Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic

Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic
S.T. Ward, J.A. Shepherd, H. Khalil
The Breast 2010 19;2:105-108

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In our breast unit a significant proportion of core biopsies are performed freehand sometimes necessitating a repeat biopsy under image guidance. The aims of this study were to establish the proportion of patients undergoing freehand core biopsies who proceeded to a repeat procedure and to determine any factors associated with a missed freehand biopsy. Four hundred and ten core biopsies over 21 months were included in the analysis. Demographic details, position and size of the lump, breast volume and lesion depth were recorded.

Twenty-four percent freehand biopsies were repeated under ultrasound guidance. The histological classification of two-thirds of the repeat biopsies were upgraded, suggesting that the lesion had been previously missed. Multivariate analysis showed that missed freehand biopsies were strongly associated with deep lesions. If all lumps sited at a depth of 6 mm or more were selected for US-guided core biopsy, the workload for the ultrasound department would increase by just less than a half and would have the effect of reducing the freehand biopsy miss rate by almost two-thirds.

Core biopsies should be performed under ultrasound guidance. A freehand technique could be limited to superficial lesions. Depth is more predictive for a missed biopsy than lesion size or breast volume

Long-term follow-up-findings in mammography and ultrasound after intraoperative radiotherapy (IORT) for breast cancer

Long-term follow-up-findings in mammography and ultrasound after intraoperative radiotherapy (IORT) for breast cancer
M. Ruch, J. Brade, C. Schoeber, U. Kraus-Tiefenbacher, A. Schnitzer, D. Engel, F. Wenz, M. Sütterlin, S.O. Schoenberg, K. Wasser
The Breast Volume 18, Issue 5, October 2009, Pages 327-334

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In early postoperative follow-up studies the radiologist is confronted with large and partially organized wound cavities in most cases after IORT. In further follow-ups, fat necroses arise from those cavities, and about 60% of patients show likewise large oil cysts on late follow-up mammograms. As a frequent phenomenon wound cavities appear sonographically as liquid lesions with pronounced polypoid inner wall thickening. Furthermore, a prolonged parenchymal scarring has to be expected after IORT. No specific factors were found, which might influence the incidence or the value of these structural alterations after IORT

Comparison of interval breast cancer rates for two-versus single-view screening mammography: A population-based study

Comparison of interval breast cancer rates for two-versus single-view screening mammography: A population-based study
A. Seigneurin, C. Exbrayat, J. Labarère, M. Colonna
The Breast Volume 18, Issue 5, October 2009, Pages 284-288

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Two-view mammography for first and subsequent screens is associated with lower rates of interval breast cancer. This is at the expense of an increased number of women being recalled for further assessment after subsequent screens

Localization of impalpable breast lesions: What are we aiming at?

Localization of impalpable breast lesions: What are we aiming at?
Brian Mucci, Robert Shaw, Jean Lauder, Russell Pickard
The Breast Volume 18, Issue 4, August 2009, Pages 267-269

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As a quality control target for wire placement in clinically occult breast lesions success in traversing the lesion in both planes in 90% of procedures is measurable and achievable with clinical relevance. We believe that this could be an improvement on the current European target of 95% of wires being within 10 mm of the lesion

Quality of mammography screening in the Milan programme: Evidence of improved sensitivity based on interval cancer proportional incidence and radiolog

Quality of mammography screening in the Milan programme: Evidence of improved sensitivity based on interval cancer proportional incidence and radiological review
Pirola Maria Elena, Houssami Nehmat, Maltagliati Ermes, Ceresa Piera, Quattrocchi Maria, Marinoni Guia, Caimi Francesco, Villa Roberto, Falda Giovanni, Gaffuri Isabella, Ciatto Stefano
The Breast 18, (3), June 2009: 208-210

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Interval cancer (IC) incidence and review-based initial evaluation of Milan service screening (ASLMI1) suggested suboptimal performance. We report results in a subsequent screening round to further determine screening quality.

Programme sensitivity is now within recommended European standards. Performance indicators improved relative to initial evaluation. Both increasing experience and formal training of radiologists are likely to have contributed to this improvement

An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions

An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions
Zhi Li Wang, Jun Lai Li, Li Su, Yong Feng Zhang, Jie Tang
The Breast 18, (3), June 2009: 192-196

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The aim of this study was to evaluate a 10-gauge vacuum-assisted system for the excision of clinically benign breast lesions.

The minimal excision of 245 lesions in 162 patients was performed with VACORA vacuum-assisted system under the guidance of ultrasound between July 2007 and April 2008. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n = 208) or had been confirmed as benign by a previous core-needle biopsy (n = 37).

As many as 244 lesions were demonstrated to be benign and one case was demonstrated to be malignant by pathology after resection. In the 244 benign lesions, 220 lesions were excised completely as demonstrated by the follow-up ultrasound examination. The malignant lesion was managed with surgical excision.

The 10-gauge vacuum-assisted system is highly successful for the excision of benign breast lesions; it is an alternative tool for minimal treatment of benign breast lesions

Accuracy of stereotactic vacuum-assisted breast biopsy with a 10-gauge hand-held system

Accuracy of stereotactic vacuum-assisted breast biopsy with a 10-gauge hand-held system
C. Salem, R. Sakr, J. Chopier, C. Marsault, S. Uzan, E. Daraï
The Breast 18, (3), June 2009: 178-182

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The mean number of core specimens obtained per procedure was 9 (range 4–24). Complete radiological excision of the target lesion was achieved in 31.6% (91 of 288) with 91% of these lesions smaller than 10 mm (mean size 7 mm; range 4–20 mm). Under-estimation of ADH and DCIS was 18.2% (2 of 11) and 19.2% (9 of 47), respectively. There was no false negative result within a 3-year follow-up (from 2005 till date). Complications were mild and consisted of immediate bleeding and delayed hematomas