Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted?

PURPOSE To determine whether mammographic or histologic features can be used to predict which cases diagnosed as ductal carcinoma in situ (DCIS) without invasion by means of stereotactic core needle biopsy (SCNB) will have invasive disease at surgery. MATERIALS AND METHODS From July 1992 to March 1999, DCIS without invasion was diagnosed by means of SCNB in 59 patients. Seventeen (29%) were found to have invasive disease after surgery. The underestimation rate for SCNB was compared with that obtained by means of open surgical biopsy. Mammographic and histologic features of cases with and those without invasion were compared. RESULTS All patients had calcifications on mammograms. There was no significant difference (P: =.26) between the underestimation rate for SCNB with the 11-gauge vacuum-assisted device and that for open surgical biopsy. No statistically significant differences between cases with and those without invasion were seen in patient age, mean number of core specimens, level of suspicion, size of lesion, distribution and morphology of the calcifications, presence of an associated mass or density, subtype of DCIS, nuclear grade, or presence of necrosis or desmoplasia. CONCLUSION Mammographic and histologic features cannot be used reliably to predict cases that are underestimated with SCNB. However, SCNB with the 11-gauge vacuum-assisted device was as reliable as open surgical biopsy for diagnosing DCIS without invasion.

[1]  D. Carter,et al.  Carcinoma in situ of the breast , 1977, Cancer.

[2]  R. Senie,et al.  Noninvasive Breast Carcinoma: Frequency of Unsuspected Invasion and Implications for Treatment , 1979, Annals of surgery.

[3]  M. Lagios,et al.  Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short‐term treatment failures , 1982 .

[4]  S. Feig,et al.  Heterogeneity of intraductai carcinoma of the breast , 1989 .

[5]  M. Lagios.  Duct carcinoma in situ. Pathology and treatment. , 1990, The Surgical clinics of North America.

[6]  J. Hendriks,et al.  Extent, distribution, and mammographic/ histological correlations of breast ductal carcinoma in situ , 1990, The Lancet.

[7]  K. Hopper,et al.  Nonpalpable breast lesions: stereotactic automated large-core biopsies. , 1991, Radiology.

[8]  J. Connolly,et al.  Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. , 1992, AJR. American journal of roentgenology.

[9]  M. Lechner,et al.  Nonpalpable breast lesions: correlation of stereotaxic large-core needle biopsy and surgical biopsy results. , 1993, Radiology.

[10]  J. Donohue,et al.  Breast biopsy: a comparative study of stereotaxically guided core and excisional techniques. , 1994, AJR. American journal of roentgenology.

[11]  R. J. Jackman,et al.  Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. , 1994, Radiology.

[12]  G. W. Eklund,et al.  Percutaneous large-core breast biopsy: a multi-institutional study. , 1994, Radiology.

[13]  L. Liberman,et al.  Stereotaxic core biopsy of breast carcinoma: accuracy at predicting invasion. , 1995, Radiology.

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

[15]  F. Burbank.  Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy. , 1997, Radiology.

[16]  V. Jackson,et al.  Stereotactic biopsy of ductal carcinoma in situ of the breast using an 11-gauge vacuum-assisted device: persistent underestimation of disease. , 1999, AJR. American journal of roentgenology.