Original Research Stereotactic breast biopsies: Radiological-pathological concordance in a South African referral unit

Natasha Alexander, Ilana Viljoen, Susan Lucas

About the author(s) Natasha Alexander, Department of Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa
Ilana Viljoen, Department of Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa
Susan Lucas, Department of Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Abstract

Background: Stereotactic breast biopsies have become the gold standard for tissue diagnosis in non-palpable, sonographically occult breast abnormalities seen on mammogram. Only limited data exist in South Africa on the correlation between imaging findings and stereotactic biopsy histology.

Objectives: To describe the mammographic findings and histological diagnosis in patients who underwent stereotactic breast biopsy at a referral hospital. In addition, to evaluate the proportion of malignancy in each Breast Imaging Reporting and Data System (BI-RADS) category.

Method: A retrospective review of stereotactic breast biopsies was performed. Imaging characteristics (including BI-RADS category) and histological diagnosis were recorded. Using histopathology, cases were classified as benign, high-risk or malignant.

Results: A total of 131 biopsies, from 123 patients, were included in the study. Most biopsies were performed on asymptomatic patients (79.3%, 104/131). The majority were categorised as BI-RADS 4 and demonstrated calcifications. Histology revealed a malignant diagnosis in 40 (30.5%) patients, a high-risk lesion in 8 (6.1%) patients and a benign diagnosis in 83 (63.4%) patients. There was a stepwise increase in the proportion of malignancy from BI-RADS category 3 to 5. When compared with surgical histology, the stereotactic biopsies demonstrated an overall ductal carcinoma in situ (DCIS) underestimation rate of 10.3%.

Conclusion: Despite resource restrictions, stereotactic breast biopsies performed in a South African context produce radiological-pathological concordance in keeping with BI-RADS guidelines, as well as with local and international studies.

Keywords

stereotactic breast biopsy; BI-RADS; breast cancer; digital breast tomosynthesis; radiological-pathological concordance

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