Contributed by: Katherine E. Dee, MD - June 1, 2002
What is your assessment?
BI-RADS 1 - Normal - normal interval follow-up in 12 months BI-RADS 2 - Benign - normal interval follow-up in 12 months BI-RADS 3 - Probably Benign - 6 month follow-up BI-RADS 4 - Suspicious - recommend stereotactic biopsy BI-RADS 5 - Highly suggestive of malignancy - recommend wire localization and excisional biopsy
BI-RADS 4, Suspicious
These are heterogeneous grouped microcalcifications, and are suspicious for malignancy
A stereotactic biopsy is performed which yields Atypical Ductal Hyperplasia. What is your recommendation now?
Follow-up mammogram in 12 months Follow-up mammogram in 6 months Surgical excisional biopsy MRI exam
Surgical excision is recommended for core needle biopsies yielding atypia
In about a third of cases, DCIS is found at excision after ADH is found at needle biopsy [Jackman, et. al., Radiology, 1999, Brem et. al, AJR, 1999]. With a core biopsy we are only sampling a portion of the area. The degree of underestimation of disease of core needle biopsy has been shown to improve (upstaging to DCIS at surgery is less common) when vacuum-assisted core needle devices (ie. Mammotome) are used [Joshi, et. al,Breast Journal, 2001]. These devices allow a larger sample to be obtained. Studies have shown that this also improves with a higher # of samples taken [Jackman et. al., Radiology, 2001] (this is why we usually obtain 12 samples instead of 3 or 6.)
