nice saint paul. biopsies mammaires, l.rotenberg 2015
TRANSCRIPT
![Page 1: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/1.jpg)
LucRotenberg–RPO-ISHHCliniqueHartmann-CMCAmbroiseParé
26-27bdVictorHugo92200NeuillySurSeine-France
PréanalyKquesurlesbiopsiesetprélèvements
![Page 2: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/2.jpg)
Niveauxdepreuve
Leniveaudepreuvecorrespondàlacota2ondesdonnéesdelali4ératuresurlesquellesreposentlesrecommanda2onsformulées.Ilestfonc2ondutypeetdelaqualitedesétudesdisponiblesainsiquedelacohérenceounondeleursrésultats;ilestspécifiepourchacunedesméthodes/interven2onsconsidéréesselonlaclassifica2onsuivante:NiveauA
Ilexisteune(des)méta-analyse(s)«debonnequalite»ouplusieursessaisrandomisés«debonnequalite»dontlesrésultatssontcohérents.
NiveauBIlexistedespreuves«dequalitecorrecte»:essaisrandomisés(B1)ouétudesprospecKvesourétrospecKves(B2).Lesrésultatsdecesétudessontcohérentsdansl'ensemble.
NiveauCLesétudesdisponiblessontcriKquablesd’unpointdevueméthodologiqueouleursrésultatsnesontpascohérentsdansl'ensemble.
NiveauDIln'existepasdedonnéesouseulementdessériesdecas.
![Page 3: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/3.jpg)
PréanalyKquesurlesbiopsiesetprélèvementsRéalisaKonetcondiKonnementdelabiopsieenpréanalyKque
1. Unebiopsieréféren2elleestelleindispensableavantpriseenchargedelésionmammairesuspecte?
![Page 4: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/4.jpg)
![Page 5: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/5.jpg)
Breastlesionsimaging
• Screening,detec2onordiagnosis:• Mammography
– FullDigitalMammography– 3DDigitalBreastTomosynthesis
• Sonography– Highfrequencyprobe– Doppler– elastography
• MRI– 1,5or3Tmagnet– Morphologicanddynamicstudy,perfusion– Diffusion– Spectroscopy-MRI
• Goal=evalua2onforarisk:BIRADSclassifica2on
![Page 6: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/6.jpg)
BI-RADS
BreastImagingReporKngandDataSystem
2ndfrenchediKon4thamericanediKon
IndicaKons
![Page 7: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/7.jpg)
Probablybenignmalignancy0,2à5%
§ Followup§ NobiopsyindicaKonexceptedfor:
§ HighriskpaKent§ BRCAmuta*on
§ synchronouscancer § Impossiblefollowup§ Cancerophobia
Bi-Rads3
![Page 8: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/8.jpg)
suspiciouslesionmalignancy5to95%
BiopsyindicaKon
4a?
Bi-Rads4
![Page 9: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/9.jpg)
Verysuspiciouslesionformalignancy
§ fineneedleaspiraKon:nomoreorsenKnallymphnodes
§ Corebiopsy16or14G§ histology,HR,Her2...
§ Suspiciousforrecidive§ aiersurgery§ aierradiotherapy
Bi-Rads5to6
![Page 10: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/10.jpg)
Frederick R. Margolin1 Jessica W. T. Leung1,2 Richard P. Jacobs1 Susan R. Denny1 Percutaneous Imaging-Guided Core Breast Biopsy: 5 Years’ Experience in a Community Hospital, AJR:177, September 2001
![Page 11: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/11.jpg)
• Histologicaldiagnosisbythepathologistalwaysmandatory
• Nohistologicaldiagnosisonimaging!
– However,diagnosKchypothesesandindicaKonsofacKontobetakenarewelcome
Breastlesionsimaging
![Page 12: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/12.jpg)
Birads1 screening
Birads2 screening
Birads3 Followupexcepthighrisk
Birads4a Followupexceptprogressiveor
highrisk
Birads4b,c LCBorVABBdiagnosis
Birads5/6 LCBorVABB
diagnosisoustategical
![Page 13: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/13.jpg)
MODALITÉSTECHNIQUESDUPRÉLÈVEMENTBIOPSIQUE:reco2009
• EncasdecalcificaKons:• macrobiopsieparvoiepercutanéeuKlisantunsystèmeàaspiraKon
• microbiopsieparvoiepercutanéesimacrobiopsietechniquementnonréalisable.
• Encasdemassespalpablesetradiologiques• Microparvoiepercutanée.
