Sonographic Visibility and Feasibility of Biopsy under Ultrasound Guidance of Suspicious Microcalcification-only Breast Lesions: a Single-centre Study

Abstract

Objectives:To assess the sonographic visibility and feasibility of biopsy under ultrasound guidance of mammographically suspicious microcalcification-only lesions. Methods: A retrospective review was performed of mammographically detected suspicious microcalcificationonly lesions in patients who underwent ultrasound-guided or surgical biopsy between March 2009 and February 2012. The identified microcalcifications were not associated with a mass, architectural distortion or asymmetry on mammography; or a mass, dilated duct, hypoechoic area or microcyst on ultrasound. Microcalcifications were divided into two groups of visible and invisible based on their sonographic visibility. An ultrasound-guided biopsy was performed for the visible group, and mammography-guided localisation and excisional biopsy were conducted for the invisible group. To confirm microcalcification retrieval, radiographs were obtained for all patients. The histological outcomes of the two groups were assessed. Results: Of the 45 lesions in 44 patients, 22 (48.9%) were in the visible group. Calcifications were retrieved from 21 (95.5%) of the visible group lesions. The malignancy rate was 50.0% (11 of 22; p = 0.029) in the visible group and 17.4% (4 of 23) in the invisible group. Among the 10 sonographically visible and one invisible lesion that underwent surgical excision after biopsy, three (30.0%) in the visible group were upgraded pathologically. Conclusion: The sonographic visibility and retrieval rates of microcalcification-only lesions were 48.9% and 95.5%, respectively. Among the suspicious microcalcification-only lesions, sonographically visible microcalcifications were more likely to be malignant than sonographically invisible microcalcifications.

Microcalcification on mammography: approaches to interpretation and biopsy

“…Calcification tends to be more conspicuous if there is any change in the adjacent soft tissue, and ultrasound-guided biopsy of calcification therefore may have a higher yield of malignancy than mammographic imaging. 27,28 The size of the biopsy needle varies with local protocols; some practitioners favour a large vacuum-assisted sample and others prefer a 14-G sample, with vacuum-assisted biopsy (VAB) for selected cases.…”