Non-stereotactic method involving combination of ultrasound-guided wire localization and vacuum-assisted breast biopsy for microcalcification

Abstract

Background: Stereotactic breast biopsy is a standard intervention for evaluation of "microcalcification-only" lesions. However, an expensive stereotactic device and radiologic expertise are necessary for this procedure. We herein report a non-stereotactic technique involving the combination of wire localization and vacuum-assisted breast biopsy (VABB) under ultrasound (US) guidance.

Methods: Twenty-two consecutive patients with category 3 or 4a microcalcification only as shown by mammography underwent the above-mentioned non-stereotactic combination method involving US-guided wire localization and VABB. The location of the microcalcification was measured by manual stereotaxis, and the microcalcification was confirmed by specimen mammography after the procedure.

Results: The mean number ± standard deviation of removed cores and calcified cores was 28.4±13.4 and 2.2±0.9, respectively. In one case, the procedure was repeated 3 times. The histologic diagnoses were fibrocystic change (n=14), fibroadenoma (n=4), sclerosing adenosis (n=1), usual ductal hyperplasia (n=2), and atypical ductal hyperplasia (n=1).

Conclusions: "Microcalcification-only" breast lesions can be easily evaluated with the combination of non-stereotactic US-guided wire localization and VABB. This would be an effective diagnostic technique for breast lesion which reveals only microcalcification.

Keywords: Breast; biopsy; microcalcification; non-stereotactic.

Figure 1

Non-stereotactic method for identification of the location of breast microcalcifications. (A) Clustered microcalcifications were detected 3.2 cm from the midline in the outer part of the left breast on a cranio-caudal (CC) mammograph; (B) clustered microcalcifications were detected 1.9 cm from the midline in the lower part of the left breast on an medio-lateral oblique (MLO) mammograph; (C) the distance between the clustered microcalcifications and the midline of the mammograph were measured with a paper ruler. The CC plane (a) and midline on the CC view (a’) cross at right angles. The MLO plane (b) and midline of the MLO view (b’) meet perpendicularly; (D) the approximate location of the clustered microcalcifications is the point at which the two drawn lines cross.

Figure 2

Hook-shaped wire insertion in left breast, which has clustered microcalcifications. (A) The wire is transpierced correctly on a cranio-caudal (CC) mammograph; (B) however, the locations of the wire and the microcalcifications are discordant by 2.5 cm. This error range should be considered when performing vacuum-assisted breast biopsy (VABB).

Figure 3

Combination technique involving ultrasound (US)-guided wire localization and vacuum-assisted breast biopsy (VABB). (A) The location of the clustered microcalcifications is identified; (B) the wire is localized at the clustered microcalcifications, and the VABB probe is inserted beneath the lesion. After the wire is removed, the procedure is performed; (C) after the procedure, the breast defect is managed according to the VABB protocol.

Figure 4

Clustered microcalcifications in breast. (A) The bright spots are identified as microcalcifications by ultrasound (US); (B) after the combination technique involving wire localization and vacuum-assisted breast biopsy (VABB), only a small hematoma remains; (C) the clustered microcalcifications were identified in two cores of specimen mammography.