Core biopsy guiada por ultra-som de lesões suspeitas (BI-RADS® 4 E 5) de mama: quantos fragmentos são necessários?

Abstract

Core biopsy (CB) is widely attested to provide high accuracy for the detection of breast cancer in breast lesions. However, the number of specimens that are required to achieve this in Breast Imaging-Reporting and Data System (BIRADS®) 4 and 5 lesions is yet to be determined. Objective: To evaluate the number of specimens required to diagnose malignancy when using ultrasound (US)-guided CB for BI-RADS® 4 (B4) and 5 (B5) suspected breast cancer lesions. Methods: We selected 59 consecutive patients who were referred to the Mastology Service of the University Hospital of the Federal University of Juiz de Fora for US-guided CB. These patients had 66 breast lesions that measured 1 cm or larger and were classified as B4 or B5. A single operator performed the biopsies, using an ultrasound device with a 10-MHz linear probe, 1 automatic biopsy gun model, 14-gauge needles and 12- or 22-mm excursion. A total of 5 cores were taken from each lesion. The fragment obtained from each biopsy was placed in a separate vial, identified according to the order in which it was taken, and submitted to histopathologic analysis. All the fragments obtained from the biopsies were included in this study, even those that provided small amounts of tissue or resulted from biopsies that had missed the lesion. The CB specimen’s anatomopathological findings were classified as benign or malignant. The CB specimens classified as malignant had a corresponding diagnosis of in situ or invasive carcinoma. The remaining CB specimens were classified as benign. The CB specimens’ anatomopathological findings were compared to those obtained from surgically resected and paraffinised specimens or the lesion’s stability during follow-up consultations. Results: The average patient age was 52.6 (± 13.9) years. Malignancy was diagnosed in 59.4% of the CB specimens, and 40.6% were classified as benign. Regarding the BI-RADS® classifications of the lesions, 43 (67.2%) lesions were classified as B4 and 21 (32.8%) were classified as B5. The average duration of follow-up for the 8 patients who did not undergo surgical resection was 19.13 months. There was 100% agreement between the anatomopathological findings from the first fragment and the anatomopathological findings from the surgical biopsy or the follow-up of the benign lesions. Conclusion: A biopsy of 1 fragment was sufficient for the correct diagnosis of malignant and or benign status in USguided CBs of lesions that were classified as B4 or B5 and measured 1 cm or larger.