Biomedical subjects

Eric L Rosen

Publications and source records attributed to Eric L Rosen.

18 recordsLinked to original sources

PubMed2006

Streaming detection for evaluation of indeterminate sonographic breast masses: a pilot study.

OBJECTIVE: Streaming detection is a novel sonography technique that uses ultrasonic energy to induce movement in cyst fluid that is detected on Doppler sonography. This pilot study evaluates the utility of streaming detection for differentiating cysts from solid masses in breast lesions that are indeterminate on sonography. SUBJECTS AND METHODS: Thirty-nine lesions-11 simple cysts and seven solid masses (control group) and 21 masses with indeterminate findings for the diagnosis of a cyst versus a solid lesion (study group)-in 34 patients were evaluated using streaming detection. All lesions underwent cyst aspiration or biopsy (n = 35) or were diagnosed simple cysts (n = 4) on sonography. Lesion size and depth were recorded. Streaming detection software was placed on conventional sonography units. Acoustic pulses were focused on the lesion, and if fluid movement was generated, it was seen on the spectral Doppler display as velocity away from the transducer. Lesions were then aspirated or underwent biopsy, and the viscosity of the aspirated fluid was recorded. The sensitivity and specificity of the technique and the effect of cyst size, cyst depth, and fluid viscosity in diagnosing fluid-filled cysts were assessed. RESULTS: Overall, 31 cysts and eight solid masses (seven benign, one carcinoma) were diagnosed in the study and control groups. Aspiration of indeterminate lesions resulted in 20 cysts and one solid mass. Lesions ranged in size from 4 to 47 mm and in depth from 4 to 29 mm. In the control group, streaming detection correctly showed nine of the 11 simple cysts (sensitivity, 82%; positive predictive value, 100%), and acoustic streaming was absent in all seven solid masses (specificity, 100%; negative predictive value, 78%). Of the indeterminate lesions, streaming detection allowed correct identification of 10 of 20 cysts (sensitivity, 50%; positive predictive value, 100%). Acoustic streaming was not detected in the one solid study group lesion. Neither cyst size or depth nor fluid viscosity had a significant effect on the ability to detect fluid. CONCLUSION: The streaming detection technique improved differentiation of cysts from solid masses in indeterminate lesions and has potential for reducing the number of recommended cyst aspirations for the diagnosis of indeterminate breast masses.

Adult↗

PubMed2006

MRI-guided vacuum-assisted breast biopsy with a handheld portable biopsy system.

OBJECTIVE: The purpose of this study was to evaluate a compact portable 10-gauge handheld battery-operated vacuum-assisted biopsy system for MRI-guided breast biopsy. CONCLUSION: The compact portable battery-operated biopsy system can be used successfully for MRI-guided core breast biopsy and is an alternative to current systems.

Adult↗

PubMed2006

Evolving concepts in the management of lobular neoplasia.

Lobular neoplasia broadly defines the spectrum of changes within the lobule, ranging from atypical lobular hyperplasia (ALH) to lobular carcinoma in situ (LCIS). This continuum of lesions is associated with an increased risk for developing subsequent invasive breast cancer, with the magnitude of that risk corresponding to the degree of proliferative change. The associated risk for developing invasive breast cancer after a diagnosis of lobular neoplasia is multicentric, bilateral, and equal in both breasts. Lobular neoplasia itself may transform into invasive carcinoma, although the frequency of this occurrence is unknown. Thus, lobular neoplasia is a risk factor for invasive breast cancer and may be a precursor lesion in unusual circumstances. The management of ALH and LCIS depends on the setting in which they are encountered. When ALH and LCIS are diagnosed after core needle breast biopsy, wire localization for surgical excision is required for definitive diagnosis because rates of histologic underestimation approach those of atypical ductal hyperplasia (ADH). When diagnosed on surgical biopsy, ALH and LCIS generally do not require further intervention, even when present at a surgical margin. However, bilateral breast cancer risk must be considered, especially when patients have a family history of breast cancer. In selected situations, bilateral prophylactic mastectomy with or without reconstruction may be considered when atypical hyperplasia or LCIS is diagnosed. Although this reduces risk for developing subsequent breast carcinoma by 90%, patients selected for prophylactic mastectomy represent a small subgroup of lobular neoplasia patients and generally have other risk factors, such as strong family history or evidence of genetic predisposition.

