Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy.

Burbank, Fred

doi:10.1148/radiology.202.3.9051043

Cited by 311 publications

(136 citation statements)

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“…Recent studies have found improved accuracy with the 14-gaugevacuum-assisted biopsy device (Mammotome; Biopsys Mcdi cal [Ethicon Endo-Surgery, a Johnson & Johnson company], Irvine, CA) compared with the 14-gauge large-core biopsy device in characterizing both atypical ductal hyper plasia lesions [9â€" I 1] and ductal carcinoma in situ (DCIS) lesions [9] and in capturing calcifications (as shown on specimen radio graphs) [12â€ "14]. The 14-gauge vacuum-as sisted device also completely removed a higher percentage oflesions on which biopsy was performed as evaluated on images after biopsy [15â€ "17].…”

Section: N Eedle-localized Breast Biopsy Hasmentioning

confidence: 99%

Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques.

Jackman¹,

Marzoni²,

Nowels³

1998

American Journal of Roentgenology

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RogerJ.FrancisA. Marzoni,Jr.2 KentW. Nowels3OBJECTIVE. The purposeof our studywas to evaluatehow often histologicallybenign lesions were completely removed as shown by the initial mammogram after biopsy. We corn pared three percutaneousbiopsy techniques.MATERIALS AND METHODS. Retrospective review wasperformedon 1206 consec utive impalpable breast lesions having percutaneous stereotactic biopsies done on a prone bi opsy table using 14-gauge automated large-core needles (n = 721); 14-gauge directional vacuum-assisted probes (n = 192); and 1I-gauge directional vacuum-assisted probes (n = 293). Lesions that were histologically benign and that did not have subsequent surgical cxci sion had mammographic follow-up. The 667 initial mammograms after biopsy (advised to be doneat 6 or 12 monthsand accomplishedat 1â€"53 months[median,7 months]after biopsy) were reviewed to see if the lesions were no longer apparent.RESULTS. The lesion was absentin 9% (40/422) of lesionsfor which 14-gaugelarge core biopsy was used, 22% (21/95) of lesions for which 14-gauge vacuum-assistedbiopsy was used, and 64% (96/150) of lesions for which I I-gauge vacuum-assisted biopsy was used

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Section: N Eedle-localized Breast Biopsy Hasmentioning

confidence: 99%

Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques.

Jackman¹,

Marzoni²,

Nowels³

1998

American Journal of Roentgenology

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“…Previous studies have shown that while CNB is highly reliable and sensitive for distinguishing between malignant and benign disease [1][2][3], it is less reliable for diagnosing atypical ductal hyperplasia (ADH). For patients diagnosed with ADH at CNB, the rate of upgrade to ductal carcinoma in situ or invasive cancer at follow-up surgical excision is reported as 19-87% [4][5][6][7][8][9]. Therefore, follow-up surgical excision is generally recommended when ADH is diagnosed at CNB.…”

Section: Introductionmentioning

confidence: 99%

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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“…[1][2][3][4][5][6] With the increasing use of needle core biopsy as the initial diagnostic workup in dealing with breast lesions, and the widespread use of mammographic screening resulting in increased detection of asymptomatic calcifications, more and more ductal carcinomas in situ (DCISs) are being detected using needle core biopsy. However, some cases of needle core biopsy-diagnosed DCISs turned out to be invasive in the final excisions.…”

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confidence: 99%

Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

Chan

Vong

et al. 2010

Modern Pathology

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A significant proportion of ductal carcinomas in situ (DCISs) of the breast diagnosed on core biopsies had invasion upon excision. An assessment of various invasion predictors in the biopsies yielded conflicting results. A cohort of 157 cases with needle core biopsy diagnosed with DCISs (including 109 histologically proven DCISs, and 48 cases with invasion upon excision) were evaluated for the numbers of positive and total cores, the percentage of positivity, lobular cancerization, tumor nuclear grade, necrosis, calcification, predominate histological pattern, lymphocytic infiltrate and excisional tumor size. The mean positive core percentage and excisional tumor size were 76% and 2.8 cm for invasive and 66% and 1.9 cm for noninvasive groups. In the biopsy of the invasive group, cancerization of lobules was present in 52%, and nuclear grades 1, 2 and 3 were present in 31, 31 and 38%, respectively. Large comedo and small noncomedo necroses were present in 48 and 10%, whereas large and small calcifications were present in 16 and 21%. Solid, cribriform and papillary patterns were observed in 88, 38 and 21%, respectively. Moderate to marked lymphoid infiltrate was present in 31%. In the biopsy of the noninvasive group, cancerization of lobules was present in 69%, and the nuclear grades 1, 2 and 3 were present in 23, 48 and 29%, respectively. Large comedo and small noncomedo necroses were present in 35 and 11%, whereas large and small calcifications were present in 33 and 23%. Solid, cribriform and papillary patterns were observed in 85, 39 and 9%, respectively. Moderate to marked lymphoid infiltrate was present in 36%. Comparing these groups, a higher positive core percentage, papillary pattern and less cancerization of lobules in the cores and larger excisional tumor size were associated with a higher chance of invasion. Calcification, necrosis and nuclear grade were not significant invasion predictors.

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Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy.

Abstract: Directional, vacuum-assisted biopsy resulted in statistically significantly fewer cases of ADH or DCIS underestimation of disease without clinical complications or the creation of postbiopsy mammographic lesions.

Cited by 311 publications

References 0 publications

Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques.

Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques.

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

Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

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