Diagnostic accuracy of tomosynthesis-guided vacuum assisted breast biopsy of ultrasound occult lesions

Abstract

This study aims to evaluate the diagnostic accuracy of digital breast tomosynthesis-guided vacuum assisted breast biopsy (DBT-VABB) of screening detected suspicious mammographic abnormalities comprising of calcifications, asymmetric densities, architectural distortions and spiculated masses. In this institutionally approved study, a total of 170 (n = 170) DBT-VABB were performed, 153 (90%) were for calcifications, 8 (4.7%) for spiculated mass, 5 (2.9%) for asymmetric density and 4 (2.4%) for architectural distortion. All these lesions were not detected on the corresponding ultrasound. Histopathology results revealed 140 (82.4%) benign, 9 (5.3%) borderline and 21 (12.4%) malignant lesions. The total upgrade rate at surgery was 40% for atypical ductal hyperplasia and 5.9% for ductal carcinoma in-situ. 3.6% discordant benign lesions showed no upgrade. DBT-VABB showed 100% specificity, 91.3% sensitivity and 100% positive predictive value (PPV) for detecting malignant lesions. The negative predictive value (NPV) was 80%. 2 (1.2%) patients had mild complications and 1 (0.6%) had severe pain. Our study showed that DBT-VABB was a safe and reliable method, with high sensitivity, specificity, PPV and NPV in the diagnosis of non-palpable benign and malignant breast lesions. Our data also confirmed the accuracy of DBT-VABB in detecting malignant lesions and we suggest further surgical excision in borderline lesions for a more accurate diagnostic evaluation.

Stereotactic breast biopsies: Radiological-pathological concordance in a South African referral unit

“…Along with DCIS, high-risk lesions as mentioned above are listed as contributors to underestimation rates. 20 , 23 , 26 , 30 , 31 Our DCIS underestimation rate of 10.3% ( n = 3) is comparable to results from other studies ( Table 5 ). All three of our cases involved the upgrading of DCIS to invasive carcinoma.…”

“…In comparison to Mendez et al, with 25.0%, and Bohan et al, with 12.5%, our malignancy rate amongst mass-like lesions is high. 21,26 However, there were no circumscribed masses in our study (they were all described as having a spiculated or indistinct margin). When excluding the circumscribed masses from the study by Mendez et al, the malignancy rate amongst mass-like lesions is 66.0%.…”

Safety and Efficacy of Vacuum-Assisted Breast Biopsies under Ultrasound and Stereotactic Guidance

“…No statistically significant association between complications and needle gauge or guiding modality was observed in this study, similar to findings published by Burbank et al Alike Bohan et al's experience (55%), most patients in this study reported mild pain (62%). 35 Mean pain score was 3 which was close to findings of Seely et al (3.1), pointing to the good overall tolerance of VABB. 36 Retrospective design of this study, small sample size, and limited follow-up are limitations of this study.…”

Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience

“…Similarly, Kettritz et al [45] obtained sensitivities and NPVs above 99%. Bohan et al [46] found a specificity of 100% and sensitivity of 91.3% with a PPV of 100% for malignancy and a high NPV (81.8%) for benignity but a higher false-negative rate of 20% due to smaller sample size.…”