Factors associated with upstaging of ductal carcinoma in situ diagnosed by core needle biopsy using imaging guidance

Wiratkapun, Cholatip; Patanajareet, Pachara; Wibulpholprasert, Bussanee; Lertsithichai, Panuwat

doi:10.1007/s11604-011-0595-5

Cited by 11 publications

(5 citation statements)

References 35 publications

(38 reference statements)

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“…The relatively low negative predictive value seen in our results 62% compared to previously reported values 90-98.9% (23)(24)(25)(26) resulted from the 8.4% false negative rate and underestimation of high-risk lesions. Several factors can contribute to this low NPV: 1) The nature of the lesion: histological underestimation occurs when the CNB samples high risk areas with atypical ductal hyperplasia or intraductal lesion while the rest of the lesion contains invasive carcinoma (9,27,28). ADH is a risk factor for cancer and can also be found alongside invasive cancer (27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

“…Several factors can contribute to this low NPV: 1) The nature of the lesion: histological underestimation occurs when the CNB samples high risk areas with atypical ductal hyperplasia or intraductal lesion while the rest of the lesion contains invasive carcinoma (9,27,28). ADH is a risk factor for cancer and can also be found alongside invasive cancer (27)(28)(29). Underestimation of ADH is one of the major issues in US guided CNB which could range from 0-100% (30).…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound Guided Core Needle Biopsy in The Diagnosis of Suspicious Breast Lesions: Radiologist’s perspectives

Aswad¹,

Abedtwfeq

2023

Al-Kindy Col. Med. J

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Background: Ultrasound guided core needle biopsy is becoming a gold standard in the work up of suspicious breast lesion. In Iraq, radiologists are not taking the lead in core needle biopsy performance. Objectives: To evaluate the radiologist performance of core needle biopsy highlighting the precession and accuracy of the procedure, the concordance of ultrasound and histopathology, and identifying challenges facing the radiologist during the procedure. Subjects and Methods: A prospective study involving a total of 50 patients with ultrasound (US) BIRADS IV or V. Ultrasound guided core needle biopsy was performed for each patient. Surgical pathology diagnosis was available for 40 patients. core needle biopsy results were correlated with Breast Imaging-Reporting and Data System (BI-RADS) categories and validity of the test was evaluated. Results: Malignancy was confirmed by histopathology in 76% of the cores. Concordance between BI-RADS(US) and histopathology for benignity and malignancy was achieved in all cores. Borderline lesions constituted 10% of total cores taken. Surgical resection of these lesions upgraded 3/5 (60%): two atypical ductal hyperplasia and an intraductal papillary lesions diagnosed by core needle biopsy found to be invasive ductal carcinoma after surgical resection. Sensitivity of core needle biopsy in this study was 91.4% with 100% specificity. Positive and negative predictive values were 100% and 62.5% respectively. The underestimation rate in high-risk group was 3/5 (60%). No significant complication was reported. Conclusion: Ultrasound guided core needle biopsy is a safe, efficient and relatively inexpensive method in diagnosing suspicious breast lesions. Radiologists can produce high sensitivity and specificity results. Radio pathological correlation is of paramount in achieving accurate results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Core Needle Biopsy in The Diagnosis of Suspicious Breast Lesions: Radiologist’s perspectives

Aswad¹,

Abedtwfeq

2023

Al-Kindy Col. Med. J

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“…Our model can help surgeons decide whether SLNB should be performed. Previous research has focused on exploring relevant clinical predictors (3,9,10,17,18). Multiple studies have reported clinical predictors for upstaging after CNB, such as age, size of the mass, and higher nuclear grade, and the relevant prediction models were established based on these factors.…”

Section: Discussionmentioning

confidence: 99%

“…Distinction between DCIS and invasive carcinoma before surgery has been addressed previously. Recently, research has focused on corresponding clinical factors as predictors of postoperative upstaging of pure DCIS diagnosed preoperatively by CNB (3,9,10). However, the evaluation of some of these clinical factors have been subjective, and the factors are difficult to apply in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Application of deep learning to predict underestimation in ductal carcinoma in situ of the breast with ultrasound