• Siimpossibilitetechniquederéaliserunebiopsiepercutanée:
• biopsiechirurgicale
![Page 14: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/14.jpg)
Wallis M et al. EJR 2007 American College of Radiology Reston 2003 Perry EJC 2001
According to the guidelines of the European Society of Breast
Imaging (EUSOBI), up to 90% of suspicious breast
lesions (BI-RADS™ 4 and 5)
should undergo most effective percutaneous biopsy before further treatment is planned.
![Page 15: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/15.jpg)
Minimal Invasive Interventions
US StereotacKcal MRI Others
FNAC - - - -
LCNB +++ - - -
VABB +++ +++ +++ -
Intact ++ ++ - -
Marking +++ +++ +++FreeHand
Galactoscopy
![Page 16: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/16.jpg)
Interventional Methods Fine Needle Aspiration Cytology (FNAC)
Britton PD The Breast 1999; 8:1-5
Sonography
FNAC CNB
N= 2,673 1,851
SensiKvity 83,1 96,7
Specificity 84,0 98,7
Meta - analysis: 31 Studies ( n = 17,108 Cases)
![Page 17: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/17.jpg)
Possibilities of Assessment
Interventional Methods FNAC (Fine Needle Aspiration Cytology) FNAC is inadvisable as a standard method.
![Page 18: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/18.jpg)
Possibilities of Assessment Interventional Methods (Ultrasound) LCNB
Autom. Large Core Needle Biopsy
![Page 19: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/19.jpg)
Large Core Needle Biopsy (LCNB)
![Page 20: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/20.jpg)
Large Core Needle Biopsy (LCNB)
Author Year SensiKvity Specificity
Parker 1991 100% 100%
Schulz-Wendtland 1994/1998 98% 100%
Brivon 1997 89% 89%
Heywang-Köbrunner 1997/1998 98% 100%
Taki 1997 89% 95%
Fornage 1999 100% 100%
![Page 21: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/21.jpg)
Interventional Methods LCNB
Verkooijen HM, Peeters PH, Buskens E et al. Br J Cancer 2000; 82: 1017-1021
Meta - analysis: 5 Studies ( n = 865 Cases)
„ The False Rate of 2.6 ( 8 / 307 maligne Diagnosis) – LCNB with a high sensitivity (97%) and specificity (94%) is an excellent alternative in contrast to the wire marking.“
![Page 22: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/22.jpg)
Possibilities of Assessment Vacuum Assisted Breast Biopsy
Interventional Methods VABB Directional Vacuum - Assisted Breast Biopsy
![Page 23: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/23.jpg)
Indications for diagnostic representative or ablative Vacuum - Biopsy (VABB)
1. StereotacKcguidance
2. MRIguidance
![Page 24: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/24.jpg)
§ localanesthesia§ externalprocedure§ ExplanaKon+++§ Time15to40mn
Breastbiopsy
14G 11G 10G 8G17mg 95mg 160mg 300mg
![Page 25: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/25.jpg)
Post contrast image of lesion Confirmation of obturator location near lesion
Post biopsy image
MacrobiopsiesousIRM
![Page 26: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/26.jpg)
auteur année typeNbrelésions(nbrepaKents)
Tempsmoyen
unique mulKple%
complicaKon%
succès%
cancer
Libermanetal. 2003 VA 27(20) 49 35 69 1(4) 26/27(96) 8/27(30)
Lehmanetal 2005 VA 38(28) 50 39 61 38/38(100) 15/38(40)
Oreletal 2005 VA 85(75) 30-60 0 85/85(100) 52/85(61)
Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience Laura Liberman & alDepartment of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.AJR 2003; 181:1283-1293
Clinical Experience with MRI-Guided Vacuum-Assisted Breast Biopsy Constance D. Lehman & alDepartment of Radiology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98195. Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224. AJR 2005; 184:1782-1787
MR Imaging–guided 9-gauge Vacuum-assisted Core-Needle Breast Biopsy: Initial Experience Susan G. Orel & alDepartments of Radiology and Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. Radiology 2005, 10.1148
MacrobiopsiesousIRM
![Page 27: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/27.jpg)
Indications for diagnostic representative or ablative Vacuum - Biopsy (VABB) /US
1. AierLargeCoreNeedleBiopsy(LCNB)andsuspicionofbreastcancer(BI-
RADS®4c/5,missmatch/discordanceoftheresultsofdiagnosKcimaging
andhistology)
2. Suspiciouslesions(BI-RADS®4/5)diameter~5mm
3. ResecKonofdefinitelybenign,butsymptomaKcfindingsorHighriskpaKents1. symptomaKcFibroadenoma
2. recurrentsymptomaKccysts
4. Intraductal/intracysKcalproliferaKons:singularyPapilloma,complexcyst
5. NeoadjuvantChemotherapy
6. Suspisciousoflocalrecurrence
7. HazardousordangerouslocaKon:deep,superficial,implants…
![Page 28: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/28.jpg)
PréanalyKquesurlesbiopsiesetprélèvementsRéalisaKonetcondiKonnementdelabiopsieenpréanalyKque
2. Existe-t-ilunnombreminimaldeprélèvementsnécessaireaudiagnos2cenfonc2ondelalésion,dutypedebiopsieetdumodedeguidagechoisis(per2nencedel’échan2llonnage)?