Antineoplastic Agents↗

PubMed2005

Screening women at high risk for breast cancer with mammography and magnetic resonance imaging.

BACKGROUND: The authors compared the performance of screening mammography versus magnetic resonance imaging (MRI) in women at genetically high risk for breast cancer. METHODS: The authors conducted an international prospective study of screening mammography and MRI in asymptomatic, genetically high-risk women age >/= 25 years. Women with a history of breast cancer were eligible for a contralateral screening if they had been diagnosed within 5 years or a bilateral screening if they had been diagnosed > 5 years previously. All examinations (MRI, mammography, and clinical breast examination [CBE]) were performed within 90 days of each other. RESULTS: In total, 390 eligible women were enrolled by 13 sites, and 367 women completed all study examinations. Imaging evaluations recommended 38 biopsies, and 27 biopsies were performed, resulting in 4 cancers diagnosed for an overall 1.1% cancer yield (95% confidence interval [95%CI], 0.3-2.8%). MRI detected all four cancers, whereas mammography detected one cancer. The diagnostic yield of mammography was 0.3% (95%CI, 0.01-1.5%). The yield of cancer by MRI alone was 0.8% (95%CI, - 0.3-2.0%). The biopsy recommendation rates for MRI and mammography were 8.5% (95%CI, 5.8-11.8%) and 2.2% (95%CI, 0.1-4.3%). CONCLUSIONS: Screening MRI in high-risk women was capable of detecting mammographically and clinically occult breast cancer. Screening MRI resulted in 22 of 367 of women (6%) who had negative mammogram and negative CBE examinations undergoing biopsy, resulting in 3 additional cancers detected. MRI also resulted in 19 (5%) false-positive outcomes, which resulted in benign biopsies.

Adult↗

PubMed2005

Accuracy of segmentation of a commercial computer-aided detection system for mammography.

PURPOSE: To assess the accuracy of segmentation in a commercially available computer-aided detection (CAD) system. MATERIALS AND METHODS: Approval for this study was obtained from the authors' institutional review board. Informed consent was not required by the board for this review, as data were stripped of patient identifiers. Two thousand twenty mammograms from 507 women were analyzed with the hardware and software of a commercial CAD system. The accuracy of the segmentation process was determined semiquantitatively and categorized as near perfect if the skin line of the breast was accurately detected, acceptable if only subcutaneous fat was excluded, or unacceptable if any breast parenchyma was excluded from consideration. The accuracy of segmentation was compared for different breast densities and film sizes by using logistic regression (P < .05). RESULTS: Overall, segmentation was near perfect or acceptable in almost 96.8% of images. However, segmentation defects were significantly more common in mammograms with heterogeneously dense breast tissue (8% unacceptable) than in those with fatty replaced (0% unacceptable), scattered (1.2% unacceptable), or extremely dense (1.8% unacceptable) breast parenchyma (P < .05). For images with unacceptable segmentation, the average percentage of breast parenchyma excluded was almost 25% (range, 5%-100%), with no significant differences among breast densities. CONCLUSION: For one commercial CAD system, segmentation was usually near perfect or acceptable but was unacceptable more than five times more frequently for mammograms of breasts with heterogeneously dense parenchyma than for those with all other breast densities. On average, one-quarter of the breast parenchyma was excluded from CAD analysis for images with unacceptable segmentation.

Adult↗

PubMed2005

Detection of primary breast carcinoma with a dedicated, large-field-of-view FDG PET mammography device: initial experience.

