Hastanemizde Nonpalpabl Meme Lezyonlu Bir Hasta Serisinde Stereotaktik Biyopsi Sonuçları

Amaç: Tarama mamografisi nonpalpabl meme kanserinin klinik tespitinde yüksek sensitivite göstermekle birlikte, mamografide saptanan ve biyopsi önerilen şüpheli lezyonların çoğunun benign olduğu görülmek- tedir. Tel lokalizasyonu ile biyopsi yapılan bu lezyonlarda malignite oranı %10–36 aralığında değişmekte- dir. Bu çalışmada mamografi ve ultrasonografi eşliğinde tel lokalizasyonu sonrasında eksizyonel biyopsi yapılan lezyonların patolojik sonuçlarının ve Meme Görüntüleme Raporlama ve Veri Sistemi (the Breast Imaging Reporting and Data System—BI-RADS) skorlarının literatür ile karşılaştırılması ve her kategori için pozitif öngörü değerinin hesaplanması amaçlanmıştır. Gereç ve Yöntemler: Elektronik ortamda hasta dosyaları incelenerek ve Hastalıkların ve İlgili Sağlık So- runlarının Uluslararası İstatistiksel Sınıflaması (ICD-10) kodları kullanılarak, Ocak 2003—Mart 2009 döne- minde Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde stereotaktik işaretleme sonrasında eksizyonel biyopsi yapılan hastalar belirlendi. Toplamda (postoperatif histopatolojik inceleme sonucuna göre 43’ü benign, 21’i malign lezyonlu) 64 hasta çalışmaya dahil edildi. Hastaların demografik özelliklerine, işaretleme nedenlerine ve histopatolojik tanılara dair veriler kaydedildi. Mamografi ve meme ultrasonografi raporları incelenerek hastaların BI-RADS skorları belirlendi. BI-RADS sınıflaması ve histopa- tolojik inceleme sonuçları yüzde (%) üzerinden karşılaştırıldı. Bulgular: Ortalama hasta yaşı 48,9 (32–76) yıldı. Mamografi raporlarına göre, stereotaktik işaretleme ve eksizyonel biyopsi için en sık neden mikrokalsifikasyon kümesi ve spiküler kitle idi. Histopatolojik inceleme sonuçlarına göre, BI-RADS skoru mamografide BI-RADS 3, BI-RADS 4 ve BI-RADS 5 olarak tespit edilen hastaların sırasıyla %8’inde, %51,8’inde ve %100’ünde malignite saptandı. Tartışma ve Sonuç: Mamografi ve ultrasonografide saptanan lezyonların BI-RADS temelinde sınıflandırıl- ması malignitenin öngörülmesine yardımcı olabilir. BI-RADS 4 ve BI-RADS 5 lezyonlarda ilk planda biyopsi yapılırken, BI-RADS 3 lezyonlarda biyopsiye alternatif olarak kısa dönem takip yapılması gereksiz biyop- sileri azaltabilir.

Stereotactic Biopsy Results of a Series of Patients with Nonpalpable Breast Lesions in Our Hospital

Aim: Although screening mammography has a high sensitivity in the clinical detection of nonpalpable breast cancer, most mammographically suspicious lesions referred to biopsy are seen to be benign. The rate of ma- lignancy in such lesions that are biopsied with needle–wire localization ranges from 10 to 36%. In this study, we aimed to compare with the literature the pathological results and Breast Imaging Reporting and Data System (BI-RADS) scores of lesions subjected to mammography and excisional biopsy after ultrasonogra- phy-guided needle–wire localization and calculate a positive predictive value for each category. Materials and Methods: By electronically reviewing patient files and using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified patients who un- derwent excisional biopsy after stereotactic marking at the General Surgery Clinic of the Istanbul Sisli Hamidiye Etfal Training and Research Hospital between January 2003 and March 2009. A total of 64 patients were included in the study, of whom 43 had benign and 21 had malignant lesions on postopera- tive histopathological examination. Data on patient demographic characteristics, indications for marking, and histopathological diagnoses were recorded. The patient BI-RADS scores were determined based on the mammography and breast ultrasonography reports. The BI-RADS classification and histopathological examination results were compared in percentages. Results: The mean patient age was 48.9 (32–76) years. Based on the mammography reports, the most common indications for stereotactic marking and excisional biopsy were microcalcification cluster and spiculated mass. Histopathological examination results revealed malignancy in 8%, 51%, and 100% of the patients whose BI-RADS scores were mammographically determined to be BI-RADS 3, BI-RADS 4, and BI-RADS 5, respectively. Discussion and Conclusion: The BI-RADS-based classification of lesions detected by mammography and ultrasonography can help in predicting malignancy. While BI-RADS 4 and BI-RADS 5 lesions are referred to biopsy primarily, short-term follow-up of BI-RADS 3 lesions as an alternative to biopsy could reduce unnecessary biopsies.

