Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy: Can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis?

Abstract

The aim of this study was to evaluate if re-biopsy with 10-gauge vacuum-assisted biopsy (VAB) could get definitive diagnosis for breast lesions with ultrasound (US) imaging-histologic discordance at 16-gauge core needle biopsy (CNB). From January 2007 to June 2008, a consecutive biopsy was performed on 1069 lesions with US-guided 16-gauge CNB. A total of 28 lesions were considered to be US imaging-histologic discordant and all of them underwent subsequent 10-gauge VAB. All malignant lesions located at VAB were treated with subsequent surgery and all benign lesions at VAB were followed up for at least 1 year. Six of the 28 lesions (21.4%) had pathologic upgrade after VAB. In them, one case upgraded from adenosis to ductal carcinoma in situ (DCIS); one case upgraded from adenosis to infiltrating ductal carcinoma (IDC); one case upgraded from atypical ductal hyperplasia to IDC; two cases upgraded from intraductal papilloma to DCIS; and one case upgraded from sclerosing adenosis to invasive lobular carcinoma (ILC). The subsequent surgery further demonstrated the diagnosis of VAB for all the lesions with histologic upgrade. Re-biopsy could improve diagnostic accuracy in patients with breast lesions showing imaging-histologic discordance during CNB, and 10-gauge VAB was a valuable method to deal with re-biopsy.

Significance of Fine Needle Aspiration Cytology and Vacuum-Assisted Core Needle Biopsy for Small Breast Lesions

“…[15][16][17][18] Among lesions with ultrasonographyehistologic discordance, 21.4% are upgraded in the pathological diagnosis after VAB, according to Li et al 19 Furthermore, it has also been reported that VAB might be valuable for definitive diagnosis when pathological results with CNB are discordant with imaging findings. [19][20][21] Accordingly, the use of VAB is supported by many physicians, especially for small lesions. 14,22,23 However, we have to keep in mind that VAB is based on the same concept as CNB: a partial sampling of the tumor.…”

Biopsy sampling of breast lesions: comparison of core needle- and vacuum-assisted breast biopsies

“…For the biopsy detection of calcifications, VAB was more sensitive in obtaining calcifications in both mass lesions and non-palpable lesions. In the detection of malignancy and calcification, VAB in general showed a better performance, either alone [19] or combined with hook wire localization [20,21]. One should, however, note that residual cancer could still be present even with VAB removal of all microcalcifications [12].…”

Benign Papillomas Without Atypia Diagnosed on Core Needle Biopsy: Experience From a Single Institution and Proposed Criteria for Excision

“…22,51,58 VAB has also gained recognition lately as an approach to manage patients after BPs without atypia are diagnosed on automated needle biopsy specimens, hence sparing a subset of patients from surgery. 47,54,59–62 Experience is still accumulating in this regard.…”