PURPOSE: To prospectively assess a dedicated, large field of view positron emission tomography (PET) mammographic device for imaging primary breast carcinoma. MATERIALS AND METHODS: Institutional review board approval was obtained for this study, and all patients provided written informed consent prior to participation. Subjects were recruited from a cohort of patients in whom diagnostic mammography and/or ultrasonography demonstrated lesions that were highly suggestive of malignancy. Twenty-three patients who met the inclusion criteria were subsequently imaged by using a dedicated PET mammography unit that was developed in conjunction with the Thomas Jefferson National Accelerator Facility (Newport News, Va). One hour after administration of 2.0-2.5 mCi (74.0-93.5 MBq) of fluorodeoxyglucose, 5-minute PET mammography of the affected breast was performed. Images were processed and reconstructed in the transverse craniocaudal and coronal planes. For each lesion, image-guided core-needle biopsy was performed immediately after PET mammography. Conventional mammography results and histologic findings were correlated with PET mammography images. The sensitivity, specificity, negative predictive value, and positive predictive value of PET mammography for demonstrating malignant lesions were calculated. RESULTS: PET mammography demonstrated 20 focal abnormalities, of which 18 were malignant and two were benign. Both benign lesions represented areas of fat necrosis. Three of 20 malignant lesions demonstrated at conventional mammography were not demonstrated at PET mammography. The overall sensitivity of PET mammography for malignancy was 86% (95% confidence interval: 65%, 95%), with a positive predictive value of 90% (95% confidence interval: 70%, 97%). The calculated specificity was 33% (95% confidence interval: 2%, 79%), and the negative predictive value was 25% (95% confidence interval: 1%, 70%). CONCLUSION: These pilot data suggest that PET mammography can demonstrate small primary breast malignancies.

Adenocarcinoma↗

PubMed2005

Comparison of recall and cancer detection rates for immediate versus batch interpretation of screening mammograms.

PURPOSE: To retrospectively compare recall and cancer detection rates between immediate and subsequent batch methods for interpretation of screening mammograms. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. Retrospective analysis was performed for 8698 screening mammograms obtained between January 1 and October 31, 2001, which were interpreted either immediately (n = 4113) or subsequently with batch method (n = 4585). Data were collected from data reporting system and patient billing records. Patients with high risk factors were excluded; 3441 patients were in the immediate group, and 3932 were in the batch group. The two groups were compared with respect to age, breast density, and availability of comparison films with Wilcoxon rank sum test. Recall rates and cancer detection rates for each group were determined and compared with Pearson chi(2) test; false-negative rates were compared with Fischer exact test. RESULTS: A significant difference (P < .001) was noted in recall rates between immediate (18%) and batch (14%) groups; however, no significant difference (P = .7) was noted in cancer detection rates (immediate, 0.5%; batch, 0.4%). Mean age of patients was 56.8 years (age range, 21-96 years) in the immediate group and 56.2 years (age range 24-98 years) in the batch group (P = .02). Comparison of breast densities between groups indicates no statistically significant difference (P = .4). The batch group had significantly fewer comparison mammograms (3106 [79%]) available than the immediate group (2856 [83%]) (P < .001). There was no significant difference in false-negative rates between the immediate group (0.1%) and the batch group (0.1%) (P > .99). CONCLUSION: Immediate interpretation of screening mammograms resulted in a statistically significant increase in recalls and additional clinical work-ups of perceived abnormalities; however, no significant difference in cancer detection rate was detected between groups.

Adult↗

PubMed2005

Computer-aided detection of amorphous calcifications.

