Madhavi Raghu MD, Presenter: Nothing to Disclose

Jaime Lynn Geisel MD, Abstract Co-Author: Nothing to Disclose

Fattaneh Tavasolli, Abstract Co-Author: Nothing to Disclose

Liane Elizabeth Philpotts MD, Abstract Co-Author: Nothing to Disclose

To assess the frequency of re-biopsy after 8-gauge vacuum-assisted stereotactic core needle biopsy (SCNB) and the outcome of those cases.

A retrospective review of the breast imaging department database was conducted to identify all 8-gauge vacuum-assisted SCNB performed at our institution between January 2007 and January 2009. Cases for which re-biopsy was recommended were identified and the reasons for rebiopsy assessed. The pathology obtained at SCNB was compared with the pathology obtained at surgical excision. Those cases upgraded to cancer were identified.

Of 358 patients who underwent 8-gauge vacuum-assisted SCNB, re-biopsy was recommended in 71 patients (20%). The reasons for re-biopsy were: atypical ductal hyperplasia (ADH) (70%), papillary lesions (10%), lobular intraepithelial neoplasia (8%), radial scar (6%), and discordance (4%). All 71 patients underwent surgical excision. Only one upgrade to carcinoma was found (1.4%). This upgrade occurred in a patient with a remote history of breast cancer and new calcifications at the lumpectomy site diagnosed as ADH on stereotactic biopsy. Subsequent excision revealed invasive and intraductal carcinoma.

Re-biopsy after 8-gauge vacuum-assisted SCNB is associated with a very low upgrade rate. Malignancy was found in only one case of ADH at SCNB. Given the relatively high rate of rebiopsy recommendations (20%) yet low upgrades (1.4%) it may be reasonable to reduce the number of surgical excisions recommended. While decisions should be individualized, many patients may be able to be appropriately managed with close mammographic surveillance instead.

Given the low rate of upgrades to cancer (1.4%) following 8-gauge SCNB, it may be reasonable to manage some patients with close mammographic surveillance instead of surgical excision.

Raghu, M, Geisel, J, Tavasolli, F, Philpotts, L, Rebiopsy Following 8-Gauge Vacuum-assisted Stereotactic Core Needle Biopsy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009059.html