The Value of Six Month Interval Imaging Following Benign Radiologic-Pathologic Concordant Minimally ...
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The Value of Six Month Interval Imaging Following Benign Radiologic-Pathologic Concordant Minimally Invasive Breast Biopsy. Manjoros DT , Collett AE, Alberty-Oller JJ, Frazier TG, Barrio AV. Comprehensive Breast Center, Bryn Mawr Hospital. Interval imaging. INTRODUCTION.

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Manjoros dt collett ae alberty oller jj frazier tg barrio av

The Value of Six Month Interval Imaging Following Benign Radiologic-Pathologic Concordant Minimally Invasive Breast Biopsy

Manjoros DT, Collett AE, Alberty-Oller JJ, Frazier TG, Barrio AV

Comprehensive Breast Center, Bryn Mawr Hospital


Introduction

Interval imaging

INTRODUCTION

  • Percutaneous breast biopsy represents “best practice”¹

  • Correlation of histologic and imaging findings strongly endorsed¹

  • NCCN guidelines recommend follow-up imaging 6-12 month after benign concordant breast biopsy for a period of 1-2 years

  • Incidence of discordance low² and value of short-term interval imaging questionable

¹Silverstein MJ, JACS, 2009

²Liberman L, Cancer, 2000


Methods

Interval imaging

METHODS

  • 689 patients identified that underwent image-guided breast biopsy at Bryn Mawr Hospital in 2010

  • Biopsy type included stereotactic, ultrasound-guided or MRI-guided biopsy

  • All image-guided biopsies performed by radiologists who met criteria set forth by American College of Radiology Breast Center of Excellence

  • All charts were evaluated for documentation of concordance assessment


Concordance assessment

Interval imaging: Results

CONCORDANCE ASSESSMENT

BenignPatients N = 498

Surgical excision 44/498 (8.8%)

Noexcision454/498 (91.2%)

No radiologyaddendum 114/454(25.1%)

Radiology addendum32/44 (72.7%)

No radiology addendum 12/44 (27.3%)

Radiologyaddendum 340/454(74.9%)

Discordant8/32 (25%)

Concordant337/340 (99.1%)

Concordant 24/32 (75%)

Discordant 3/340 (0.9%)


Outcomes in 11 discordant lesions

Interval imaging: Results

OUTCOMES IN 11 DISCORDANT LESIONS

  • In total, 11/372 (3.0%) discordant minimally invasive biopsies


Cancer incidence with interval imaging

Interval imaging: Results

CANCER INCIDENCE WITH INTERVAL IMAGING

  • 169 (50.1%) of 337 benign concordant patients underwent interval imaging < 12 months

  • 5(3%) with suspicious imaging

    • 3 at biopsy site, 2 away from biopsy site

  • 1 cancer was identified, representing 0.6% (95% CI, 0 – 3.6%) of all benign concordant patients

  • No cancers were identified with interval imaging after stereotactic or ultrasound-guided biopsy


Cost analysis

Interval imaging: Results

COST ANALYSIS


Conclusion

Interval imaging

CONCLUSION

  • Documentation of imaging-histologic correlation essential

    • Concordance assessment as a quality measure

  • Our data do not support the routine use of interval imaging following benign concordant breast biopsy

    • No interval imaging with specimen radiography

    • Selective use should be considered when confirmation of lesion retrieval difficult


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