USG-guided excision biopsy in case of ambiguous breast USG images

In 2003-2006 1068 excision biopsies (USG-, MGR- guided anchor biopsies) were performed in OCCD. In 182 patients (17%), USG-guided biopsies were performed. The youngest patient was 22 years old, the oldest 84, the mean age in the group was 53 years. The group consisted of 77 premenopausal patients (42%) and 105 (58%) postmenopausal ones. The family histories of 32 patients (17.5%) were positive. 169 (93%) had undergone mammography, including 115, for whom it was the first examination of that type in their life. The lesions were located most frequently in the upper lateral quadrant of the mammary gland (89 patients - 49%). In 5 patients, the lesions were of multifocal character. In 29 (16%), MGR revealed microcalcifications. All the patients underwent USG of the breasts. In 122 (68.5%), the lesions visualized by USG were hypoechogenic. Only in 4 (2%), the lesions revealed by USG were suspicious of cancer. The mean lesion size was 13 mm (range 4-60 mm). All the patients underwent surgical treatment. Partial resection of breast tissue localized by means of a USG-guided needle was performed. The results of histopathological investigations of the surgical material were as follows: 43 patients (23.5%) were diagnosed with malignant tumors, 139 (76.5%) - with benign ones. Among the benign tumors, adenofibroma was predominant (72 patients - 52%), among the malignant ones - carcinoma infiltrans (35 patients - 81.4%). After ultimate histopathology results were obtained, 17 patients underwent BCT, 17 - Madden mastectomy, 2 - simple mastectomy, and 3 patients developed tumors in the other breast which was operated on by Madden mastectomy. The following conclusions, based on the analysis of own material, were drawn: 1. USG-guided excision biopsy on case of ambiguous findings in breast USG is an effective method, both in diagnostics and in therapy. 2. In the OCCD material, 23.5% of patients with ambiguous USG findings were diagnosed histopathologically with malignant tumors, which confirms the necessity to perform excision biopsies. 3. Only good cooperation between the radiologist and the surgeon guarantees the success of this method

Vacuum mammotomy under ultrasound guidance

Background: Breast ultrasound is a non-invasive method of breast examination. You can use it also for fine needle biopsy, core needle biopsy, vacuum mammotomy and for placing the "wire" before open surgical biopsy. Material/Methods: 106 patients (105 women and 1 man) aged 20-71 years (mean age 46.9) were treated in Cancer Institute in Cracow by vacuum mammotomy under ultrasound guidance. The lesions found in ultrasonography were divided into three groups: benign lesions (BI RADS II), ambiguous lesions (BI RADS 0, III and IVa), and suspicious lesions (BI RADS IV B, IV C and V). Then lesions were qualified to vacuum mammotomy. Results: According to USG, fibroadenoma or "fibroadenoma-like" lesions were found in 75 women, in 6 women complicated cysts, in 6 women cyst with dense fluid (to differentiate with FA), and in 19 patients undefined lesions. Fibroadenoma was confirmed in histopathology in 74% patients among patients with fibroadenoma or "fibroadenoma-like" lesions in ultrasound (in others also benign lesions were found). Among lesions undefined after ultrasound examination (total 27 patients) cancer was confirmed in 6 % (DCIS and IDC). In 6 patients with complicated cysts in ultrasound examination, histopathology confirmed fibroadenoma in 4 women, an intraductal lesion in 1 woman and inflamatory process in 1 woman. Also in 6 women with a dense cyst or fibroadenoma seen in ultrasound, histopathology confirmed fibroadenoma in 3 women and fibrosclerosis in 3 women. Conclusions: Any breast lesions undefined or suspicious after ultrasound examination should be verified. The method of verification or kind of operation of the whole lesion (vacuum mammotomy or "wire") depends on many factors, for example: lesion localization; lesion size; BI RADS category