OBJECTIVE: Computer-aided detection (CAD) systems have been used successfully to detect malignant calcifications on mammography, with sensitivities ranging from 86% to 99%. Amorphous calcifications are a subset of small indistinct calcifications of intermediate concern that have a 20% likelihood of being malignant and that are frequently overlooked on mammography. The purpose of our study was to determine the sensitivity of one commercially available CAD system for detecting amorphous calcifications. MATERIALS AND METHODS: A commercially available CAD system evaluated mammograms of 82 patients with 85 mammographically detected and histologically sampled groups of amorphous calcifications (21 malignant, 14 high risk, and 50 benign). The sensitivity of the system for detecting the calcifications on at least one image of the two-view mammographic examination (case sensitivity) and on each individual mammographic image (image sensitivity) was determined. Findings were correlated with results from large core needle biopsy or surgical excision in each case. RESULTS: The CAD system detected amorphous calcifications in 43 of 85 cases (case sensitivity, 51%) and in 59 of 146 mammographic images (image sensitivity, 40%). The case sensitivities by histologic outcome were 57% for malignant calcifications, 29% for high-risk calcifications, and 54% for benign calcifications. An average of 2.0 false-positive marks were displayed per case. CONCLUSION: The CAD sensitivity for malignant amorphous calcifications is markedly lower than previously reported for all malignant calcifications. Breast imaging radiologists who use CAD systems should continue to search diligently for these difficult-to-detect lesions.

Adult↗

PubMed2005

BI-RADS for sonography: positive and negative predictive values of sonographic features.

OBJECTIVE: The purpose of this study was to assess the positive predictive value (PPV) and negative predictive value (NPV) of features described in the new sonographic BI-RADS lexicon for evaluating solid masses with known histologic diagnoses. MATERIALS AND METHODS: Sonograms of 403 solid lesions were analyzed by one of three dedicated breast radiologists. Each lesion was described using features from the sonographic BI-RADS lexicon. Lesion description and biopsy results were correlated. PPV and NPV were calculated. RESULTS: Histologic results showed that 141 (35%) of 403 masses were malignant. Sonographic BI-RADS descriptors showing high predictive value for malignancy include spiculated margin (86%, 19/22), irregular shape (62%, 102/164), and nonparallel orientation (69%, 75/109). Sonographic BI-RADS descriptors highly predictive of benign lesions include circumscribed margin (90%, 160/178), parallel orientation (78%, 228/294), and oval shape (84%, 200/237). For the sonographic BI-RADS features of mass margin, shape, orientation, lesion boundary, echo pattern, and posterior acoustic features, descriptors chosen were significantly (p < 0.001) different for malignant and benign masses. CONCLUSION: Descriptors from the new sonographic BI-RADS lexicon can be useful in differentiating benign from malignant solid masses.

Adolescent↗

PubMed2003

Diagnostic accuracy of digital mammography in patients with dense breasts who underwent problem-solving mammography: effects of image processing and lesion type.

PURPOSE: To determine effects of lesion type (calcification vs mass) and image processing on radiologist's performance for area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for detection of masses and calcifications with digital mammography in women with mammographically dense breasts. MATERIALS AND METHODS: This study included 201 women who underwent digital mammography at seven U.S. and Canadian medical centers. Three image-processing algorithms were applied to the digital images, which were acquired with Fischer, General Electric, and Lorad digital mammography units. Eighteen readers participated in the reader study (six readers per algorithm). Baseline values for reader performance with screen-film mammograms were obtained through the additional interpretation of 179 screen-film mammograms. A repeated-measures analysis of covariance allowing unequal slopes was used in each of the nine analyses (AUC, sensitivity, and specificity for each of three machines). Bonferroni correction was used. RESULTS: Although lesion type did not affect the AUC or sensitivity for Fischer digital images, it did affect specificity (P =.0004). For the General Electric digital images, AUC, sensitivity, and specificity were not affected by lesion type. For Lorad digital images, the results strongly suggested that lesion type affected AUC and sensitivity (P <.0001). None of the three image-processing methods tested affected the AUC, sensitivity, or specificity for the Fischer, General Electric, or Lorad digital images. CONCLUSION: Findings in this study indicate that radiologist's interpretation accuracy in interpreting digital mammograms depends on lesion type. Interpretation accuracy was not influenced by the image-processing method.

Area Under Curve↗

PubMed2003

Sonographic detection and sonographically guided biopsy of breast microcalcifications.

