1. 6ème PAIRS-Hammamet-Tunis-avril2012
THE IMPACT OF INTERVENTIONNAL SENOLOGY IN SURGICAL MANAGEMENT OF INFRACLINICAL LESIONS. L’IMPACT DE L’INTERVENTIONNEL EN SENOLOGIE SUR LA PRISE EN CHARGE CHIRURGICALE DES LESIONS INFRACLINIQUES.
AB. BENDIB .m.H. MEKHILEF
Central Department of Radiology Mustapha Bacha University Hospital, Algiers, Algeria, 16000
6ème PAIRS-Hammamet-Tunis-avril2012

2. INTRODUCTION
The interest of the percutanious biopsy : Histology RH(RP/RO/HER2/KI67)
The advent of percutaneous biopsy with its different modalities made a changement in the management of the infracliniques breast lesions.
How ?

3. INDICATIONS OF BIOPSY
ALL lesions categorized as ACR5 histological type, HR , Pronostic , chemotherapy…
ALL lesions categorized as ACR4  histology M/B.
Some lesions categorized as ACR 3 with high risk (BRCA), anxiety …

4. PURPOSE
Evaluate of the impact of the interventionnal in senology in surgical management of infraclinical lesions:
The rate of surgery avoided.
Surgery in one step/ sentinal node.

5. THE HISTORY OF THE INTERVENTIONNAL IN SENOLOGY
1986:FNA
1990: Microbiopsy : 18 to 14 G
1994:Microbiopsy with automatic pistol 14G on dedicated table  PARKER
1996: Parker et Burban mammotome with vacuum and 12 G
After : G.

6. THE INTERVENTIONAL TECHNICS
MICROBIOPSY
14Gsamples :1.6mm
XX introductions
LARGE CORE BIOPSY
12, 09 G  samples 2-3.2mm
One introduction
marker

7. DIFFERENTS POSSIBILITIES
Microbiopsy under ultrasonography
Large core biopsy under ultrasonography
Large core biopsy stereotactic

8. I-MICROBIOPSY UNDER US
INDICATIONS:
All anomalies detectable under US as mass or distorsion.
Size ≥5 mm
Difficult case / experience :
Target :movable ,deep, isoéchoic/fatty and larger breast.
Breast : fibrous / introduction of the needle.

9. MICROBIOPSY UNDER US MATERIALS:
144 microbiopsy realised in 136 patientes
Age : 21 to 82 years old.
Target : mass, distorsion, solido-cystic
Classified using Bi-rads :
20 cases as ACR3
79 cases as ACR4
45 cases as ACR5

10. MICROBIOPSY UNDER US METHOD Choose the acess, asepsis.
Local anesthesia.
05 samples, min 03 samples.
Formol  fixation.

12. MICROBIOPSY UNDER US RESULTS
Sensibility: 96%.
Malignant results + HR  49%.
FN :2.2%.
Technic failure: 0.7%.
02 cases of atypia  1 case of IDC.
02 cases of CIS  underestimation of IDC.
Evicton of surgery : 47%.

13. MICROBIOPSY UNDER US RESULTS
SENSIBILITY : 92% to 98%
FN : 1.7%*3.3%** 4.8%***
FN in surgery: 2.5%****
ann surg 2005*
Liberman 1998**
Derschaw 1996***
jackman radiology 1997****

14. II-LARGE CORE BIOPSY UNDER US INDICATIONS
Diagnostic purposes:
Very small mass <<5mm, in difficult situation
Failure in microbiopsy.
Excision purposes:
Of mass no suspecte (papilloma, Adenofibroma)

15. LARGE CORE BIOPSY UNDER US MATERIALS
16 biopsies realized in 14 patientes.
Age : 26 to 62 years old.
Background of breast cancer :3/14 cases.
Targets were classified using bi-rads:
ACR3: 03 cases
ACR4 :13 cases
ACR5: 00 cases

16. LARGE CORE BIOPSY UNDER US METHOD
Choose the access, patient in DD
Local anesthesia
Biopsy under vacuum and continu control US.
Put a clip.
Take out the samples and fixed in formol.

18. LARGE CORE BIOPSY UNDER US HISTOLOGICAL RESULTS
Benign: ADF 09 / FCM : 05 / B Papilloma:01.
Atypia : EAH 01 case
Malignant :00
Totale excision :…………………..80%
Complications: hematoma……01 cases
vagal shock…..01 cases
FN:0%
Rate of underestimation : 0%

19. LARGE CORE BIOPSY UNDER US RESULTS
Total excision  size < 15 mm
The only complication : hemorrhagy <2%
Rate of FN =0
Rate of underestimation :0%* to 0.75%**
*Plantade :Journal de Radiologie 2007 vol 86 – 20
** Sebag ,Tourasse et Lebas : journal de radiologie vol

20. III-LARGE CORE STEREOTACTIC BIOPSY INDICATIONS
Microcalcifications
Distorsions without image in US
Mass in some difficult situations

21. LARGE CORE STEREOTACTIC BIOPSY
METHOD
MATERIALS:
130 biopsies in 122 patientes
Age : 33 to 82 years old

22. LARGE CORE STEREOTACTIC BIOPSY RESULTS
Malignant in 39%  surgery
Atypia in 9%  surgery / follow up
Benign in 53%  eviction of surgery

23. CONCLUSION 43% of malignant Dg  TRT 53 % of eviction of surgery
FAILURE/EXCISION
Large core biopsy under us
TARGET VISIBLE ON US
Microbiopsy under US
TARGET NO VISIBLE ON US
Large core stereotactic biopsy
43% of malignant Dg  TRT
53 % of eviction of surgery
4% of chirurgical biopsy with frozen