Adding merits of vacuum assisted biopsy in diagnosis and management of indeterminate breast micro-calcifications

Abstract

Background Stereotactic guided biopsies have become the sampling method of choice in diagnosis of non-palpable breast microcalcifications which directly impact patients’ management plans and consequently morbidity and mortality. Purpose The purpose is to compare the diagnostic accuracy of VAB and CNB in diagnosis of indeterminate breast microcalcifications and subsequent management of cases of indeterminate breast micro-calcifications. Methods Retrospective review of stereotactic CNB and VAB was done, pathological data were classified as benign, high risk and malignant lesions and compared with gold standard surgical specimen. The influence on patients’ surgical planning was depicted. Results A total of 268 lesions were included in our study divided as 136 lesions that underwent VAB and 132 lesions that underwent CNB, for the VAB group the overall PPV was 100% (96–100% CI) and NPV was 95.8% (90–98% CI) with overall diagnostic accuracy of 97% (92–99% CI), while for the CNB group the PPV was 100% (95–100% CI) and NPV was 80.2% (74.2–85% CI) with overall diagnostic accuracy of 84.8% (77–90% CI). 4/136 VAB lesions did not match the surgical specimen malignant diagnosis this could be explained by their mean diameter of 9.725 ± 1.8 cm and 3.172 ± 1.84 cm which was found statistically significant P value of less than 0.0001. The percentage of re-operation in VAB group was 2.9% while in CNB group was 7.5%. Conclusions VAB is a superior diagnostic tool over CNB in diagnosis of indeterminate breast microcalcifications and reducing the percentage of re-operations which directly impacts the patient’s morbidity. Moreover, it can replace surgery in cases of benign lesions and totally resected high risk lesions especially when operations are contraindicated or refused by the patient, yet with strict follow up.