Criteria for Excision of Suspicious Calcifications Using the Breast Lesion Excision System (BLES)

Background: The aim of the study was to retrospectively evaluate possible imaging and histopathology criteria that can be used in a clinical basis to assess the success of excision of suspicious calcifications using the breast lesion excision system (BLES).Methods: We investigated 400 BLES stereotactic biopsies of suspicious calcifications with the mean size of 15.38 mm (st. dev.= 13.579 mm, range 3-78 mm) using a 20 mm probe performed in our department between January 2014 and 2016. The mean age of our population was 58.5 years old (range 39-78 years). The pathology results of BLES specimens were compared with the final surgical results to assess excision success rates. Possible imaging and histopathology criteria for removal were statistically analyzed (mammographic size, disease free margins, grade, comedo phenotype, molecular type).Results: The results showed that 90/400 (22.5%) biopsies were cancers (80% DCIS) and 38/400 were lesions with cell atypia (9.5%) of which 29/38 had subsequent surgery and were included in the study. Excision was achieved in 31/90 cancers (34.4%) and in 23/29 lesions with cell atypia (76.3%). The imaging and histopathology criteria for BLES excision that could be potentially clinically assessed were the initial mammographic size (p<0.001), the distance of the lesion from the specimen margins (p<0.001), the presence of comedo necrosis (p=0.014) and the grade of the cancers (p=0.021). The underestimation rate was 15.5%. Conclusion: the mammographic size, grade, comedo presence and disease-free margins, were the main criteria for BLES success rate of excision of suspicious calcifications.