Purpose: Tomosynthesis-guided biopsy allows for tissue sampling of breast imaging findings which are best seen by tomosynthesis without a sonographic correlate, such as architectural distortion. If the finding is not visualized on the day of biopsy, the procedure cannot proceed and is cancelled. This study reports the outcomes of cancelled tomosynthesis-guided biopsy of architectural distortion due to nonvisualization in order to inform appropriate management.
Materials and Methods: In this IRB-approved, HIPAA compliant study, retrospective chart review was performed to identify tomosynthesis-guided biopsy exams at our institution from 6/1/2017 to 11/1/2020 which were cancelled due to nonvisualization. Cases without follow-up imaging were excluded.
Results: Thirty-three of 256 architectural distortions recommended for biopsy during the study period were cancelled due to nonvisualization (13%). Patients with cancelled biopsies had mean age of 56 years (standard deviation [SD] 9.6 years) and mean follow-up time of 23.7 months (SD 12.4 months, range 6.8 to 50.9 months). Four patients (12%) had a breast MRI performed following the cancelled biopsy, with none demonstrating a correlating suspicious finding. During the follow-up period, most cases were assessed as probably benign and followed with diagnostic mammography (19/33, 57%). Seven cases (7/33, 21%) were assessed as BI-RADS 1 or 2 with the patients recommended to return to screening. Seven cases were subsequently biopsied (7/33, 21%), with one malignant outcome (1/33, 3%; invasive lobular carcinoma). The one malignant architectural distortion had been visualized on the CC, MLO and ML views of the diagnostic exam, compared to the 32 benign cases which were only seen on one or two views.
Conclusion: At our institution, 13% of architectural distortions recommended for biopsy were cancelled due to nonvisualization. During available follow-up, there was a low likelihood that these distortions represented malignancy (1/33, 3%). Architectural distortion that is seen on all views should increase the level of suspicion for malignancy.
Clinical Relevance Statement: As tomosynthesis-guided biopsy utilization is increasing, we must establish appropriate clinical management for findings not visualized on the biopsy day. In this preliminary analysis, our study found that architectural distortions not visualized at the time of recommended tomosynthesis-guided biopsy had a low rate of malignancy (3%).
