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 Interval imaging 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 Interval imaging

CONCORDANCE ASSESSMENT Interval 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 LESIONS Interval imaging: Results PathologyN (%) Benign7 (63.6%) High Risk1 (9.1%) Invasive Cancer3 (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 Interval imaging: Results

COST ANALYSIS Diagnostic imaging or procedure performed Cost Unilateral 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 Interval imaging: Results

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 Interval imaging