![Page 29: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/29.jpg)
03/01/16
S Vacuumassisteddevices
S MammotomeS 1995,11et8g
S Vacora(Bard)S 2003,10gS 2007,14g
S Atec(Suros-Hologic)S 2007,12g9g
S SenoRX (Bard)• 2009,10g,7g
S Intact2009
S Largecoredevices
S 16gS 14gS Singleusedevices+++
S OtherbiopsydevicesS Spirotome&Coramate
(Medinvents)S 2007,14et9g
S Celero(Hologic)S 200812g
S Finesse(Bard)S 201014g
ChoiceoftheNeedle
![Page 30: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/30.jpg)
03/01/16
![Page 31: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/31.jpg)
![Page 32: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/32.jpg)
RöFo 175; 94 - 98 (2003)
![Page 33: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/33.jpg)
Discussion VABB
• Underestimation rate ADH, DCIS, ALH, LCIS…
– Not eliminated with VABB
» >> PPV : malignant » >> NPV : benign
– Surgical indication : paradigme and guidelines
![Page 34: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/34.jpg)
DCISRogerJ.Jackman&al,RadiologyFebruary2001218:497-502
Stereotac2cBreastBiopsyofNonpalpableLesions:Determinantsof
DuctalCarcinomainSituUnderes2ma2onRates
• DCISunderes2ma2onratesbybiopsydevicewere– 20.4%(76of373)atlarge-corebiopsy– 11.2%(107of953)atvacuum-assistedbiopsy(P<.001)
• 24.3%(35of144)ofmasses• 12.5%(148of1,182)ofmicrocalcifica2ons(P<.001)• andbynumberofspecimensperlesion
– 17.5%(88of502)with10orfewerspecimens– 11.5%(92of799)withgreaterthan10(P<.02).
• DCISunderes2ma2onsincreasedwithlesionsize
1.9KmesmorefrequentwithmassesthanwithcalcificaKons
1.8KmesmorefrequentwithLCBthanwithVAB
1.5Kmesmorefrequent<10orfewerspecimensperlesionthanwith≥10specimensperlesion.
![Page 35: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/35.jpg)
ADH
Peter R. Eby, Jennifer E. Ochsner, Wendy B. DeMartini & al, Frequency and Upgrade Rates of Atypical Ductal Hyperplasia Diagnosed at Stereotactic Vacuum-Assisted Breast Biopsy: 9- Versus 11-Gauge. AJR 2009; 192:229–234
![Page 36: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/36.jpg)
ADHPrevalence
RJ Jackman, RL Birdwell, DM Ikeda, Atypical Ductal Hyperplasia: Can Some Lesions Be Defined as Probably Benign after Stereotactic 11-gauge Vacuum- assisted Biopsy, Eliminating the Recommendation for surgical exision ? Radiology 2002; 224:548–554
![Page 37: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/37.jpg)
RadialScarsR. James Brenner, Roger J. Jackman, Steve H. Parker & al, Percutaneous Core Needle Biopsy of Radial Scars of the Breast: When Is Excision Necessary? AJR:179, November 2002
• Carcinomawasfoundatexcisionin– 28%(8/29)oflesionswithassociatedatypicalhyperplasia– 4%(5/128)oflesionswithoutassociatedatypia
• Inthela4ergroup,carcinomawasfoundatexcisionin– 3%(2/60)ofmasse– 8%(3/40)ofarchitecturaldistorKons– 0%(0/28)ofmicrocalcificaKonlesions
• Malignancywasmissedin– 9%(5/58)oflesionsbiopsiedwithaspring-loadeddeviceLCB– 0%(0/70)oflesionsbiopsiedwithadirecKonalvacuum-assisteddeviceVABB– 8%(5/60)oflesionssampledwithlessthan12specimens– 0%(0/68)sampledwith12ormorespecimens
• Lesiontype,maximallesiondiameter,andtypeofimagingguidance(stereotac2corsonographic)werenotsignificantfactorsindeterminingthepresenceofmalignancy
• CONCLUSION:Diagnosisofradialscarbasedoncoreneedlebiopsyislikelytobereliablewhen
– noassociatedatypicalhyperplasia– biopsyincludesatleast12specimens(VABB)– mammographicfindingsarereconciledwithhistologicfindings.– Ifmissacriteria,excisionalbiopsyisindicated
![Page 38: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/38.jpg)
Projektpartner
1. Fraunhofer-Institut für Integrierte Schaltungen IIS, Erlangen,
Kohr et al. Radiology 255: 723 - 730 (2010) N = 991; N = 147 cases of atypia The upgrade rate is significantly higher when ADH involves at least three foci. Surgical excision is recommended even when ADH involves fewer than three foci and all mammographic calcifications have been removed, because the upgrade rate is 12%.
