Rates of presurgical underestimation of breast cancer after standardized assessment of breast calcifications

Abstract

Purpose: To determine the frequency of histopathological underestimation of breast cancer after vacuum-assisted biopsy (VAB) in standardized assessment of breast calcifications compared to postsurgical diagnosis. Materials and methods: The retrospective study included acquired data of 506 consecutively examined women, who underwent VAB for the assessment of pure calcifications after standardized digital mammographic and sonographic imaging. 119/506 (24.5?%) women underwent further surgical procedures: 37 women had a surgical diagnostic excision biopsy, 82 women a surgical procedure based on a therapeutic concept. Presurgical results of VAB were compared with the postsurgical histopathological reports. Results: In 91/119 women (76.5?%) the final histology was malignant. The rate of ductal carcinoma in situ (DCIS) was 79.1?% (72/91) and the rate of invasive carcinoma was 20.9?% (19/91). In 9/37 women with diagnostic excision biopsy, the presurgical status of benign or uncertain changed to a postsurgical diagnosis of malignant (24.3?%). In?eight cases underestimation included DCIS (21.6?%) and in one case invasive cancer (2.7?%). Seven of the nine underestimated cases (77.8?%) resulted from excision biopsy of atypical epithelial proliferation of ductal type (AEPDT, positive predictive value 30.4?% (7/23)). After surgery due to DCIS in 7/71 women invasive breast cancer was diagnosed (9.9?%). In 11/82 women with oncological surgery, invasive cancer was already diagnosed by VAB. Conclusion: Underestimation of invasive cancer in terms of presurgical DCIS diagnosis can be minimized by the standardized assessment protocol to about 10?%. Underestimation of DCIS is mainly related to presurgical diagnosis of AEPDT. Key points:

Stereotactic vacuum-assisted breast biopsy (SVAB) in the management of suspicious calcifications

“…Infiltrating status has been underestimated in 4.76% of the cases, which can be considered a good result, when compared with the results published to date [9,26,28,45] (Table 3), although the underestimation criteria are not totally coincident in all the series consulted.…”

Digital Mammography Screening: Does Age Influence the Detection Rates of Low-, Intermediate-, and High-Grade Ductal Carcinoma in Situ?

“…The cancer registry was recently able to provide the nuclear grade of DCIS postsurgically, in combination with age of the women, with a low rate of missing values (6.3%). The use of postsurgical histologic findings is essential because presurgical histologic findings of DCIS that are based on minimal invasive biopsy samples may lead to underestimation of invasive components (18). Furthermore, data were obtained only for the baseline screening examinations of the statewide implementation phase of the program.…”