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CC BY-NC-ND 4.0 · South Asian J Cancer
DOI: 10.1055/s-0044-1792007
Original Article

Role of Image-Guided Biopsy in Nonpalpable Breast Lesions: A Study in the Sub-Himalayan Region of North India

Surya Pratap Singh
1   Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
,
Charu Smita Thakur
1   Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
,
Sushma Makhaik
1   Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
,
Shruti Thakur 
1   Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
,
Anupam Jhobta
1   Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
,
Sumala Kapila
1   Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
,
Neelam Sharma
2   Department of Pathology, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
,
Neeti Aggarwal
1   Department of Radiodiagnosis, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India
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Abstract

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Shruti Thakur

Background Nonpalpable breast lesions pose a challenge in their early diagnosis. Image-guided biopsy is preferred in these cases so that a pathological diagnosis of breast carcinoma is reached timely for a better prognosis as the disease has an increased chance of successful outcome with early identification and treatment.

Objective The study aims at evaluating the role of stereotactic core needle biopsy (CNB) and percutaneous ultrasound-guided core needle biopsy (US-CNB) in diagnosing suspicious nonpalpable breast lesions.

Methods Our study included 35 patients with nonpalpable breast lesions and having a Breast Imaging Reporting and Data System (BI-RADS) risk assessment category IV or V on mammography or sonography. These 35 lesions were subjected to percutaneous image-guided (stereotactic or US) biopsy for histopathological analysis.

Results Out of a total of 35 cases, 17 were pathologically malignant (48.6%), with the most common subtype being invasive ductal carcinoma (82.3%). Twenty-nine cases underwent US-CNB, 16 (55.1%) of which were malignant and 13 (44.8%) were benign on histopathological evaluation (HPE). The remaining six cases, which on mammography showed no mass but suspicious malignant calcification only, were subjected to stereotactic CNB, out of which one (16.6%) was malignant and five (83.3%) were benign on HPE. Hence, the lesions visible on sonography were more likely to be malignant.

Conclusion Sonography and mammography play a complimentary role in detecting breast carcinoma. Percutaneous biopsy under image guidance can be used as an accurate diagnostic alternative to open surgical excisional biopsy to avoid diagnostic delay.

Keywords

breast cancer - ultrasound-guided core needle biopsy - stereotactic core needle biopsy - Breast Imaging Reporting and Data System - histopathology

Authors' Contributions

C.S.T. and S.M. developed the study concept and design. S.P.S., C.S.T., and N.S. contributed to data acquisition. S.P.S., S.K., and S.T. analyzed the data. S.T. and S.P.S. drafted the manuscript. A.J. and N.A. contributed to critical revision of the manuscript. All authors read and approved the final manuscript.




