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Failure of stereotactic core needle biopsy in women recalled for suspicious calcifications at screening mammography: frequency, causes, and final outcome in a multi-institutional, observational follow-up study

  • Breast
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Abstract

Objectives

We determined the failure rate of stereotactic core needle biopsy (SCNB) and its causes and final outcome in women recalled for calcifications at screening mammography.

Methods

We included a consecutive series of 624,039 screens obtained in a Dutch screening region between January 2009 and July 2019. Radiology reports and pathology results were obtained of all recalled women during 2-year follow-up.

Results

A total of 3495 women (19.6% of 17,809 recalls) were recalled for suspicious calcifications. SCNB was indicated in 2818 women, of whom 12 had incomplete follow-up and another 12 women refused biopsy. DCIS or invasive cancer was diagnosed in 880 of the remaining 2794 women (31.5%). SCNB failed in 62 women (2.2%, 36/2794). These failures were mainly due to a too posterior (n = 30) or too superficial location (n = 17) of the calcifications or calcifications too faint for biopsy (n = 13). Of these 62 women, 10 underwent surgical biopsy, yielding one DCIS (intermediate grade) and two invasive cancers (one intermediate grade and one high grade) and another two women were diagnosed with DCIS (both high grade) at follow-up. Thus, the malignancy rate after SCNB failure was 8.1% (5/62). Calcifications were depicted neither at SCNB specimen radiography nor at pathology in 16 women after (repeated) SCNB (0.6%, 31/2732). None of them proved to have breast cancer at 2-year follow-up.

Conclusions

The failure rate of SCNB for suspicious calcifications is low but close surveillance is warranted, as breast cancer may be present in up to 8% of these women.

Key Points

• The failure rate of stereotactic core needle biopsy (SCNB) for calcifications recalled at screening mammography was 2.2%.

• Failures were mainly due to calcifications that could not be reached by SCNB or calcifications too faint for biopsy.

• The management after failed SCNB was various. At least, close surveillance with a low threshold for surgical biopsy is recommended as breast cancer may be present in up to 8% of women with SCNB failure.

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Abbreviations

BI-RADS:

Breast Imaging and Reporting System

CCMO:

Central Committee on Research involving Human Subjects

DCIS:

Ductal carcinoma in situ

MRI:

Magnetic resonance imaging

SCNB:

Stereotactic core needle biopsy

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands

    Lucien E. M. Duijm

  2. Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands

    Luc J. A. Strobbe

  3. Department of Radiology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, ‘s-Hertogenbosch, The Netherlands

    Vivian van Breest Smallenburg

  4. Department of Pathology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands

    Willem Vreuls

  5. Department of Pathology, PAMM Laboratories, De Run 6250, 5504 DL, Veldhoven, The Netherlands

    Thom Boerman

  6. Department of Radiology, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Hermen C. van Beek

  7. Department of Radiology, Bernhoven Hospital, Nistelrodeseweg 10, 5406 PT, Uden, The Netherlands

    Clemence L. op de Coul-Froger

  8. Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Wikke Setz-Pels

  9. Department of Epidemiology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Adri C. Voogd

Authors
  1. Lucien E. M. Duijm
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  2. Luc J. A. Strobbe
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  3. Vivian van Breest Smallenburg
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  4. Willem Vreuls
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  5. Thom Boerman
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  6. Hermen C. van Beek
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  7. Clemence L. op de Coul-Froger
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  8. Wikke Setz-Pels
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  9. Adri C. Voogd
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Corresponding author

Correspondence to Lucien E. M. Duijm.

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Guarantor

The scientific guarantor of this publication is Lucien EM Duijm, MD, PhD.

Conflict of interest

Lucien EM Duijm is Associated Editor for the “Breast section” of European Radiology. He has not taken part in the review or selection process of this article. The authors do not opt for preprint-sharing.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Prior to participation, women gave informed consent that their data may be used for quality assurance of the screening program and for scientific purposes. An opt-out construction enables the women to refrain from this consent. Only three recalled women used this opt-out and they were excluded from analysis.

Ethical approval

Ethical approval was not required for the current study, according to the Dutch Central Committee on Research involving Human Subjects (CCMO).

Methodology

• prospective

• observational

• multicenter study

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Duijm, L.E.M., Strobbe, L.J.A., van Breest Smallenburg, V. et al. Failure of stereotactic core needle biopsy in women recalled for suspicious calcifications at screening mammography: frequency, causes, and final outcome in a multi-institutional, observational follow-up study. Eur Radiol 32, 7420–7429 (2022). https://doi.org/10.1007/s00330-022-08806-3

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  • DOI: https://doi.org/10.1007/s00330-022-08806-3

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