OBJECTIVE: The purpose of this study was to evaluate the ability of sonography to depict and guide biopsies of mammographically suspicious microcalcifications and to reveal the mammographic features and histologic outcomes of lesions amenable to sonographically guided biopsy. SUBJECTS AND METHODS: . Suspicious clusters of microcalcifications without other mammographic abnormalities were evaluated on sonography before biopsy and divided into two groups: those with and those without microcalcifications seen on sonography. Sonographically detected lesions underwent sonographically guided biopsy; lesions not seen on sonography underwent mammographically guided biopsy. Imaging features and histologies were correlated, and the positive predictive value of sonography was determined. RESULTS: Of 111 lesions (105 patients), 26 lesions (23%) were identified and underwent sonographically guided biopsy; 85 lesions (77%) were not identified sonographically. The diameters of microcalcification clusters in the sonographically identified group were significantly larger (p = 0.0005) and contained larger numbers of microcalcification particles (p = 0.038) compared with clusters not identified sonographically. Sonographically identified lesions were seen as masses (77%) or dilated ducts (23%) with echogenic foci. Sonographically identified lesions were more likely to be malignant than those not seen on sonography (69% vs 21%, respectively; p < 0.00002). Of 38 malignant lesions, those visible on sonography were more likely to be invasive than those not seen on sonography (72% vs 28%, respectively; p = 0.018). In malignant lesions undergoing core biopsy and surgical excision, the extent of disease was underestimated less with sonographically guided biopsy (7%, 1/15) than with stereotactic biopsy (33%, 5/15). CONCLUSION: Suspicious microcalcifications are seen infrequently on sonography (23%) but, when detected, can be successfully biopsied with sonographic guidance and more frequently are malignant and represent invasive cancer than those seen on mammography alone.

Adult↗

PubMed2003

Computer-aided detection (CAD) in screening mammography: sensitivity of commercial CAD systems for detecting architectural distortion.

OBJECTIVE: Computer-aided detection (CAD) algorithms have successfully revealed breast masses and microcalcifications on screening mammography. The purpose of our study was to evaluate the sensitivity of commercially available CAD systems for revealing architectural distortion, the third most common appearance of breast cancer. MATERIALS AND METHODS: Two commercially available CAD systems were used to evaluate screening mammograms obtained in 43 patients with 45 mammographically detected regions of architectural distortion. For each CAD system, we determined the sensitivity for revealing architectural distortion on at least one image of the two-view mammographic examination (case sensitivity) and for each individual mammogram (image sensitivity). Surgical biopsy results were available for each case of architectural distortion. RESULTS: Architectural distortion was deemed present and actionable by a panel of expert breast imagers in 80 views of the 45 cases. One CAD system detected distortion in 22 of 45 cases of distortion (case sensitivity, 49%) and in 30 of 80 mammograms (image sensitivity, 38%); it displayed 0.7 false-positive marks per image. Another CAD system identified distortion in 15 of 45 cases (case sensitivity, 33%) and 17 of 80 mammograms (image sensitivity, 21%); it displayed 1.27 false-positive marks per image. Sensitivity for malignancy-caused distortion was similar to or lower than sensitivity for all causes of distortion. CONCLUSION: Fewer than one half of the cases of architectural distortion were detected by the two most widely available CAD systems used for interpretations of screening mammograms. Considerable improvement in the sensitivity of CAD systems is needed for detecting this type of lesion. Practicing breast imagers who use CAD systems should remain vigilant for architectural distortion.

Adult↗

PubMed2003

Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy.

OBJECTIVE: This study was undertaken to evaluate the ability of MRI to accurately show residual primary breast malignancy in women treated with neoadjuvant chemotherapy. MATERIALS AND METHODS: Twenty-one patients with locally advanced primary breast carcinoma underwent contrast-enhanced MRI before and after treatment with neoadjuvant anthracycline-based chemotherapy. For each patient, the maximum extent of the MRI abnormality was measured both before and after treatment. These measurements were subsequently compared with physical examination findings and histologic results to determine the ability of MRI to accurately reveal tumor extent after neoadjuvant chemotherapy. RESULTS: MRI after chemotherapy showed a correlation coefficient of 0.75 with histology, which was better than physical examination (r = 0.61). MRI underestimated the extent of residual tumor in two patients by more than 1 cm (including one false-negative examination), was within 1 cm in 12 of 21 patients, and overestimated tumor extent by more than 1 cm in seven of 21 patients. CONCLUSION: MRI can show residual malignancy after neoadjuvant chemotherapy better than physical examination, particularly in patients who have not had a complete clinical response to therapy.