Publication History

Received: 22 June 2024

Accepted: 21 September 2024

Article published online:
29 October 2024

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  • References

  • 1 Sutton EJ, Braunstein LZ, El-Tamer MB. et al. Accuracy of magnetic resonance imaging–guided biopsy to verify breast cancer pathologic complete response after neoadjuvant chemotherapy: a nonrandomized controlled trial. JAMA Netw Open 2021; 4 (01) e2034045
    CrossrefPubMedGoogle Scholar
  • 2 Henry NL, Hayes DF, Ramsey SD, Hortobagyi GN, Barlow WE, Gralow JR. Promoting quality and evidence-based care in early-stage breast cancer follow-up. J Natl Cancer Inst 2014; 106 (04) dju034
    CrossrefPubMedGoogle Scholar
  • 3 Youk JH, Kim EK, Kim MJ, Oh KK. Sonographically guided 14-gauge core needle biopsy of breast masses: a review of 2,420 cases with long-term follow-up. AJR Am J Roentgenol 2008; 190 (01) 202-207
    CrossrefPubMedGoogle Scholar
  • 4 Hao S, Liu ZB, Ling H. et al. Changing attitudes toward needle biopsies of breast cancer in Shanghai: experience and current status over the past 8 years. OncoTargets Ther 2015; 8: 2865-2871
    CrossrefPubMedGoogle Scholar
  • 5 Bick U, Trimboli RM, Athanasiou A. et al; European Society of Breast Imaging (EUSOBI), with language review by Europa Donna–The European Breast Cancer Coalition. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2020; 11 (01) 12
    CrossrefPubMedGoogle Scholar
  • 6 Moon WK, Im JG, Koh YH, Noh DY, Park IA. US of mammographically detected clustered microcalcifications. Radiology 2000; 217 (03) 849-854
    CrossrefPubMedGoogle Scholar
  • 7 Soo MS, Baker JA, Rosen EL. Sonographic detection and sonographically guided biopsy of breast microcalcifications. AJR Am J Roentgenol 2003; 180 (04) 941-948
    CrossrefPubMedGoogle Scholar
  • 8 Sickles EA. ACR BI-RADS® Atlas: Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013: 39
    Google Scholar
  • 9 Schmidt G, Findeklee S, Del Sol Martinez G. et al. Accuracy of breast ultrasonography and mammography in comparison with postoperative histopathology in breast cancer patients after neoadjuvant chemotherapy. Diagnostics (Basel) 2023; 13 (17) 2811
    CrossrefPubMedGoogle Scholar
  • 10 Lu W, Tu L, Xie D. et al. A systematic review and meta-analysis: value of ultrasound-guided vacuum-assisted biopsy in the diagnosis and treatment of breast lesions. Gland Surg 2021; 10 (10) 3020-3029
    CrossrefPubMedGoogle Scholar
  • 11 Al-Ismaeel AH, Nugud A, Nugud A, Nugud S. Ultrasonography-guided core needle biopsy diagnostic value in breast lump assessment: an experience from the Middle East. J Diagn Med Sonogr 2021; 37 (01) 5-11
    CrossrefGoogle Scholar
  • 12 Parker SH, Jobe WE, Dennis MA. et al. US-guided automated large-core breast biopsy. Radiology 1993; 187: 507-511
    CrossrefPubMedGoogle Scholar
  • 13 Brancato B, Crocetti E, Bianchi S. et al. Accuracy of needle biopsy of breast lesions visible on ultrasound: audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes. Breast 2012; 21 (04) 449-454
    CrossrefPubMedGoogle Scholar
  • 14 Shah VI, Raju U, Chitale D, Deshpande V, Gregory N, Strand V. False-negative core needle biopsies of the breast: an analysis of clinical, radiologic, and pathologic findings in 27 consecutive cases of missed breast cancer. Cancer 2003; 97 (08) 1824-1831
    CrossrefPubMedGoogle Scholar
  • 15 Liberman L, Ernberg LA, Heerdt A. et al. Palpable breast masses: is there a role for percutaneous imaging-guided core biopsy?. AJR Am J Roentgenol 2000; 175 (03) 779-787
    CrossrefPubMedGoogle Scholar
  • 16 Verkooijen HM. Core Biopsy After Radiological Localisation (COBRA) Study Group. Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicenter prospective study with 95% surgical confirmation. Int J Cancer 2002; 99 (06) 853-859
