Alison Elizabeth Corr MBBCh, BSC, Presenter: Nothing to Disclose

Deirdre Mary Duke MD, Abstract Co-Author: Nothing to Disclose

Jennifer Kerr MBBCh, Abstract Co-Author: Nothing to Disclose

Jane Denise Cunningham MBBCh, MRCPI, Abstract Co-Author: Nothing to Disclose

Karen Lyons MBBCh, MRCPI, Abstract Co-Author: Nothing to Disclose

To evaluate the need for percutaneous core needle biopsy in women <30yrs with symptomatic breast lesions. 

According to our current protocols all solid palpable breast masses are biopsied under image-guidance irrespective of patient age. We retrospectively reviewed  all image-guided percutaneous core needle breast biopsies performed over a four year period (Sept. 2006 to Sept. 2010) in a symptomatic breast service. 2097 patients (F:M 2087:10) underwent image guided biopsy in this time period. 417 of these patients (all female) were <30 yrs of age. 391/417 (94%) were categorised according to pre-procedural ultrasound imaging (mammography is not routinely used in this age-group) as BI-RADS category 3 or 4a, 26/417 (6%) were categorised as BI-RADS 4b and above. All pre-procedural imaging and subsequent biopsies were performed by experienced, dedicated breast radiologists.Imaging and pathological findings as well as decisions from multi-disciplinary meetings were examined.  

All biopsies were performed under ultrasound-guidance, with 14G tru-cut core biopsy needle. No significant post-biopsy complications were experienced. The costs, excluding medical man hours for an ultrasound guided breast biopsy in our institution is €58 with a further €140 for pathological processing of the specimen.The pathological results of the biopsies performed on the 391 patients scored as BI-RADS 3 or 4a, <30yrs of age, included fibroadenoma 317/391 (81%), other benign findings 71/391(18.3%), invasive carcinoma 0/391(0%), DCIS 0/391(0%). In 3/391(0.7%) the pathological findings suggested likely fibroadenoma but could not exclude phyllodes. All 3 underwent surgical excision where the final pathology demonstrated fibroadenoma only. In total 63/391(17%) underwent surgical excision post biopsy, either as a result of patient or surgical preference, with all lesions benign on excision. The negative predictive value of ultrasound assessment and BI-RADS categorisation of symptomatic breast lesions in a population under 30yrs of age was 100%.

In experienced hands US combined with correct application of the BI-RADS scoring of palpable breast lesions safely predicts those women <30yrs who do not require image-guided percutaneous breast biopsy with significant financial savings.

US imaging of symptomatic solid breast lesions in women under 30yrs of age safely predicts benign findings, subsequent percutaneous biopsy is not required.

Corr, A, Duke, D, Kerr, J, Cunningham, J, Lyons, K, Is image-guided Biopsy Always Necessary in Women under 30 Years with Solid, Palpable Breast Masses?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012050.html