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

Abstract

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.

Tomosynthesis guided core biopsy of breast lesions – method review and our results

“…46 Badan i suradnici ističu da se prisut nost ostatne promjene nakon biopsije može iskoristiti kao prirodni marker za kasniji kirurški zahvat ili pra ćenje. 54 Mi smo biopsije izvodili s pomoću igle debljine 14 G, promjene nismo uklanjali u cijelosti te nismo postavljali marker. Na kontrolnoj tomosintezi, pri biopsijama promjena bez kalcifikata, na slojevnim smo snimkama uvijek identificirali postbiopsijsku šupljinu, što smo iskoristili kao potvrdu ispravno uze tih uzoraka.…”

“…49,50,51,56 Stope podcjenjivanja kreću se od 13 do 50% za benigne promjene nesigurnoga malignog po tencijala te od 4 do 28% za DCIS. 10,49,51,54,[57][58][59][60][61] Mi smo biopsije izvodili s pomoću široke igle debljine 14 G jer ne raspolažemo opremom za vakuumsku biopsiju, koja je znatno skuplja. S našom stopom lažno negativ nih nalaza od 2,8%, stopom podcjenjivanja benignih promjena nesigurnoga malignog potencijala od 25% i stopom podcjenjivanja DCISa od 14,3% kretali smo se u okviru referiranih vrijednosti drugih autora.…”

Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

“…Atypical ductal hyperplasia and lobular neoplasms (atypical lobular hyperplasia and lobular carcinoma in situ ) are not only precursor lesions but also risk factors for breast cancer, their diagnosis increasing the relative risk of developing cancer by 4 to 10 times ( 33 , 34 ) . There is a consensus that breast cancer screening with mammography should be started soon after the diagnosis of such lesions.…”

Breast Cancer Screening: Updated Recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

“…Atypical ductal hyperplasia and lobular neoplasms (atypical lobular hyperplasia and lobular carcinoma in situ) are not only precursor lesions but also risk factors for breast cancer, their diagnosis increasing the relative risk of developing cancer by 4 to 10 times. 33,34 There is a consensus that breast cancer screening with mammography should be started soon after the diagnosis of such lesions. The great debate is regarding the use of magnetic resonance imaging in screening for breast cancer in women with such lesions.…”