Incidence, Causes, and Implications of Unsuccessful Calciication Retrieval at Stereotactic Breast Biopsy - 5 Years' Experience

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KMK Kwok, CY Lui, PYE Fung, LK Chan, HS Lam

Hong Kong J Radiol 2009;11:154-60

Objective: To determine the incidence, causes, and implications of calcification retrieval failure at stereotactic breast biopsy.

Methods: Retrospective review of the medical charts of 710 patients who underwent percutaneous stereotactic biopsy of calcifications at the Kwong Wah Hospital, Hong Kong, between January 2001 and December 2005 was performed. The outcomes for patients for whom calcification retrieval was unsuccessful were evaluated by repeat biopsy or mammographic follow-up for more than 1 year.

Results: Fifty five lesions (7.5%) were negative on the specimen radiographs. The causes of retrieval failure were significant bleeding (80.0%), perception factors (65.4%), targeting factors (40.0%), unfavourable calcification location (20.0%), patient movement (20.0%), use of short-throw needle for patients with thin breasts (8.4%), and technical factors (5.4%). The histology results for negative radiographs were as follows: malignancy (n = 4), high risk (n = 2), benign (n = 44), and inconclusive (n = 5). The 2 high-risk lesions on percutaneous biopsy were upgraded to malignant lesions on subsequent excision biopsy.

Conclusions: The failure rate of calcification retrieval for percutaneous stereotactic breast biopsy was 7.5%. The most common causes of unsuccessful biopsy were significant bleeding during biopsy and perception difficulties. Technical factors were the least common cause of failure, but could be avoided by meticulous technique and proper training. Mammographic follow-up and repeat biopsy are recommended for patients for whom calcification retrieval failed, particularly those with high-risk or inconclusive pathological results.