Minimal Invasive Interventions
Wagoner et al. Am J Clin Pathol 131: 112 - 121 (2009) N = 123; Patients with ADH restricted to fewer than 3 foci may not need surgical excision, especially when the mammographic abnormality is completely removed by VAB.
![Page 39: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/39.jpg)
Lobularcarcinomainsitu/atypicallobularhyperplasiaonbreastneedlebiopsies:doesitwarrantsurgicalexcisionalbiopsy?Astudyof27casesO’NeilM,MadanR,TawfikOW,ThomasPA,FanF.AnnDiagnPathol2010;14(4):251–255
• 3163breastcoreneedlebiopsieswereretrievedfromthesurgicalpathologyfilesbetween2003and2009
• amongthem,56(1.8%)caseswereiden2fiedwithadiagnosisofALHorLCIS• Elevencaseswereexcludedbecauseofthepresenceofaconcurrentmore
severelesioninthebiopsiesthatmandatedexcision• Theremaining45casescontainedonlyALHorLCIS
– 27hadsurgicalexcisionfollow-up
– Inthesurgicalexcisionspecimens,5(19%)of27(11%of45)casesshowedmoreseverelesionsorwere"upgraded»
• 3invasiveductalcarcinomas• 1invasivelobularcarcinoma• 1ductalcarcinomainsitu• Histologicfeaturesofthelobularneoplasiaonthecorewerefoundtohaveno
predicKvevalueforamoreseverelesioninthesubsequentexcision
• Wesuggestthatpa2entswithLCIS/ALHoncoreneedlebiopsyshouldbeconsideredforsurgicalexcisiontoruleoutamoresignificantlesionregardlessofthehistologicfeatures.
![Page 40: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/40.jpg)
AtypicalLobularHyperplasiaandLobularCarcinomainSituatCoreBreastBiopsy:UseofCarefulRadiologic-PathologicCorrelaKontoRecommendExcisionorObservaKonKristenA.Atkins,MichaelA.Cohen,BrandiNicholson,SandraRao.NorthwesternMemorialHospital,PrenKceWomen’sHospital,Chicago.Radiology,2013,Vol.269:340-347,10.1148/radiol.13121730
Flow diagram of total number of cases partitioned into radiologic and histologic concordance or discordance. IC = invasive carcinoma.
![Page 41: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/41.jpg)
• AdvanceinKnowledge– Whencarefulradiologic-pathologiccorrelaKonisconductedinthese�ngofa
breastcorebiopsywithatypicallobularhyperplasiaorlobularcarcinomainsitusomewomencanbesafelytriagedtoobservaKon
• ofthe43benignconcordantcases,nonewereupgradedatsurgeryorextendedfollow-up
• ImplicaKonforPaKentCare– Focusedandcompleteradiologic-pathologiccorrelaKonmayobviate
excisionalbiopsyinpaKentswithbenignconcordantbiopsyfindings– AddiKonalvalidaKonofthisisrequiredbeforethisapproachcanbe
universallyapplied
AtypicalLobularHyperplasiaandLobularCarcinomainSituatCoreBreastBiopsy:UseofCarefulRadiologic-PathologicCorrelaKontoRecommendExcisionorObservaKonKristenA.Atkins,MichaelA.Cohen,BrandiNicholson,SandraRao.NorthwesternMemorialHospital,PrenKceWomen’sHospital,Chicago.Radiology,2013,Vol.269:340-347,10.1148/radiol.13121730
![Page 42: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/42.jpg)
Discussion
toexciseortosample?
