Ultrasound-guided vacuum-assisted biopsy of microcalcifications detected at screening mammography

Abstract

Background: Microcalcifications detected at screening mammography are frequently diagnosed by means of a stereotactic biopsy. Ultrasound (US)-guided percutaneous breast biopsy has several advantages over stereotactic biopsy, e.g., it offers real-time needle visualization, improves patient comfort, the procedure time is generally considered to be shorter, and it usually does not require ionizing radiation or dedicated equipment. Purpose: To assess the frequency of calcification retrieval and factors affecting retrieval success for US-guided 11-G vacuum-assisted biopsies of microcalcifications. Material and Methods: Seventy-five consecutive women (age range: 25–68 years, mean age: 47 years) with 75 lesions of microcalcifications detected at screening mammography underwent US-guided 11-G vacuum-assisted biopsy. Calcification retrieval was defined as being successful when calcifications were detected in radiographs of specimens. Mammographic, ultrasonographic, and histologic findings were analyzed to identify factors that affected calcification retrieval. Results: Among 75 lesions that had US-guided vacuum-assisted biopsy, calcifications were retrieved in 53 (71%) lesions. Calcification retrieval was more frequent for lesions; associated with masses or dilated ducts at US (85% [41/48] vs. 44% [12/27], P<0.001), located in the anterior or middle part of the breast vs. posterior part of the breast (81% [47/58] vs. 35% [6/17], P=0.001), of maximal diameter more than 10 mm (82% [41/50] vs. 48% [12/25], P=0.002), with a segmental or regional distribution vs. clustered distribution (95% [18/19] vs. 63% [35/56], P=0.008), or lesions of category 4c or 5 vs. category 4a or 4b (100% [8/8] vs. 67% [45/67], P=0.054) at mammography. Conclusion: US-guided 11-G vacuum-assisted biopsy retrieved calcifications from 71% (53/75) of lesions. Successful calcification retrieval was found to be related to the visibility of associated masses or dilated ducts by US, and to lesion depth, size, and distribution, and level of suspicion at mammography.