Breast biopsy cores with calcifications better indicate malignant lesions

Just like double-checking a grocery receipt to make sure you haven't been overcharged, researchers suggest attention be paid to x-ray stereotactic biopsy cores to ensure they contain previously targeted calcifications. Cores obtained without such calcifications have a higher chance of missing malignant lesions.

While it is a common practice to radiograph these cores, this is the first study to compare the diagnostic results of cores with calcifications with cores obtained without calcifications, according to the report published in the October issue of Radiology.

"Our study indicates that you haven't done the biopsy satisfactorily if you have retrieved cores without calcifications," said Dr. Frederick R. Margolin, director of the Breast Health Center at the California Pacific Medical Center in San Francisco.

In a retrospective study, Margolin and colleagues examined 113 patients who had undergone vacuum-assisted 11- or 14-gauge needle stereotactic core biopsy for calcifications.

At least one core obtained from each of the 116 lesions examined contained calcifications. Investigators sent cores both with and without calcifications to pathologists.

The researchers then compared the final diagnosis on the core samples given by the pathologists with the diagnosis achieved from surgical excisions performed on all of the patients within seven weeks of the core biopsy.

Eighty-four percent of the cores with calcifications led to final diagnoses of malignancy compared with 71% of the cores without calcifications. Furthermore, 11% of cores without calcifications led to missed cancers compared with only 1% for those cores with calcifications.

And while the smaller 14-guage needles were subject to more underestimates of malignancy than the 11-guage needles, the size of the needle did not affect underestimation of cancer between cores with and without calcification.

Based on the study results, the authors note that radiography of the core tissues obtained was essential to adequately performing a core breast biopsy.

For more information from the online Diagnostic Imaging archives:

Radio-frequency introducer cuts through tough breast tissue

Patient positioning affects biopsy success

Biopsy advances guide MR to new era

Breast calcifications may presage invasive cancer