� Excisionforprobablybenignlesion+clip
• Birads3• Birads4a
� Sampleforsuspiciousormalignantlesion
• Birads4b&c• Birads5&6
![Page 43: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/43.jpg)
ToExciseorToSampletheMammographicTarget:WhatIstheGoalofStereotac2cII-GaugeVacuum-AssistedBreastBiopsy?LauraLiberman,JenniferB.Kaplan,ElizabethA.Morris,AndreaF.Abramson,JenniferH.MenellandD.DavidDershawAJR2002;179:679-683
Completeexcisionratherthansamplingofmammographictargetwasassociatedwith:• lowerfrequenciesofdiscordanceandductalcarcinomain
situunderesKmaKon• nootheradvantageordisadvantage• Amongcancersinwhichthemammographictargetwas
excised,surgeryrevealedresidualcancerinalmost80%.
![Page 44: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/44.jpg)
PréanalyKquesurlesbiopsiesetprélèvementsRéalisaKonetcondiKonnementdelabiopsieenpréanalyKque
3.Leradiologuedispose-ild’argumentspréperetpostbiopsiquesluiperme4antdeconcluresurlecaractèrecontribu2fetconcordantdesesprélèvements?
![Page 45: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/45.jpg)
BiospsiecontribuKveetconcordante
• Avant• ConsultaKonBalisKqueetdefaisabilité• ExplicaKonsetconsentementéclairé
• Pendant• Technique• ÉchanKllonage• FixaKonetCRpouranapath
• Après• ConsultaKonJ8-J15+/-imagerie• Concordanceradio-anatomopathologique• CourrierprescripteurincluantCAT• RCP
![Page 46: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/46.jpg)
BreastIntervenKon:HowIDoItMaryC.Mahoney,MaryS.Newell,CincinnaK,AltlantaRadiology,2013,Vol.268:12-24,10.1148/radiol.13120985
• Wri4eninformedconsentisrequiredbeforeallbreastinterven2ons
• Therisksexplainedtothepa2entincludebleedingandinfec2on• An2coagula2onisarela2vecontraindica2ontoallbiopsies
– paKentsareusuallyaskedtodisconKnuetherapyforashortKmepriortothebiopsy
• Thepa2entshouldbeinformedofthepoten2albenefitsofthebiopsy– includingavoidanceofsurgerywithbenignresults– preoperaKveconfirmaKonofmalignancy,whichallowsdefiniKvesurgical
treatmentinonesurgicalse�ng
• Tailoredprebiopsycounselingmaybe4erpreparewomenforpercutaneousbreastbiopsyandimprovetheiroverallexperience.
![Page 47: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/47.jpg)
• youngerwomenaremoreadverselyaffectedbythebiopsyexperience.
• ImplicaKonforPaKentCare• Tailoredprebiopsycounselingmaybeverpreparewomen
forpercutaneousbreastbiopsyandimprovetheiroverallexperience.
PercutaneousBreastBiopsy:EffectonShort-termQualityofLifeKathrynL.Humphrey;JanieM.Lee;KarenDonelan;ChungY.Kong;OlubunmiWilliams;OmosalewaItauma;ElkanF.Halpern;BeverlyJ.Gerade;ElizabethA.Rafferty;J.ShannonSwan;MITMGH,Boston,Radiology2013,10.1148/radiol.13130865
![Page 48: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/48.jpg)
03/01/16
• Side • Size
• h x L x l
• Location • Quadrant • Radius zone • Distance to the
nipple
BalisKctargettracking• US• RX• MRI
![Page 49: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/49.jpg)
03/01/16
• Side• Size
• hxLxl• LocaKon
• Quadrant• Radiuszone• Distancetothenipple
• Deep / cutaneous plane
USbalisKctargettracking
![Page 50: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/50.jpg)
03/01/16
Mme A. 40 ans. Atcd KS qsiD 1997. Atcd familiaux. Surv /6 mois M+US/IRM nles en 2010
05/2011 SD
CNB 14g : CCI g2
![Page 51: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/51.jpg)
03/01/16
![Page 52: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/52.jpg)
03/01/16
![Page 53: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/53.jpg)
BreastUSdiagnosKc&balisKc
![Page 54: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/54.jpg)
USBiopsy&WireMarking
Surgery:IDCgrade1,RH+,Her2-
Largecore16gBiopsy Wiremarker
LCB:DCISHighgrade
![Page 55: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/55.jpg)
Biopsy&pathology
• RepresentaKvesamples• Rxofsamplesifμcal
• Formol>12h<24h:KmeoffixaKon+++• Histology,RH,Her2• clinicalfindings,report
![Page 56: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/56.jpg)
SpecimensXRays
![Page 57: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/57.jpg)
InteracKveCaseReviewofRadiologicandPathologicFindingsfromBreastBiopsy:AreTheyConcordant?HowDoIManagetheResults?ChristopherP.Ho,MD,JenniferE.Gillis,MD,KristenA.Atkins,MD,JenniferA.Harvey,MD,and,BrandiT.Nicholson,MDUniversityofVirginiaHeathSystem,Chalovesville,Va.Radiographics,Volume33-4,2013
• Tosuccessfullyperformaminimallyinvasivebreastbiopsy• itisimportanttonotonlybefamiliarwiththetechnique• butalsowithhowtodetermineradiologic-pathologicconcordance• andtheappropriatetreatmentsforpaKentsaiertheprocedure
• Whenreviewingpathologicresultsforconcordance• itisimportanttoensurethatmicrocalcificaKonsareidenKfiedinthe
histologicspecimen• andthespecificpathologicdiagnosisisconsistent
• withthemorphologiccharacterisKcsseenatmammography• andthepretestprobabilityofmalignancy.
