The Value of Six Month Interval Imaging Following Benign

Radiologic-Pathologic Concordant Minimally Invasive Breast Biopsy

Manjoros DT, Collett AE, Alberty-Oller JJ, Frazier TG, Barrio AV

Comprehensive Breast Center, Bryn Mawr Hospital

INTRODUCTION

Percutaneous breast biopsy represents “best practice”¹

Correlation of histologic and imaging findings strongly endorsed¹

NCCN guidelines recommend follow-up imaging 6-12 month after benign concordant breast biopsy for a period of 1-2 years

Incidence of discordance low² and value of short-term interval imaging questionable

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¹Silverstein MJ, JACS, 2009

²Liberman L, Cancer, 2000

METHODS

689 patients identified that underwent image-guided breast biopsy at Bryn Mawr Hospital in 2010

Biopsy type included stereotactic, ultrasound-guided or MRI-guided biopsy

All image-guided biopsies performed by radiologists who met criteria set forth by American College of Radiology Breast Center of Excellence

All charts were evaluated for documentation of concordance assessment

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CONCORDANCE ASSESSMENTInterval imaging: Results

No radiology addendum 114/454

(25.1%)

Concordant 24/32

(75%)

Benign Patients N = 498

Surgical excision

44/498 (8.8%)

No excision 454/498

(91.2%)

Discordant 3/340 (0.9%)

Radiology addendum 340/454

(74.9%)

Discordant 8/32 (25%)

Radiology addendum 32/44

(72.7%)

Concordant 337/340

(99.1%)

No radiology addendum 12/44

(27.3%)

OUTCOMES IN 11 DISCORDANT LESIONSInterval imaging: Results

Pathology N (%)

Benign 7 (63.6%)

High Risk 1 (9.1%)

Invasive Cancer 3 (27.3%)

•In total, 11/372 (3.0%) discordant minimally invasive biopsies

CANCER INCIDENCE WITH INTERVAL IMAGING

169 (50.1%) of 337 benign concordant patients underwent interval imaging < 12 months

5(3%) with suspicious imaging– 3 at biopsy site, 2 away from biopsy site

1 cancer was identified, representing 0.6% (95% CI, 0 – 3.6%) of all benign concordant patients

No cancers were identified with interval imaging after stereotactic or ultrasound-guided biopsy

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COST ANALYSISDiagnostic imaging or procedure performed CostUnilateral mammogram $338 x 146 = $49,348

Breast ultrasound $1,104 x 43 = $47,472

Breast MRI $5,701 x 15 = $85,515

Stereotactic biopsy $2,447 x 0 = $0

Ultrasound guided biopsy $1,198 x 3 = $3,594

MRI biopsy $2,718 x 2 = $5,436

Pathologic analysis of core biopsy

$276 x 5 = $1,380

Total Cost $192,745

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CONCLUSION

Documentation of imaging-histologic correlation essential– Concordance assessment as a quality measure

Our data do not support the routine use of interval imaging following benign concordant breast biopsy– No interval imaging with specimen radiography– Selective use should be considered when

confirmation of lesion retrieval difficult

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