Adult↗

PubMed2003

Accuracy of a collagen-plug biopsy site marking device deployed after stereotactic core needle breast biopsy.

OBJECTIVE: The goal of this study was to compare the accuracy of clip placement of a collagen-plug biopsy marking device with that of the more conventional, previously evaluated metallic tissue-marking clips. SUBJECTS AND METHODS. The placement accuracy of 31 collagen-plug marking devices was compared with the placement accuracy of 43 metallic marker clips deployed at biopsies performed between August 1, 2002, and November 20, 2002. The precision of marker placement was assessed by determining the position of the clip relative to the targeted mammographic lesion. Statistical analysis comparing the distance from the clip to the targeted lesion was performed. RESULTS: Using a two-group Wilcoxon's rank sum test, we found the clip-to-target distances for the collagen-plug central titanium marker were significantly different from the clip-to-target distances of the conventional metallic marker clips (p = 0.04). There were significantly fewer cases in which the clip-to-target distance was 1 cm or greater on at least one mammographic projection with the collagen-plug marker (5/31) than with the conventional metallic marker clip (19/43) (chi-square test, p = 0.02). CONCLUSION: The collagen-plug marking device is an effective alternative to existing marker clips, and use of this device may result in fewer cases in which the marker clip is substantially displaced (> or = 1 cm) away from the actual biopsy site.

Biopsy, Needle↗

PubMed2002

Malignant lesions initially subjected to short-term mammographic follow-up.

PURPOSE: To determine whether systematically evaluated criteria for probably benign lesions were actually applied to lesions placed into that category. MATERIALS AND METHODS: A search of the mammography database yielded 295 cases that were initially followed up with short-term interval mammography but eventually received a biopsy recommendation for the same breast. Of the 83 malignancies (81 patients) for which mammograms and pathology reports were available for review, 51 malignancies corresponded to the lesions for which short-term follow-up was recommended. Each case was retrospectively reviewed to determine whether the lesion followed up represented the subsequently diagnosed malignancy. Each lesion was characterized with appropriate Breast Imaging Reporting and Data System descriptors, based on the mammographic imaging available when short-term follow-up was first recommended. These characteristics were then used to determine if, in retrospect, the mammographic appearance met previously published criteria for probably benign lesions. RESULTS: Of the 51 malignancies, 23 (45%) appeared mammographically as microcalcifications, 12 (24%) as masses, four (8%) as architectural distortion, and 12 (24%) as developing densities. None fulfilled strict criteria for a probably benign lesion when reviewed in retrospect. Forty-seven (92%) of 51 lesions had already demonstrated progression at the time of follow-up recommendation. CONCLUSION: Short-term mammographic follow-up is often recommended for lesions that, in retrospect, do not fulfill established diagnostic criteria for probably benign lesions.

Breast Neoplasms↗

PubMed2002

Sonographically guided biopsy of suspicious microcalcifications of the breast: a pilot study.