![Page 58: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/58.jpg)
• Atthefollow-upexamina2on• boththehistologicandimagingfindingsshouldberevisited• andthemassshouldbeassessedatmammographyorUStoensurethat
itisstable
• Ifithasgrowninsizeoritsmorphologiccharacteris2cshavechanged
• Ifcalcifica2onsincreaseinnumberorextentorthemasschanges
• Increasesinsizeoritsfeaturesbecomemoresuspicious• appropriateacKonshouldbetaken• Excisionistypicallyrecommended
• Ifthelesionisstableatfollow-upexamina2on• thepaKentmayreturntothegeneralscreeningpopulaKon
InteracKveCaseReviewofRadiologicandPathologicFindingsfromBreastBiopsy:AreTheyConcordant?HowDoIManagetheResults?ChristopherP.Ho,MD,JenniferE.Gillis,MD,KristenA.Atkins,MD,JenniferA.Harvey,MD,and,BrandiT.Nicholson,MDUniversityofVirginiaHeathSystem,Chalovesville,Va.Radiographics,Volume33-4,2013
![Page 59: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/59.jpg)
Imaging-HistologicDiscordanceAierSonographicallyGuidedPercutaneousBreastBiopsy:AProspecKveObservaKonalStudyEunJuSon,Eun-KyungKim,JiHyunYouk,MinJungKim,JinYoungKwak,SeonHyeongChoi,August22,2011
• FromJanuary2005toDecember2006,• US-guided14-gaugeautomatedCNBon3339breastlesionsandobtained
benignresultsin2194cases.• 1588lesionsthatwereeitherexcised(n=658)orfollowedupforatleast2
years(n=930)aierCNB.• Imaging-histologicdiscordancewaspresentin103of1588(6.5%)lesions.• Theupgraderatewas
– 6.8%(7/103)indiscordantlesions– 0.4%(6/1485)inconcordantlesions(p<0.01)
• Lesionsize,BreastImaging,ReporKngandDataSystem(BI-RADS)categoryandthepresenceorabsenceofsymptomswasstaKsKcallysignificantbetweentheupgradeandnon-upgradegroupsindiscordantcases(p<.05).
• Imaging-histologicdiscordanceisanindica2onforexcisionbecauseithasahigherupgraderatethanconcordantlesions.
![Page 60: Nice saint paul. biopsies mammaires, L.Rotenberg 2015](https://reader034.vdocuments.site/reader034/viewer/2022052705/588043161a28abfd0a8b67d3/html5/thumbnails/60.jpg)
• Noimagingspecificityforbreastlesion• BiopsyhistologycorrelaKonforallBirads4and5lesions• LCNB:16or14G≥4samples• Under-esKmaKonrateforpremalignantlesion
• ≈10%VABB• ≈20%LCNB• PMLreferedforsurgicalexcision
• VABBunderstereotacKcguidance• 11G≥10samples• 7G≥6samples
• VABBunderUSorMRIguidance• Noguidelines:targetexcisionorsampling
• Concordance• BalisKcconsultaKon• Samplingquality:guidance/biopsydevice/samples• Birads/histologicalcorrelaKon• FollowuporsurgicalexcisionindicaKon:RCP
Takehomemessage