Tomosynthesis-guided Vacuum-assisted Breast Biopsy of Sonographically Occult Non-calcified Breast Lesions Detected on Tomosynthesis

Abstract

Objectives: To analyse the pathological results from tomosynthesis-guided vacuum-assisted breast biopsy (VAB) of tomosynthesis-detected sonographically occult non-calcified breast lesions. Methods: We performed a retrospective review of patients who had undergone tomosynthesis-guided VAB from December 2017 to May 2019. Imaging findings and pathological outcome were evaluated. The technical success rate and complications of tomosynthesis-guided VAB were reviewed. Results: In our centre, all sonographically occult non-calcified lesions detected on digital breast tomosynthesis (DBT) with grade ≥4a or above according to Breast Imaging Reporting and Data System (BI-RADS) are selected for VAB under tomosynthesis guidance. Among the 41 cases reviewed, sampling was successful in 40 (97.6%). Among the 40 cases with pathologies, three malignancies, 14 high-risk lesions and 23 benign lesions were identified. All three malignancies in our study presented as architectural distortion, which was the main feature of the majority of DBTdetected sonographically occult non-calcified breast lesions (n = 38, 95%); the remaining two had focal asymmetry (n = 2, 5%). The positive predictive value for malignancy of architectural distortion detected on DBT only was 7.9%. All reported complications were clinically insignificant haematomas (n = 7, 17.5%). Conclusion: Tomosynthesis-guided VAB is a safe and effective method for evaluation of sonographically occult lesions detected on DBT. The feature associated with the majority of these lesions was architectural distortion.