Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution*

Objective To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.

[1]  G. Badan,et al.  Complete internal audit of a mammography service in a reference institution for breast imaging* , 2014, Radiologia brasileira.

[2]  P. Lertsithichai,et al.  Fibroadenoma versus phyllodes tumor: distinguishing factors in patients diagnosed with fibroepithelial lesions after a core needle biopsy. , 2014, Diagnostic and interventional radiology.

[3]  Cholatip Wiratkapun,et al.  Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy. , 2013, Diagnostic and interventional radiology.

[4]  G. Badan,et al.  Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS®) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy , 2013 .

[5]  Rafael Dahmer Rocha,et al.  Step-by-step of ultrasound-guided core-needle biopsy of the breast: review and technique , 2013 .

[6]  A. Sever,et al.  Factors that impact the upgrading of atypical ductal hyperplasia. , 2013, Diagnostic and interventional radiology.

[7]  A. Sever,et al.  Causes of failure in removing calcium in microcalcification-only lesions using 11-gauge stereotactic vacuum-assisted breast biopsy. , 2012, Diagnostic and interventional radiology.

[8]  L. Tabár,et al.  Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades. , 2011, Radiology.

[9]  S. Duffy,et al.  Mammographic screening and "overdiagnosis". , 2011, Radiology.

[10]  João Leite da Silva,et al.  Câncer de mama estádio inicial e radioterapia: atualização , 2011 .

[11]  S. Ciatto,et al.  Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. , 2011, Radiology.

[12]  Luiz Claudio Santos Thuler,et al.  Grau de subestimação histopatológica por core biopsy de lesões não palpáveis da mama , 2011 .

[13]  C. Zuiani,et al.  Borderline breast lesions: comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device , 2011, European Radiology.

[14]  Mika Watanabe,et al.  Radiologic-pathologic correlation of ductal carcinoma in situ. , 2010, Radiographics : a review publication of the Radiological Society of North America, Inc.

[15]  Wendy B DeMartini,et al.  Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. , 2010, Radiology.

[16]  S. Bianchi,et al.  Diagnostic Concordance in Reporting Breast Needle Core Biopsies using the B Classification—A Panel in Italy , 2009, Pathology & Oncology Research.

[17]  C. Lehman,et al.  Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. , 2009, AJR. American journal of roentgenology.

[18]  W. Moon,et al.  Underestimation of atypical ductal hyperplasia at sonographically guided core biopsy of the breast. , 2008, AJR. American journal of roentgenology.

[19]  J. Cawson,et al.  Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy? , 2008, Breast.

[20]  R. Birdwell.  Underestimation of Atypical Ductal Hyperplasia at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy , 2008 .

[21]  D. Giri,et al.  Stereotactic breast biopsy: comparison of histologic underestimation rates with 11- and 9-gauge vacuum-assisted breast biopsy. , 2007, AJR. American journal of roentgenology.

[22]  D. Dabbs,et al.  Predictors of Residual Invasive Disease after Core Needle Biopsy Diagnosis of Ductal Carcinoma In Situ , 2007, The breast journal.

[23]  Ralph T. Wynn,et al.  Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. , 2007, AJR. American journal of roentgenology.

[24]  Eun-Kyung Kim,et al.  Missed breast cancers at US-guided core needle biopsy: how to reduce them. , 2007, Radiographics : a review publication of the Radiological Society of North America, Inc.

[25]  S. Ciatto,et al.  Accuracy and Underestimation of Malignancy of Breast Core Needle Biopsy: the Florence Experience of Over 4000 Consecutive Biopsies , 2007, Breast Cancer Research and Treatment.

[26]  M. Dillon,et al.  Diagnostic accuracy of core biopsy for ductal carcinoma in situ and its implications for surgical practice , 2006, Journal of Clinical Pathology.

[27]  S. Vieni,et al.  Validity of needle core biopsy in the histological characterisation of mammary lesions. , 2006, Breast.

[28]  K. Fahrbach,et al.  A comparison of the accuracy of two minimally invasive breast biopsy methods: a systematic literature review and meta-analysis , 2006, Archives of Gynecology and Obstetrics.

[29]  K. Linnau,et al.  Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy. , 2004, Radiology.

[30]  S. Swain,et al.  Ductal carcinoma in situ, complexities and challenges. , 2004, Journal of the National Cancer Institute.

[31]  Luiz Claudio Santos Thuler.  Considerações sobre a prevenção do câncer de mama feminino , 2003 .

[32]  K. Kerlikowske,et al.  Detection of ductal carcinoma in situ in women undergoing screening mammography. , 2002, Journal of the National Cancer Institute.

[33]  D. Ikeda,et al.  Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? , 2002, Radiology.

[34]  Darrell N. Smith,et al.  Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. , 2000, AJR. American journal of roentgenology.

[35]  R. J. Jackman,et al.  Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. , 1999, Radiology.

[36]  W. P. Evans,et al.  Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy. , 1997, Radiology.