Table 5.
Literature overview of articles concerning benign calcifications of the breast.
| Study | Number of patients | Study design | Lesions | Modality (X-ray guided, stereotactic, US) | Management of benign result after VASB | Development malignancy after biopsy without surgery | duration follow-up | lost-to-follow-up | Main conclusion |
|---|---|---|---|---|---|---|---|---|---|
| Cangiarella et al., 2000 [21]. | 142 (160 biopsies whereof 132 benign) | retrospective | Mammographic calcifications | Stereotactic VASB biopsy; 11G | Surgical excision or mammographic follow-up | 0 | 6–36 months (mean 20,5 months) | 40 (34%) | A diagnosis of atypia on Mammotome biopsy warranted excision of the atypical area, yet the underestimation rate for the presence of carcinoma remained low. The likelihood of an invasive component at excision was low for microcalcification diagnosed as DCIS on Mammotome biopsy. Mammotome biopsy proved to be an accurate technique for the sampling and diagnosis of mammary microcalcification. |
| M. Kikruchi et al., 2007 [22]. | 51 | Retrospective study | calcifications on mammogram | stereotactic guided vacuum-assisted breast biopsy; 11G | n/a | n/a | n/a | n/a | Attention should be paid to prevent unnecessary MMT procedures. Heterogeneity in the density and size of calcifications is a reliable criterion for clinical decision-making. |
| V. Kumaroswamy et al., 2008 [23]. | 100 (benign + without excision = 17) | Retrospective; | microcalcifications | Stereotactic biopsy; 11G | Excision or follow-up | n/a | n/a | n/a | MMT biopsy is particularly useful for further assessment of an inadequate (B1) or suspicious (B4) CNB diagnosis. Diagnostic surgical excision remains the method of choice for managing atypical/uncertain lesions (B3). |
| B. Sigal-Zafrani et al., 2008 [15]. | 1009 (529 = benign) | Retrospective study | ACR IV-V microcalcifications | Stereotactic biopsy; 11G | Benign result = Surveillance (95%) | n/a for benign lesions | n/a for benign lesions | n/a for benign lesions | VLNB constitutes an alternative to surgical biopsy. This procedure avoids surgery for most benign lesions and reduces the number of surgical procedures in malignant lesions |
| N. Cho et al., 2009 [24]. | 75 (benign = 45) | prospectively evaluated | suspicious calcifications on screening mammography | US-guided VASB | n/a | n/a | n/a | n/a | US-guided 11-G vacuum-assisted biopsy retrieved calcifications from 71% (53/75) of lesions. Successful calcification retrieval was found to be related to the visibility of associated masses or dilated ducts by US, and to lesion depth, size, and distribution, and level of suspicion at mammography |
| K. Suzuki et al., 2009 [25]. | 39 (lesions) | Retrospective study | segmental calcifications | MMT biopsy with screen-film mammography system | FU of lesion using mammography and ultrasonography | n/a | n/a | n/a | Lesions with heterogeneous calcifications are frequently malignant, and biopsy should be considered. |
| S. Bae et al., 2015 [26]. | 406 | Retrospective review | BI-RADS 4,5 lesions - only microcalcification | US-CNB, US-VAB, S-VAB | Mammographic follow-up | 0 | 1173.8 days (range, 385–1924 days). | 15 (4%) | Ultrasonography-guided vacuum-assisted biopsy is more accurate than US-CNB when suspicious microcalcifications are detected on US. Calcifications with malignant pathology are significantly more visible on US than benign lesions |
| M.M. Atasoy et al., 2015 [4]. | 63 patients (66 lesions whereof 51 benign) | Retrospective study | BI-RADS 4 microcalcifications-only lesions | Stereotactic vacuum-assisted core needle breast biopsy; 10G | follow-up - first FU at 6th month after biopsy | 0 | mean = 21.2 months (at least 10 months) | 3 (6%) | VASB should be the standard method of choice for BI-RADS 4 microcalcifications. This method obviates the need for a surgical procedure in 73% of BI-RADS 4 microcalcifcation-only patients. |
| R. Yonekura et al., 2019 [27]. | 594 (371 = benign) | Retrospective study | breast calcifications | SVAB procedure; 11 G | annual follow with mammography, US and examination | 4 | 71.5 months (range 5.6–119.3 months) | 63 patients (17%) | When SVAB results in non-malignant, patients may be followed by annual screening, while re-biopsy needs to be performed for the patients with a discordant result of SVAB and with changes in an imaging finding during a follow-up |
VASB = Vacuum-Assisted Stereotactic Biopsy; G = Gauge; VB = vacuum biopsy; VLNB = Vacuum-assisted large-core needle biopsy; FU = follow-up; US = ultrasound; FEA = flat epithelial atypia; VABB = vacuum-assisted breast biopsy; ADH = Atypical ductal hyperplasia; MMT = mammatome; CNB = Core Needles Biopsy; SIFU = Short-Interval Follow-Up; RTAS = Return To Annual Screening.