Percutaneous biopsy of non-palpable breast lesions with the Advanced Breast Biopsy Instrumentation (ABBI): Analysis of indication strategies.

Purpose: To compare the indications for biopsy with and without the use of the Breast Imaging Reporting and Data System. Material and Methods: Biopsie s using the ABBI were performed in 62 patients with 64 non-palpable evident mammographic lesions. The initial decision for biopsy was made by non-radi ologists due to suspicious microcalcifications (n = 53) and masses (n = 11) . The indication was retrospectively reassessed by adopting the BI-RADS cla ssification by three radiologists in consensus. The positive predictive val ue (PPV) of both indication strategies was assessed and compared. Results: Biopsies adopting ABBI were performed without major side-effects and were d iagnostic. Carcinoma was present in 14 lesions: nine specimens were diagnos ed as DCIS and five as invasive carcinomas. For the 50 benign lesions histo logy revealed mastopathies (26/50) and fibroadenomas (8/50) as the most fre quent diagnosis. The positive predictive value (PPV) for the initial indica tion was 22 %, whereas PPV for BI-RADS based indications (categories 4 and 5) was 31 %. Conclusion: ABBI enables stereotactically-guided procedures th at result in representative and diagnostic biopsies. Standardized criteria like BI-RADS improve the PPV and should be a mandatory part of mammographic evaluation. Radiologists should remain involved in the decision malting.