Qian

Zhang

et al. 2021

Ann Transl Med

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Background: To develop an ultrasound-based deep learning model to predict postoperative upgrading of pure ductal carcinoma in situ (DCIS) diagnosed by core needle biopsy (CNB) before surgery.Methods: Of the 360 patients with DCIS diagnosed by CNB and identified retrospectively, 180 had lesions upstaged to ductal carcinoma in situ with microinvasion (DCISM) or invasive ductal carcinoma (IDC) postoperatively. Ultrasound images obtained from the hospital database were divided into a training set (n=240) and validation set (n=120), with a ratio of 2:1 in chronological order. Four deep learning models, based on the ResNet and VggNet structures, were established to classify the ultrasound images into postoperative upgrade and pure DCIS. We obtained the area under the receiver operating characteristic curve (AUROC), specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) to estimate the performance of the predictive models. The robustness of the models was evaluated by a 3-fold cross-validation.Results: Clinical features were not significantly different between the training set and the test set (P value >0.05). The area under the receiver operating characteristic curve of our models ranged from 0.724 to 0.804.The sensitivity, specificity, and accuracy of the optimal model were 0.733, 0.750, and 0.742, respectively. The three-fold cross-validation results showed that the model was very robust. Conclusions:The ultrasound-based deep learning prediction model is effective in predicting DCIS that will be upgraded postoperatively.

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“…Nondiagnostic samples, typically classified as those which are void of epithelial cells (4), occur in up to 35% of palpation-guided FNAB (1-3) procedures and 12% of image-guided CNB procedures targeting nonpalpable lesions (9). These difficulties lead to rebiopsy in approximately 4% of the patients that undergo percutaneous procedures (10-11). …”

Section: Introductionmentioning

confidence: 99%

Clinical Feasibility of Microscopically-Guided Breast Needle Biopsy Using a Fiber-Optic Probe with Computer-Aided Detection

Zysk

Nguyen

Chaney

et al. 2009

Technol Cancer Res Treat

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Needle biopsy of small or nonpalpable breast lesions has a high nondiagnostic sampling rate even when needle position is guided by stereotaxis or ultrasound. We assess the feasibility of using a near-infrared fiber optic probe and computer-aided detection for the microscopic guidance of needle breast biopsy procedures. Specimens from nine consented patients undergoing breast-conserving surgery were assessed intraoperatively using a needle device with an integrated fiber-optic probe capable of assessing two physical tissue properties highly correlated to pathology. Immediately following surgical resection, specimens were probed by inserting the optical biopsy needle device into the tissue, simulating the procedure used to position standard biopsy needles. Needle positions were marked and correlated with histology, which verified measurements obtained from 58 needle positions, including 40 in adipose and 18 in tumor tissue. This study yielded tissue classifications based on measurement of optical refractive index and scattering. Confidence-rating schemes yielded combined sensitivity of 89% (16/18) and specificity of 78% (31/40). Refractive index tests alone identified tumor tissue with a sensitivity of 83% (15/18) and specificity of 75% (30/40). Scattering profiles independently identified tumor tissue with a sensitivity of 61% (11/18) and specificity of 60% (24/40). These results show that a biopsy needle with an integrated fiber optic probe can be used to identify breast tumor tissue for sampling. Integration of this probe into current practices offers the potential to reduce nondiagnostic sampling rates by directly evaluating in situ microscopic tissue properties in real-time, before removal.

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Factors associated with upstaging of ductal carcinoma in situ diagnosed by core needle biopsy using imaging guidance

Abstract: High-grade DCIS, using a smaller needle, and the presence of comedonecrosis in the CNB specimen were associated with a higher risk for invasive carcinoma.

Cited by 11 publications

References 35 publications

Ultrasound Guided Core Needle Biopsy in The Diagnosis of Suspicious Breast Lesions: Radiologist’s perspectives

Ultrasound Guided Core Needle Biopsy in The Diagnosis of Suspicious Breast Lesions: Radiologist’s perspectives

Application of deep learning to predict underestimation in ductal carcinoma in situ of the breast with ultrasound

Clinical Feasibility of Microscopically-Guided Breast Needle Biopsy Using a Fiber-Optic Probe with Computer-Aided Detection

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