OBJECTIVE: The purpose of this study is to evaluate the use of sonographic guidance for biopsy of mammographically detected suspicious microcalcifications. SUBJECTS AND METHODS: Twenty-three patients with suspicious microcalcifications detected on mammography (15 associated with masses or distortion; eight with microcalcifications alone) underwent sonographically guided core biopsy (n = 18) or sonographically guided needle localization before excision (n = 5). Microcalcifications were targeted, and specimen radiographs were obtained for each lesion, with the success of the procedure based on identifying microcalcifications on the specimen radiograph. For core biopsies, the number of cores obtained was compared with that in 49 control patients who underwent sonographically guided core biopsy of noncalcified masses. RESULTS: All 23 lesions (100%) were successfully biopsied under sonographic guidance, with microcalcifications seen on specimen radiographs in each case. Of 18 core biopsies, a mean of 8.7 cores was obtained compared with a mean of 5.5 cores in the control group (p<0.0001). Of 13 lesions sampled with core biopsy that subsequently underwent surgical excision, three (23%) were upgraded from atypical ductal hyperplasia to ductal carcinoma in situ (n = 1) and from ductal carcinoma in situ to invasive carcinoma (n = 2). Mammographically, most lesions contained more than 15 pleomorphic microcalcifications. On sonography, echogenic foci corresponded to microcalcifications in all but two cases in which broader echogenic regions were seen. When no mass or distortion was visible on mammography, sonography showed a mass or dilated ducts with internal echogenic foci. CONCLUSION: Microcalcifications identifiable on sonography can be successfully biopsied under sonographic guidance. Further study is necessary to determine whether targeting microcalcifications seen sonographically in the mass or duct can improve the rate of underestimation of disease compared with stereotactic core biopsy.

Biopsy, Needle↗

PubMed2002

Imaging-guided core needle biopsy of papillary lesions of the breast.

OBJECTIVE: Our objective was to assess the incidence of papillary lesions of the breast diagnosed at imaging-guided core needle biopsy and the need for surgical excision after a benign diagnosis. MATERIALS AND METHODS: This retrospective study included 1374 patients with consecutive suspicious breast lesions that underwent either mammography or sonographically guided large-core needle breast biopsy. Fifty-seven lesions (4%) were classified as papillary lesions. Eleven of the 57 cases were lost to follow-up (n = 6) or had not yet shown 2 years of stability (n = 5) and were excluded from this study. The remaining 46 papillary lesions constitute our study population. RESULTS: Surgical excision was performed in 17 (37%) of 46 papillary lesions. In the group of patients whose lesions were recommended for excision because carcinoma was identified at core biopsy, surgical excision revealed one false-positive and two true-positive diagnoses. In four cases, histologic diagnoses of the excisional biopsy and the core needle biopsy were discordant. One false-positive finding at core needle biopsy initially was interpreted as invasive ductal carcinoma on the basis of core needle biopsy specimens. In three false-negative findings, the initial diagnosis at core needle biopsy was upgraded after surgical excision. Two cases of papilloma with adjacent atypical ductal hyperplasia and one of atypical papilloma were upgraded to ductal carcinoma in situ after surgical excision. Imaging follow-up was performed in the remaining 29 patients. All lesions were stable or had decreased in size during the 2-year follow-up period. The negative predictive value of core needle biopsy for excluding malignancy among the papillary lesions diagnosed in our study was 93%. CONCLUSION: When the histologic diagnosis is benign, our data suggest that papillary lesions may be safely managed with imaging follow-up rather than with surgical excision. However, atypical papillary lesions or those associated with atypia require surgical excision because histologic underestimation occurs at a frequency similar to that in other atypical lesions undergoing core needle biopsy.

Biopsy, Needle↗

PubMedDate not supplied

Stereotactic breast biopsy of noncalcified lesions: a cost-minimization analysis comparing 14-gauge multipass automated core biopsy to 14- and 11-gauge vacuum-assisted biopsy.

A decision model was used to compare the relative costs of the 14-gauge automated gun technique to the 14-gauge and 11-gauge vacuum-assisted techniques for stereotactic biopsy of noncalcified breast lesions. Probability and cost variables were estimated from clinical experience with 76 automated gun biopsies, seventy-eight 14-gauge vacuum-assisted biopsies and thirty-nine 11-gauge vacuum-assisted biopsies. The 14-gauge automated gun was the preferred strategy from a cost standpoint: the 14-gauge vacuum technique was 1.19 times more expensive, and the 11-gauge was 1.22 times more expensive.

Biopsy↗