Stereotactic vacuum-assisted breast biopsy (SVAB) in the management of suspicious calcifications

Objectives: Stereotactic vacuum assisted breast biopsy (SVAB) is the most efficient and habitual method for the management of suspicious calcifications. However, it’s a not perfect method: false negatives cases can be observed, and some malignant lesions may be underestimated. Our purpose is to evaluate the diagnostic value of stereotactic vacuum-assisted breast biopsy (SVAB) in the management of suspicious calcifications, without associated mass. Materials and methods: Retrospective review of 1,106 procedures of SVAB performed on a prone digital table on calcifications without associated mass classified as BI-RADS 3, 4 or 5. The samples were analysed in the same laboratory of pathology. In situ lobular carcinomas have been considered malignant lesions. The “gold standard” has been the pathological analysis after surgery, and/or the follow-up for a minimum of 2 years. The following variables were evaluated: age, diagnostic category, size of lesions, number of samples extracted and diagnostic parameters: Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Accuracy. Results: The average age has been 52.75 years. According to the diagnostic category, 28.03% of cases corresponded to category 3, 57.32% to category 4 and 14.65% to category 5. The PPV was 14.84%, 35.80% and 93.21%, for category 3, 4 and 5, respectively, with an average PPV of 38.34%. A sensitivity of 96.81%, specificity of 100%, VPP of 100%, VPN of 98.28% and an accuracy of 98.87% were obtained. 1.47% of false negatives and 4.76% of underestimation have been observed. Conclusion: A high indication for category 3 calcifications cluster is observed, since most patients prefer to undergo the procedure, rather than radiological follow-up. The PPV observed in category 3 (14.84%) is higher than that reported “officially” (2%), probably due to the great inter-observer variability. Introduction Vacuum Assisted Biopsy (VAB) is a percutaneous breast biopsy procedure which can be used in the management of non-palpable breast lesions with a variable degree of suspicion, that ́s, those classified with the BI-RADS (“Breast Imaging Reporting and Data System”) categories 3, 4 or 5 [1]. Several studies emphasize a better surgical pathological correlation of VAB with respect to other percutaneous methods such as the usual core biopsy, in which variable percentages of underestimation (in relation to the infiltration status in breast cancer) and false negatives cases (in benign, borderline or high-risk lesions: atypical epithelial hyperplasia, papillomatosis, radial scar) have been described [2-5]. Therefore, a majority of authors [5-7] consider that VAB is especially indicated in the percutaneous biopsy of calcifications without associated mass. Although several studies have been reported about the eco-guided VAB [8,9], or by means of digital tomosynthesis [10], the vast majority of procedures are still performed using a stereotactic guide. The current use of VAB has demonstrated, once again, the interobserver variability [11,12] to assess the diagnostic category as well as the existence of different protocols for the management of same type of image (for example, the clusters of calcifications classified as *Correspondence to: Jose A. López-Ruiz, Preteimagen Radiologic Centre: Breast Imaging, Bilbao, Spain, Tel: 34-944-437-499, Fax: 34-944-437-997, E-mail: jalopez@preteimagen.com