STEREOTAXIC CORE BIOPSY OF CALCIFICATIONS HIGHLY SUGGESTIVE OF MALIGNANCY

PURPOSE: To assess stereotactic core biopsy for evaluation of Breast I maging Reporting and Data System (BI-RADS) category 5 calcifications ( highly suggestive of malignancy). MATERIALS AND METHODS: Retrospective review of mammograms revealed 31 women (aged 34-86 years) with BI-RAD S category 5 calcifications who underwent 14-gauge stereotactic core b iopsy with an automated gun. Records were reviewed to determine the fr equency with which stereotactic core biopsy obviated a surgical proced ure. Cost savings were based on Medicare estimates of $472 for stereot actic core biopsy and $1,335 for surgical biopsy. RESULTS: Of 31 patie nts, stereotactic core biopsy revealed carcinoma in 19 (61%), atypical ductal hyperplasia (ADH) in eight (26%), and benign findings discorda nt with mammographic results in four (13%). Surgical biopsy was recomm ended for the 12 patients with ADH or benign but discordant core biops y diagnoses. Of the 19 patients with carcinoma at stereotactic core bi opsy, two chose to undergo a second biopsy surgically, two had small f oci of ductal carcinoma in situ (DCIS) that would have been fully exci sed with surgical biopsy, one with DCIS at stereotactic fore biopsy un derwent axillary dissection after invasion was found at surgery, and o ne underwent excision but had tumor at lumpectomy margins. Thirteen (4 2%) of 31 patients were spared a surgical procedure, saving $100 per p atient. CONCLUSION: Stereotactic core biopsy with an automated gun obv iated a surgical procedure in 42% of patients with BI-RADS category 5 calcifications, resulting in modest cost savings in this group.