ABSTRACT

We aimed to determine the feasibility and accuracy of digital breast tomosynthesis–guided vacuum-assisted breast biopsy (DBT-VAB) for noncalcified lesions without a sonographic correlate and to assess the concordance of imaging and pathology findings.

A retrospective review of our institutional biopsy database between December 11, 2015, and August 31, 2016, identified 72 consecutive women with 73 noncalcified lesions on digital breast tomosynthesis who underwent attempted DBT-VAB. Relevant imaging was reviewed in consensus by 3 fellowship-trained breast radiologists for imaging features and biopsy parameters. Medical records were reviewed for histopathology and imaging follow-up.

The target lesion was successfully sampled by DBT-VAB in 99% (72 of 73) of cases. The median time to complete DBT-VAB was 16 minutes. No major complications were reported. Findings included 3 focal asymmetries (4%), 7 asymmetries (10%), 21 masses (29%), and 41 architectural distortions (ADs) (57%). Final histopathology was malignant in 24% (17 of 72), actionable high-risk in 4% (3 of 72), and benign in 72% (52 of 72). VAB pathology was concordant in 86% (62 of 72): 21% malignant, 6% high risk, and 60% benign. VAB pathology was discordant in 14% (10 of 72). One malignancy and 4 complex sclerosing lesions were missed after DBT-VAB of AD, which was confirmed on surgical excision. Therefore, the misdiagnosis rate for DBT-VAB was 7% (5 of 72).

DBT-VAB is a quick and feasible biopsy method for targeting noncalcified mammographic lesions without a sonographic correlate. The 24% malignancy rate reaffirms that biopsy is necessary for suspicious mammographic lesions occult on ultrasound. Although DBT-VAB shows high accuracy for noncalcified lesions, meticulous radiology-pathology correlation is required in the interpretation of DBT-VAB results, with surgical excision of discordant cases.