients diagnosed with histologically benign papillary lesions on CNB from 2000 to 2010, who subsequently underwent surgical excision. Pathology slides of the CNB were reviewed to document the benign histologic features of the papilloma, the number of cores sampled and the area of tissue biopsied (mm2). Statistical analysis was performed to identify the characteristics of the CNB that were associated with retention of benign histology on excision. Results: Atypical ductal hyperplasia (ADH) and carcinoma were identified in 6% (3/53) and 8% (4/53) of papillary lesions, respectively, when excised. Clinical and radiographic characteristics did not distinguish the ADH/malignant lesions from benign papillomas. The CNB needle sizes ranged from 9- to 18-gauge (median 14). The number of cores sampled ranged from 3-16 (mean 4.5). Patients with benign excisions had a significantly larger area of tissue sampled by CNB than those found to have ADH/malignant lesions on excision (mean ± SD: 95.6 ± 101.2 vs. 41.7 ± 21.9, respectively, p=0.003). By logistic regression, CNB tissue samples consisting of ≥7 cores, or measuring >96 mm2 in aggregate, had a negative predictive value for ADH/malignancy of 100% (AUC of 0.69 and 0.68, respectively). Conclusions: Although no clinical or radiologic features distinguished benign from pathologically significant papillary lesions, larger sample sizes significantly improved the predictive value of benign histology on CNB. A papilloma sampled by ≥ 7 cores or > 96 mm2 showing benign histology at CNB, retained benign features upon excision. Close surveillance may be a reasonable option for patients whose benign papillomas are generously sampled at the time of CNB.

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