Stereotatic vacuum assisted biopsy of mammographically suspicious microcalcifications - the initial experience in China

Abstract

Background: Incidental indeterminate/suspicious microcalcification has become a more common encounter due to increased use of screening mammogram. However, open biopsy and surgical excision still remain the choice of diagnosis and treatment in many parts of Mainland China due to financial and technical reasons, particularly in rural areas. Stereotatic-guided vacuumassisted biopsy (SVAB) under local anesthesia is becoming more popular in larger cities and with the aid of immediate imaging using TRIDENT specimen mammogram system. Methods: All mammograms were reported by specialist radiologist and all SVAB were performed by specialist breast surgeon and radiologist. Retrospective review of a prospectivelymaintained database was performed. Result: From 1st December 2015 to 31st May 2017, 190 patients (192 procedures) with BIRADS 4 microcalcifications had undergone SVAB. Median age was 45 year-old (Range 24–81). Three patients had failed identification of microcalcification with the procedure abandoned. Median duration of procedure was 40 minutes (Range 10–90). There was no reported major complication, hematoma occured in 10 (5.2%) of patients. 23 (12%) of the biopsied specimens were malignant, including 19 ductal carcinoma in situ (DCIS), 1 microinvasive DCIS and 3 invasive ductal carcinoma (IDC). Fifteen-one hundred forty eight (10.1%) were mammographic BIRADS 4a lesions, 6/38 (15.8%) were BIRADS 4b and 2/6 (33%) were BIRADS 4c. Of note, there were 16 (8.3%) atypical ductal hyperplasia (ADH) detected in the current cohort, 6 patients received open excision, there was no upgraded diagnosis of DCIS or IDC. Conclusions: Nearly 90% of BIRADS 4 mammographic lesions were benign, widespread introduction of SVAB in China can potentially decrease the public health budget burden.