Successful Stereotactic-Guided Vacuum-Assisted Biopsy in the Evaluation of Breast Microcalcifications: A Study in a Single Tertiary Referral Center in the Middle East

Abstract

Background: Breast microcalcifications are a category of lesions that can lead to malignancies. They remain a major concern in imaging of suspected cases. Vacuum-assisted biopsy (VAB) has been proposed as a safe and effective measure to evaluate microcalcifications. Objectives: The present study aimed to assess the results of VAB for breast microcalcifications. Patients and Methods: This cross-sectional study was conducted on patients with microcalcifications detected on mammograms. Patients were recruited through simple random sampling during 2019 - 2020, based on the inclusion criteria. The inclusion criteria were microcalcifications on mammography, classified as the breast imaging-reporting and data system (BI-RADS) categories 3, 4B, 4C, and 5, and undergoing mammography-guided VAB for the microcalcifications. Patients with missing data and those who could not be followed-up for at least six months were excluded from the study. They were assessed regarding different imaging characteristics of lesions, including the breast density, BI-RADS classification, microcalcification distribution and morphology, and other demographic and clinical features before biopsy. Additionally, the results of stereotactic-guided VAB were assessed for various benign and malignant pathologies of microcalcifications. The results of descriptive and analytical tests for various radiological and pathological features of lesions were reported. Results: A total of 257 patients, with a mean age of 50.3 ± 8.3 yars, were included in this study. Almost half of the patients (n = 125, 48.6%) had a C-grade breast composition. Regarding the BI-RADS classification, 206 (80.2%) patients were diagnosed with 4B lesions, followed by 44 (17.1%) patients with 4C lesions. The assessment of the pattern of microcalcification distribution in imaging showed that more than half of the patients (n = 148, 57.6%) had lesions in multiple groups. The most prevalent morphology of microcalcifications was punctate amorphous (n = 109, 42.4%). The majority of patients (n = 180, 70%) had benign findings in the pathological assessment, and only 69 (26.8%) had malignant features in pathology. The distribution of malignancies differed among various BI-RADS categories. In the 4B category of lesions, there were 166 benign lesions versus 32 malignant lesions, while in the 4C category, there were 10 benign lesions versus 34 malignant lesions (P < 0.001). Conclusion: This study described the findings of successful stereotactic-guided VAB for breast microcalcifications. VAB can be implemented as a promising assessment tool to evaluate suspected breast microcalcifications effectively.