Correlation between core biopsy and excisional biopsy in breast high-risk lesions

Margenthaler, Julie A.; Duke, Deirdre; Monsees, Barbara; Barton, Premsri; Clark, Chrystia; Dietz, Jill R.

doi:10.1016/j.amjsurg.2006.06.003

Cited by 88 publications

(43 citation statements)

References 20 publications

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“…In our institution, the calcification is also subjected to vacuum-assisted biopsy under ultrasound guidance when lesions are evident on sonography because sampling the sonographically visible component often helps target the invasive component [15,25,26]. Such calcified lesions were a significant causal factor for underestimation not only in our study but also other studies [1,27]. Therefore, the underestimation rate for the 11-gauge vacuum-assisted biopsy was higher in the present study due to selection bias.…”

Section: Discussionsupporting

confidence: 46%

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

Han

Lee

et al. 2007

Breast Cancer Res Treat

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Background The aim of this study was to determine factors that predict under-evaluation of malignancy in patients diagnosed with atypical ductal hyperplasia (ADH) at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to malignancy based on clinical, radiological and pathological factors. Methods The study enrolled patients diagnosed with ADH at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. Results A total of 102 patients with ADH at CNB were identified. Of the 74 patients who underwent subsequent surgical excision, 34 (45.8%) were diagnosed with invasive or in situ malignant foci. Multivariate analysis revealed that age [50 years, microcalcification on mammography, size on imaging [15 mm and a palpable lesion were independent predictors of malignancy. Focal ADH was a negative predictor. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.903 (95% CI: 0.82-0.94), and the negative predictive value was 100% for a score B3.5. Similar findings were observed for a validation dataset of 54 patients at other institutions. Conclusions A scoring system to predict malignancy in patients diagnosed with ADH at CNB was developed based on five factors: age, palpable lesion, microcalcification on mammography, size on imaging and focal ADH. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.

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Section: Discussionsupporting

confidence: 46%

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

Han

Lee

et al. 2007

Breast Cancer Res Treat

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“…The number of cases included in previously published studies (combining atypical lobular hyperplasia and lobular carcinoma in situ) varies from less than 10 up to 92 cases of lobular neoplasia followed by immediate excision. [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] In comparison, our study includes a relatively high number of cases (87 cases of lobular neoplasia followed by immediate excision). Another limitation in our study and others is that it is retrospective and may suffer from selection bias regarding the patients that underwent excision.…”

Section: Discussionmentioning

confidence: 99%

Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary

Hwang

Barke

Mendelson³

et al. 2008

Modern Pathology

104

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Standardized recommendations for the management of lobular neoplasia in core biopsy specimens are not established. The aim of our study was to define morphologic features of lobular neoplasia in core biopsies that predict the finding of ductal carcinoma in situ or invasive carcinoma in the subsequent excisional specimen. We reviewed 333 cases of atypical lobular hyperplasia or lobular carcinoma in situ without ductal carcinoma in situ or invasive carcinoma diagnosed in core biopsies from 1996 to 2006. Subsequent excision was performed in 41% (136/333) of cases, including atypical lobular hyperplasia (n ¼ 48), lobular carcinoma in situ (n ¼ 39), and lobular neoplasia associated with atypical ductal hyperplasia (n ¼ 49). Upgrades were identified in 2% (1/48) of atypical lobular hyperplasia, 23% (9/39) of lobular carcinoma in situ, and 27% (13/49) of lobular neoplasia associated with atypical ductal hyperplasia cases. When further analyzed, the upgraded cases of lobular carcinoma in situ were associated with radiologic-pathologic discordance in 6/9 cases and with nonclassic pathology (two lobular carcinoma in situ with necrosis and one pleomorphic lobular carcinoma in situ) in the remaining three cases. The frequency of upgrade was 11% (3/26) in classic lobular carcinoma in situ, and 46% (6/13) in nonclassic types (pleomorphic or with necrosis). After excluding cases with discordant imaging/ pathology, there was a 5% upgrade in our excisional specimens. After excluding cases where the upgrade was associated with nonclassic morphology, the upgrade in our study was 1%. Our results suggest that atypical lobular hyperplasia and classic lobular carcinoma in situ with concordant radiology and pathology can be appropriately managed with clinical follow-up without surgery.

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“…Needle core biopsy underestimates the presence of malignant disease when high risk lesions such as ADH, ALH and lobular carcinoma in situ are present. 11,12 Core biopsy may not detect foci of malignancy in benign tissue, especially if the foci are small. Using a smaller core needle or taking four or fewer core biopsy samples is associated with a risk of underdiagnosing breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Using a smaller core needle or taking four or fewer core biopsy samples is associated with a risk of underdiagnosing breast cancer. 11,13 Increasing the volume of tissue excised by using larger gauge needles, 11 vacuum assisted devices 12 or newer basket techniques may facilitate accurate preoperative diagnosis. Further evaluation is required to assess the potential role of these devices as previous studies have been retrospective and non-randomised.…”

Section: Discussionmentioning

confidence: 99%

Lesions of uncertain malignant potential (B3) on core biopsy in the NHS Breast Screening Programme: is the screening round relevant?

Hunt

Steel

Porter

et al. 2012

annals

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INTRODUCTION Most women who have screening mammography and undergo subsequent open biopsy following an indeterminate core biopsy result are eventually found to have benign disease. However, a significant number have malignant disease and the rate of malignancy in such cases may be influenced by various factors. This study examined the effect of the type of screening round (prevalent or incident) on the likelihood of breast cancer being present. METHODS A total of 199 women who had NHS breast screening mammograms and subsequent indeterminate (B3) core biopsy results followed by excision biopsy over an 11-year period in a single breast screening unit were reviewed. RESULTS The rate of malignancy following excision of a lesion graded as B3 on core biopsy was 21% for women in the prevalent screening round compared to 33% in subsequent rounds (Fisher's exact test, p=0.038). CONCLUSIONS The incidence of malignancy associated with a B3 core biopsy result appears to be related to the screening round in which the lesion is detected, being approximately 50% higher in the subsequent incident rounds compared to the initial prevalent round. This finding may be useful in formulating management plans for women who have an indeterminate biopsy result.

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Correlation between core biopsy and excisional biopsy in breast high-risk lesions

Cited by 88 publications

References 20 publications

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy

Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary

Lesions of uncertain malignant potential (B3) on core biopsy in the NHS Breast Screening Programme: is the screening round relevant?

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