Role of high magnification specimen radiography in surgical and core biopsies of the breast

The clinical relevance of a high magnification specimen radiography (HMSR) system in breast biopsies was evaluated and compared with conventional spec imen radiography with a mammography system (SRM). 100 surgical biopsies of 72 patients and 248 core biopsies of 30 patients were examined in (a) maxim al 20-fold HMSR in combination with storage phosphors and (b) 1.8-fold SRM using a film-screen system. Detection of calcifications/soft tissue lesions and the impact on management were evaluated. In surgical biopsies, SRM cou ld detect only 22% of individual microcalcifications, 39% of calcified lesi ons and 67% of soft tissue lesions identified with HMSR. Calcifications dow n to 10 mum were identified with HMSR. In five biopsies, peripheral calcifi cations leading to additional resection were recognized only with HMSR; in three of these they were indicative of malignant tissue. In core biopsies, only 12% of individual microcalcifications seen with HMSR were identified w ith SRM. 52% and 16% of all cores were calcified on HMSR and SRM, respectiv ely. Microcalcifications within cores were found only with HMSR in 41% of p atients with calcified lesions. In conclusion, the better detectability of microcalcifications with HMSR led to justified additional tissue resections in surgical patients and reduced the number of core biopsies required in i nterventional patients.