Value of Digital Breast Tomosynthesis-guided Vacuum-assisted Biopsy (DBT-VAB) in Diagnosis and Management of Suspicious Non-mass Microcalcifications of Breast: An Experience of Lop Buri Cancer Hospital

Abstract

Background: DBT-VAB is an alternative to surgical biopsy for early breast cancer detection when presented as calcifications without a mass. However, there is a possibility of pathologic underestimation. Objective: To evaluate malignancy rate and pathologic upgrade rate in suspicious calcifications via DBT-VAB. Method: A retrospective analysis of 98 patients (104 DBT-VAB procedures) was performed. Surgical pathology served as the gold standard for high-risk and malignant groups, with a 1-year follow-up for the benign group. The median follow-up was 51 months. Result: Malignancy rate: 29.8%, total upgrade rate: 21%. Breast MRI and MRI-guided biopsy detected one false negative. Final malignancy rates: BIRADS 4B: 27%, 4C: 56%, 5: 100%. Fine linear calcifications showed a malignancy rate of 70%, while linear and segmental distributions had rates of 100% and 60% respectively. Malignancy rates for calcifications related to BIRADS 3 follow-up, increasing calcifications, new calcifications, stable calcifications: 25%, 40%, 44%, 33% respectively. One-third of developing calcifications in benign background were malignant. Success rate: 98%, complications: small hematomas (15.3%), vasovagal reactions (2%), marker migration (24.4%). Conclusion: DBTVAB is a safe, minimally invasive, and accurate tool for diagnosing and planning the management of suspicious calcifications without masses, with a relatively low pathologic upgrade rate. High-risk and malignant lesions require surgery, while benign results enable reliable follow-up.