Percutaneous ultrasound-guided vacuum-assisted removal versus surgery for breast lesions showing imaging-histology discordance after ultrasound-guided core-needle biopsy

Abstract

Objective: To evaluate the upgrade rate and delayed false-negative results of percutaneous vacuum-assisted removal (VAR) and surgical excision in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy (CNB) of the breast and to validate the role of VAR as a rebiopsy method for these discordant lesions.

Materials and methods: Percutaneous US-guided 14-gauge CNB was performed on 7470 patients between August 2005 and December 2010. Our study population included 161 lesions in 152 patients who underwent subsequent rebiopsy due to imaging-histologic discordance. Rebiopsy was performed using VAR (n = 88) or surgical excision (n = 73). We investigated the upgrade rate immediately after rebiopsy and delayed false-negative results during at least 24 months of follow-up after rebiopsy. We also evaluated the clinicoradiological differences between VAR and surgical excision.

Results: Total upgrade to malignancy occurred in 13.7% (22/161) of lesions at rebiopsy including both VAR and surgical excision: 4.6% (4/88) of VAR cases (4/88) and 24.7% (18/73) of surgical excision cases (p < 0.001). Surgical excision was performed significantly more frequently in older patients and for larger-sized lesions than that of VAR, and a significant difference was detected between VAR and surgical excision in the Breast Imaging and Reporting and Data System category (p < 0.007). No delayed false-negative results were observed after VAR or surgical excision during the follow-up period.

Conclusion: Long-term follow-up data showed no delayed cancer diagnoses after US-guided VAR in imaging-histologic discordant lesions of the breast, suggesting that VAR might be a rebiopsy method for these lesions.

Keywords: Core needle biopsy; Imaging-histologic discordance; Surgical excision; Vacuum-assisted removal.

Fig. 1

Diagram of our study population. F/U = follow-up

Fig. 2

51-year-old woman with mammographic abnormality. A. Left mediolateral oblique mammography view shows partially obscured hyperdense mass. B. Transverse sonogram corresponding to mammographic abnormality shows microlobulated hypoechoic mass (arrows) classified as Breast Imaging and Reporting and Data System category 4a. Ultrasound-guided core needle biopsy reveals fibrocystic change; however, this result was regarded as discordant benign. C. Eleven-gauge vacuum-assisted removal (arrowheads) was performed, and histological results indicated invasive ductal carcinoma.

Fig. 3

77-year-old woman with palpable mass in her left breast. A. Left mediolateral oblique mammography view shows irregular shaped hyperdense mass. B, C. Transverse (B) and longitudinal (C) sonogram corresponding to palpable site shows irregular and hypoechoic mass (arrows) classified as Breast Imaging and Reporting and Data System category 5. Ultrasound-guided core needle biopsy revealed intraductal papilloma; however, this result was regarded as discordant benign. Surgical excision was performed, and histological results revealed ductal carcinoma in situ.