A core biopsy estereotÃxica no diagnÃstico das lesÃes mamÃrias impalpÃveis altamente suspeitas de malignidade (categoria mamogrÃfica BIRADS Â 5): um estudo de correlaÃÃo radiologia/anatomia patolÃgica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Clinical indications for core biopsies are essentially the same as for excisional biopsies; however, there is no consensus in the literature as to the value of core needle biopsies in the work up of lesions of the radiologic BI-RADSÂ 5 category (ACR/Breast Imaging Reporting and Data System). Objective: To determine the association between mammography findings and histopathologic diagnosis of samples obtained by stereotactic core biopsy of nonpalpable breast lesions classified as BI-RADSÂ 5 mamographic category, and to determine the positive predictive value of mammography in lesions highly suggestive of malignancy. Materials and methods: According to a retrospective, transversal, analytical study with comparison of diagnostic methods, 70 stereotactic core biopsies of nonpalpable breast lesions radiologically classified as highly suggestive of malignancy (BI-RADSÂ 5) of 70 patients attempted at private services of Pathologic Anatomy and Radiology at Recife city â Pernambuco, Brazil, from 2001 and 2006, were analyzed. Results: Sixty-eight (97.1%) patients were female and 2 (2.9%) were male. The age varied from 17 to 87 years with a mean of 58 Â 15. The left breast was involved in 42 (60%) cases, and the right breast in 28 (40%). The lesions were predominantly located in the upper outer quadrant (44 cases; 62.9%) and consisted on irregular spiculated nodules (49 cases; 70%), 11 (15.7%) of them were also associated with microcalcifications. Microcalcifications were present in 31 (44.3%) cases and 16 (22.9%) of them were not associated to nodules, architectural distortion or asymmetry of density. The number of core fragments per patient varied from 3 to 16 (mean: 6Â2). There was no significant difference on frequency distribution of number of fragments according to histopathologic (p>0.05) or radiologic (p=0.63) results. The diagnoses were: 59 (84.3%) cases of carcinoma, 7 (10%) cases of benign histology and 4 (5.7%) cases considered "borderline". Invasive carcinoma was the most frequent (49 cases; 70%), 15 (21.4%) of which also had an associated in situ component. Carcinoma in situ was the sole finding in 10 (14.3%) cases. Invasive carcinoma was identified in 41 (58.6%) cases having irregular spiculated nodules and this association was statistically significant (p= 0.005). The most common histologic subtype was invasive ductal carcinoma (34 cases; 69.4%). Among the invasive carcinomas, 36 (73,5%) were histologic grade 2, with a score sum of 6 (34 cases; 69,4%). Pure comedo DCIS was more frequently associated with the radiologic finding of microcalcifications. The positive predictive value of mammography in lesions classified as BI-RADSÂ 5 was 84.3%. Irregular spiculated nodules associated with microcalcifications had the highest positive predictive value (100%), followed by irregular spiculated nodules with or without calcifications (87,8%), irregular spiculated nodules without microcalcifications (84,2%) and microcalcifications without nodules (75%). Conclusions: Mammography of breast lesions classified as highly suggestive of malignancy (BI-RADSÂ 5) had a high positive predictive value, with most of these lesions corresponding to invasive carcinoma. Irregular spiculated nodules, particularly when associated with microcalcifications, were highly associated with a diagnosis of carcinoma

ASSUNTO(S)

anatomia patologica e patologia clinica breast cancer core biopsy bi-rads 5 cÃncer de mama bi-rads 5 core biopsy

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