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Sonographic Guidance for Vacuum-assisted Percutaneous Biopsy of Microcalcifications of the Breast

SONOGRAPHIC GUIDANCE for Vacuum-assisted PERCUTANEOUS BIOPSY of Microcalcifications of the Breast

PURPOSE

Sonographic guidance is a widely accepted procedure and has well-known advantages compared to stereotactic guidance for the percutaneous sampling of breast lesions. The purpose of this study is to demonstrate the faisabillity of the sonographic guidance to perform percutaneous sampling of microcalcifications, detected on mammography, with a vacuum-assisted biopsy device.

METHOD AND MATERIALS

20 women who presented with a cluster of microcalcifications, BIRADS 3-5, detected on mammography and visible sonographically as small hyperechoïc spots without any other US sign, underwent a vacuum-assisted biopsy under sonographic guidance. The number of microcalcifications on the specimen, analysed on a digital mammography, was classified according to the number of microcalcifications seen on the first mammogram : > 50%, 20-50%, 1-20%, and none. The success of the procedure was based on the amount of microcalcifications on the specimen compared to the first mammogram and on the concordance between the initial diagnosis of the obtained specimen and the final microscopic diagnosis based on the surgical excisional biopsy. The duration of the procedure and the possible complications were recorded.

RESULTS

In 17/20 of the cases, more than 50% of the microcalcifications were removed, 20-50% in 2 cases, 1-20% in 1 case. The mean duration of the procedure for the radiologist was 20 min (10-32 min). There was no complication. The microscopic analysis of the percutaneous specimen was : ductal carcinoma in situ = 6, invasive ductal carcinoma (one micro-invasive) = 5, invasive ductal and lobular carcinoma = 1, mastopathy = 5, fibrosis = 1, adenosis = 1, normal tissue = 1. Ten women who had the initial diagnosis of a carcinoma underwent a lumpectomy ; the definitive microscopic diagnosis was identical in 9 cases and in one, a carcinoma in situ was up-graded in invasive.

CONCLUSION

Sonographic guidance allowed a representative sampling of clusters of microcalcifications with a vacuum-assisted biopsy device. This procedure has some advantages (absence of radiation, faster, lower cost) and could be an alternative to the stereotactic guidance which has some limitations (thin breast, very deep or peripherical lesion).