ObjectiveTo 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 MethodsRetrospective 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.ResultsThe 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%.ConclusionThe 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.
Objective To evaluate the BI-RADS as a predictive factor of suspicion for malignancy in breast lesions by correlating radiological with histological results and calculating the positive predictive value for categories 3, 4 and 5 in a breast cancer reference center in the city of São Paulo. Materials and Methods Retrospective, analytical and cross-sectional study including 725 patients with mammographic and/or sonographic findings classified as BI-RADS categories 3, 4 and 5 who were referred to the authors' institution to undergo percutaneous biopsy. The tests results were reviewed and the positive predictive value was calculated by means of a specific mathematical equation. Results Positive predictive values found for categories 3, 4 and 5 were respectively the following: 0.74%, 33.08% and 92.95%, for cases submitted to ultrasound-guided biopsy, and 0.00%, 14.90% and 100% for cases submitted to stereotactic biopsy. Conclusion The present study demonstrated high suspicion for malignancy in lesions classified as category 5 and low risk for category 3. As regards category 4, the need for systematic biopsies was observed.
Ductal carcinoma in situ of the breast: evaluation of main presentations on magnetic resonance imaging compareD with finDings on mammogram anD histology rev Assoc MeD brAs 2016; 62 (5) Objective: The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS.Method: A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI.
Results:The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases. Conclusion: DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.
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