PDF

___

1. Lacey Jr JV, Devesa SS, Brinton LA. Recent trends in breast cancer incidence and mortality. Environ Mol Mu- tagen. 2002;39(2–3):82–8.
2. Hortobagyi GN, de la Garza Salazar J, Pritchard K, Ama- dori D, Haidinger R, Hudis CA, et al. The global breast cancer burden: variations in epidemiology and survival. Clin Breast Can. 2005;6(5):391–401.
3. Kopans DB. The positive predictive value of mammogra- phy. AJR Am J Roentgenol. 1992;158(3):521–6.
4. Özel BD, Özel D, Özkan F, Halefoglu AM, Özer Ö, Basak M. BIRADS ultrasonografi solid meme lezyonlarında bi- opsi öncesi yeterli fikir verebilir mi? Şişli Etfal Hastanesi Tıp Bülteni. 2015;49(4):284–8.
5. Bilgen IG, Memiş A, Üstün EE. İşaretleme biyopsisi ile değerlendirilen 550 nonpalpabl meme lezyonunun retrospektif analizi. Tanısal ve Girişimsel Radyoloji. 2002;8:487–95.
6. Yetkin G, Uludağ M, Çitgez B, Kartal A. Nonpalpable meme lezyonlarında stereotaktik eksizyonel biopsinin yeri. Şişli Etfal Hastanesi Tıp Bülteni. 2009;43(3):123–5.
7. Obenauer S, Hermann K, Grabbe E. Applications and literature review of the BI-RADS classification. Eur Ra- diol. 2005;15(5):1027–36.
8. Tate P, Rogers E, McGee E, Page GV, Hopkins SF, Shearer RG, et al. Stereotactic breast biopsy: a six-year surgical experience. J Ky Med Assoc. 2001;99(3):98–103.
9. Al-Khowaiter SS, Brahmania M, Kim E, Madden M, Harris A, Yoshida EM, et al. Clinical and endoscopic sig- nificance of bowel–wall thickening reported on abdomi- nal computed tomographies in symptomatic patients with no history of gastrointestinal disease. Can Assoc Radiol J. 2014;65(1):67–70. 10. Fornage BD. Percutaneous biopsies of the breast: state of the art. Cardiovasc Intervent Radiol. 1991;14(1):29–39.
11. Vizcaíno I, Gadea L, Andreo L, Salas D, Ruiz-Perales F, Cuevas D, et al. Short-term follow-up results in 795 non- palpable probably benign lesions detected at screening mammography. Radiology. 2001;219(2):475–83.
12. Siegmann K, Wersebe A, Fischmann A, Fersis N, Vo- gel U, Claussen CD, et al. Stereotactic vacuum-assisted breast biopsy--success, histologic accuracy, patient ac- ceptance and optimizing the BI-RADSTM-correlated indication. RoFo. 2003;175(1):99–104.
13. Mendez A, Cabanillas F, Echenique M, Malekshamran K, Perez I, Ramos E. Mammographic features and cor- relation with biopsy findings using 11-gauge stereotactic vacuum-assisted breast biopsy (SVABB). Ann Oncol. 2004;15(3):450–4.
14. Hasselgren O, Hummel R, Fieler M. Breast biopsy with needle localization: influence of age and mammographic feature on the rate of malignancy in 350 nonpalpable breast lesions. Surgery. 1991;110(4):623–8.
15. Hall FM, Storella JM, Silverstone DZ, Wyshak G. Non- palpable breast lesions: recommendations for biopsy based on suspicion of carcinoma at mammography. Ra- diology. 1988;167(2):353–8.
16. Balleyguier C, Ayadi S, Van Nguyen K, Vanel D, Drom- ain C, Sigal R. BIRADS™ classification in mammography. Eur J Radiol. 2007;61(2):192–4.
17. Samardar P, de Paredes ES, Grimes MM, Wilson JD. Fo- cal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics. 2002;22(1):19–33.
18. Travade A, Isnard A, Bagard C, Bouchet F, Chouzet S, Gaillot A, et al. Stereotactic 11-gauge directional vacu- um-assisted breast biopsy: experience with 249 patients. J Radiol. 2002;83(9):1063–71.
19. Linebarger JH, Landercasper J, Ellis RL, Gundrum JD, Marcou KA, De Maiffe BM, et al. Core needle biopsy rate for new cancer diagnosis in an interdisciplinary breast center: evaluation of quality of care 2007–2008. Ann Surg. 2012;255(1):38–43.
20. Yasmeen S, Romano PS, Pettinger M, Chlebowski RT, Robbins JA, Lane DS, et al. Frequency and predictive value of a mammographic recommendation for short- interval follow-up. J Natl Cancer Inst. 2003;95(6):429– 36.
21. Hatzung G, Grunwald S, Zygmunt M, Geaid AA, Beh- rndt PO, Isermann R, et al. Sonoelastography in the di- agnosis of malignant and benign breast lesions: initial clinical experiences. Ultraschall Med. 2010;31(06):596– 603.
22. Rotter K, Haentschel G, Koethe D, Goetz L, Born- hofen-Pöschkea A, Lebrecht A, et al. Evaluation of mammographic and clinical follow-up after 755 ste- reotactic vacuum-assisted breast biopsies. Am J Surg. 2003;186(2):134–42.
23. Agacayak F, Ozturk A, Bozdogan A, Selamoglu D, Alco G, Ordu C, et al. Stereotactic vacuum-assisted core bi- opsy results for non-palpable breast lesions. Asian Pac J Cancer Prev. 2014;15:5171–4.
24. Rageth CJ, O’Flynn EA, Comstock C, Kurtz C, Ku- bik R, Madjar H, et al. First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2016;159(2):203–13.
25. Ashkenazi I, Ferrer K, Sekosan M, Marcus E, Bork J, Aiti T, et al. Papillary lesions of the breast discovered on per- cutaneous large core and vacuum-assisted biopsies: reli- ability of clinical and pathological parameters in identi- fying benign lesions. Am J Surg. 2007;194(2):183–8.
26. Medjhoul A, Canale S, Mathieu MC, Uzan C, Garbay JR, Dromain C, et al. Breast lesion excision sample (BLES bi- opsy) combining stereotactic biopsy and radiofrequen- cy: is it a safe and accurate procedure in case of BIRADS 4 and 5 breast lesions? Breast J. 2013;19(6):590–4.