Role of ultrasound-guided vacuum-assisted breast biopsy in the management of radiologic-pathologic discordance: a retrospective single-centre study.

IF 9.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiologia Medica Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI:10.1007/s11547-024-01864-1

Giulia Vatteroni, Giulia Pinna, Rubina Manuela Trimboli, Riccardo Levi, Isabella Bolengo, Francesco Patrone, Daria Volpe, Bethania Fernandes, Daniela Bernardi

{"title":"Role of ultrasound-guided vacuum-assisted breast biopsy in the management of radiologic-pathologic discordance: a retrospective single-centre study.","authors":"Giulia Vatteroni, Giulia Pinna, Rubina Manuela Trimboli, Riccardo Levi, Isabella Bolengo, Francesco Patrone, Daria Volpe, Bethania Fernandes, Daniela Bernardi","doi":"10.1007/s11547-024-01864-1","DOIUrl":null,"url":null,"abstract":"Purpose: To evaluate the efficacy of US-guided vacuum-assisted biopsy (US-VAB) in radiologic-pathologic (rad-path) discordance in women with suspicious breast lesions.Methods: Two thousand three hundred and sixty patients with 2385 BI-RADS category 4 and 5 lesions underwent percutaneous US-guided CNB. Thirty-six lesions were classified as discordant benign and underwent second-line US-VAB. A 14-gauge needle was utilized for CNB and 10-gauge for US-VAB. Final pathology was the reference standard for women who underwent surgery, imaging follow-up in other cases. Rates of malignancy for US-VAB and subsequent surgery were evaluated. Lesions with upgrade and no upgrade to second-line VAB were compared in terms of patient's age, lesion type and characteristics, size and BI-RADS category. Positive predictive value (PPV), negative predictive value (NPV) for BI-RADS categories and diagnostic performance for second-line US-VAB were calculated. p value < 0.05 was considered statistically significant (t-test, Mann-Whitney, χ2).Results: US-VAB identified 10 B2, 9 B3 and 17 B5 lesions with upgrade to malignancy of 47.2% (17/36). There were 8 invasive no special type, 7 ductal in situ, 1 invasive lobular carcinoma and 1 angiosarcoma, and their distribution among BI-RADS categories was: 2/2 in BI-RADS 5 (100%), 12/18 in BI-RADS 4C (67%) and 3/16 in BI-RADS 4B lesions (19%) (p = 0.006). Of the remaining 19 lesions, 6 underwent surgery and 2 were upgraded to ductal carcinoma in situ; 13 underwent radiological follow-up and one resulted malignant. False-negative rate for US-VAB was 15.8% (3/19) with final upgrade to malignancy of 55% (20/36). The univariate analysis revealed mass shape (p = 0.008) and BI-RADS categories (p = 0.006) to be associated with upgrade to malignancy. Sensitivity, specificity, PPV, NPV and accuracy for US-VAB were 85, 100, 100, 84 and 92%, respectively.Conclusions: US-VAB identified almost 50% of cancers missed by CNB, avoiding surgical biopsies and validating as an effective mini-invasive approach in rad-path discordance.","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":" ","pages":"1454-1462"},"PeriodicalIF":9.7000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiologia Medica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11547-024-01864-1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/5 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: To evaluate the efficacy of US-guided vacuum-assisted biopsy (US-VAB) in radiologic-pathologic (rad-path) discordance in women with suspicious breast lesions.

Methods: Two thousand three hundred and sixty patients with 2385 BI-RADS category 4 and 5 lesions underwent percutaneous US-guided CNB. Thirty-six lesions were classified as discordant benign and underwent second-line US-VAB. A 14-gauge needle was utilized for CNB and 10-gauge for US-VAB. Final pathology was the reference standard for women who underwent surgery, imaging follow-up in other cases. Rates of malignancy for US-VAB and subsequent surgery were evaluated. Lesions with upgrade and no upgrade to second-line VAB were compared in terms of patient's age, lesion type and characteristics, size and BI-RADS category. Positive predictive value (PPV), negative predictive value (NPV) for BI-RADS categories and diagnostic performance for second-line US-VAB were calculated. p value < 0.05 was considered statistically significant (t-test, Mann-Whitney, χ²).

Results: US-VAB identified 10 B2, 9 B3 and 17 B5 lesions with upgrade to malignancy of 47.2% (17/36). There were 8 invasive no special type, 7 ductal in situ, 1 invasive lobular carcinoma and 1 angiosarcoma, and their distribution among BI-RADS categories was: 2/2 in BI-RADS 5 (100%), 12/18 in BI-RADS 4C (67%) and 3/16 in BI-RADS 4B lesions (19%) (p = 0.006). Of the remaining 19 lesions, 6 underwent surgery and 2 were upgraded to ductal carcinoma in situ; 13 underwent radiological follow-up and one resulted malignant. False-negative rate for US-VAB was 15.8% (3/19) with final upgrade to malignancy of 55% (20/36). The univariate analysis revealed mass shape (p = 0.008) and BI-RADS categories (p = 0.006) to be associated with upgrade to malignancy. Sensitivity, specificity, PPV, NPV and accuracy for US-VAB were 85, 100, 100, 84 and 92%, respectively.

Conclusions: US-VAB identified almost 50% of cancers missed by CNB, avoiding surgical biopsies and validating as an effective mini-invasive approach in rad-path discordance.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

超声引导下真空辅助乳腺活检在处理放射学与病理学不一致中的作用：一项回顾性单中心研究。

目的：评估 US 引导下真空辅助活检（US-VAB）对患有可疑乳腺病变的女性放射病理（rad-path）不一致的疗效：2385 名 BI-RADS 4 类和 5 类病变患者接受了经皮 US 引导的 CNB。有 36 个病灶被归类为不一致的良性病灶，并接受了二线 US-VAB。CNB 使用 14 号针头，US-VAB 使用 10 号针头。接受手术的女性以最终病理结果为参考标准，其他病例则以影像学随访结果为参考标准。对 US-VAB 和后续手术的恶变率进行了评估。根据患者的年龄、病变类型和特征、大小和 BI-RADS 类别，对升级和未升级为二线 VAB 的病变进行了比较。计算了 BI-RADS 类别的阳性预测值（PPV）、阴性预测值（NPV）和二线 US-VAB 的诊断性能：US-VAB 发现了 10 个 B2、9 个 B3 和 17 个 B5 病变，升级为恶性肿瘤的比例为 47.2%（17/36）。其中无特殊类型的浸润性病变 8 例，原位导管癌 7 例，浸润性小叶癌 1 例，血管肉瘤 1 例，它们在 BI-RADS 分类中的分布为：2/2 例 BI-RADS 5（100%），12/18 例 BI-RADS 4C（67%），3/16 例 BI-RADS 4B 病变（19%）（P = 0.006）。在剩余的 19 个病灶中，6 个接受了手术，2 个升级为导管原位癌；13 个接受了放射学随访，1 个结果为恶性。US-VAB的假阴性率为15.8%（3/19），最终升级为恶性的比例为55%（20/36）。单变量分析显示，肿块形状（p = 0.008）和 BI-RADS 类别（p = 0.006）与升级为恶性肿瘤有关。US-VAB的敏感性、特异性、PPV、NPV和准确性分别为85%、100%、100%、84%和92%：结论：US-VAB发现了CNB漏诊的近50%的癌症，避免了手术活检，是放射路径不一致情况下有效的微创方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Radiologia Medica 医学-核医学

CiteScore

14.10

自引率

7.90%

发文量

133

审稿时长

4-8 weeks

期刊介绍： Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.