    CrossrefPubMedGoogle Scholar
  • 17 Tchaou M, Darré T, Gbandé P. et al. Ultrasound-guided core needle biopsy of breast lesions: results and usefulness in a low-income country. Open J Radiol 2017; 7 (04) 209-218
    CrossrefGoogle Scholar
  • 18 Sueningrat AA, Mendy M. Comparison ultrasound-guided handheld vacuum assisted breast biopsy and core biopsy in breast cancer. New Ropanasuri J Surg 2022; 7 (02) 6
    Google Scholar
  • 19 Wiratkapun C, Treesit T, Wibulpolprasert B, Lertsithichai P. Diagnostic accuracy of ultrasonography-guided core needle biopsy for breast lesions. Singapore Med J 2012; 53 (01) 40-45
    PubMedGoogle Scholar
  • 20 Kim HS, Kim MJ, Kim EK, Kwak JY, Son EJ, Oh KK. US-guided vacuum-assisted biopsy of microcalcifications in breast lesions and long-term follow-up results. Korean J Radiol 2008; 9 (06) 503-509
    CrossrefPubMedGoogle Scholar
  • 21 Bohan S, Ramli Hamid MT, Chan WY. et al. Diagnostic accuracy of tomosynthesis-guided vacuum assisted breast biopsy of ultrasound occult lesions. Sci Rep 2021; 11 (01) 129
    CrossrefPubMedGoogle Scholar
  • 22 Bae S, Yoon JH, Moon HJ, Kim MJ, Kim EK. Breast microcalcifications: diagnostic outcomes according to image-guided biopsy method. Korean J Radiol 2015; 16 (05) 996-1005
    CrossrefPubMedGoogle Scholar
  • 23 Park JW, Ko KH, Kim EK, Kuzmiak CM, Jung HK. Non-mass breast lesions on ultrasound: final outcomes and predictors of malignancy. Acta Radiol 2017; 58 (09) 1054-1060
    CrossrefPubMedGoogle Scholar
  • 24 Pijnappel RM, Peeters PH, van den Donk M. et al. Diagnostic strategies in non-palpable breast lesions. Eur J Cancer 2002; 38 (04) 550-555
    CrossrefPubMedGoogle Scholar
  • 25 Rahbar G, Sie AC, Hansen GC. et al. Benign versus malignant solid breast masses: US differentiation. Radiology 1999; 213 (03) 889-894
    CrossrefPubMedGoogle Scholar
  • 26 Parmar J, Choudhary S, Zope A. et al. Comprehensive comparison of diagnostic accuracy of ultrasound and mammography in young women with radiographically dense breasts. Arch Clin Biomed Res 2022; 6 (02) 308-321
    CrossrefGoogle Scholar
  • 27 Berg WA, Bandos AI, Mendelson EB, Lehrer D, Jong RA, Pisano ED. Ultrasound as the primary screening test for breast cancer: analysis from ACRIN 6666. J Natl Cancer Inst 2015; 108 (04) djv367
    CrossrefPubMedGoogle Scholar
  • 28 Kettritz U, Rotter K, Schreer I. et al. Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer 2004; 100 (02) 245-251
    CrossrefPubMedGoogle Scholar
  • 29 Schueller G, Jaromi S, Ponhold L. et al. US-guided 14-gauge core-needle breast biopsy: results of a validation study in 1352 cases. Radiology 2008; 248 (02) 406-413
    CrossrefPubMedGoogle Scholar
  • 30 Eren H, Akkurt TS, Ozmen HI. et al. Ultrasound-guided breast biopsy: evaluation of the correlation between radiologic and histopathologic findings. Cam Sakura Med J 2022; 2 (02) 70-74
    CrossrefGoogle Scholar
  • 31 Kasliwal A, Kasliwal N, Kasliwal V, Narvel N, Mashadi Y, Sayed A. Study of ultrasound-guided biopsy of breast lesions in the rural population of Maharashtra: a cross-sectional study. MedPulse Int J Radiol 2021; 17 (02) 39-41
    CrossrefGoogle Scholar
  • 32 Shah B, Shah M, Degloorkar S, Parab S, Vijay R. Analysis of histopathological findings of breast biopsies at a tertiary care centre. Int Surg J 2023; 10 (06) 1009-1013
    CrossrefGoogle Scholar
  • 33 Chakrabarthi S. Stereotactic breast biopsy: a review & applicability in the Indian context. Indian J Med Res 2021; 154 (02) 237-247
    CrossrefPubMedGoogle Scholar
  • 34 Bhattacharya S, Varshney S, Heidler P, Tripathi SK. Expanding the horizon for breast cancer screening in India through artificial intelligent technologies: a mini-review. Front Digit Health 2022; 4: 1082884
    CrossrefPubMedGoogle Scholar