The Accuracy of Ultrasound, Stereotactic, and Clinical Core Biopsies in the Diagnosis of Breast Cancer, With an Analysis of False-Negative Cases

Dillon, Marcus L.; Hill, A. D. K.; Quinn, Cecily; O’Doherty, Ann; McDermott, Enda; O’Higgins, N.

doi:10.1097/01.sla.0000186186.05971.e0

Cited by 112 publications

(77 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has a preoperative accuracy of diagnosing breast cancer of approximately 97%, 11,17 and it also has been shown to decrease the rate of compromised margins, 18 reduce the overall number of operations 19 and allow for the planning of axillary surgery. In this study, it is also shown to have the additional benefit of identifying patients most suitable for breast-conserving surgery or those who would benefit from a wider excision at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy of a three-core retrieval policy had been validated in two previous studies. 11,12 The principle indication for stereotacticguided core biopsies was for lesions not seen on ultrasound. Stereotactic-guided core biopsies were performed in the upright position using a digital Siemens Optima machine (Solna, Sweden) and a spring-loaded biopsy device (Tru-Guidet, Bard Ltd, Crawley, UK).…”

Section: Image-guided Biopsymentioning

confidence: 99%

See 1 more Smart Citation

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

et al. 2008

View full text Add to dashboard Cite

Selection of patients for breast-conserving surgery relies on inexact parameters such as the preoperative estimation of lesion size. This study investigates the value of needle core biopsy findings, in particular, the relative quantity of DCIS, in improving patient selection for breast conservation. Patients undergoing breastconserving surgery for invasive ductal carcinoma from 1999 to 2004 were identified. Only patients who had a preoperative diagnosis of carcinoma (DCIS and invasive) on core biopsy were included. All core biopsies were reviewed by a breast histopathologist to document the quantity and characteristics of the DCIS component. Of a total of 281 patients, 46% (n ¼ 129) had invasive disease on core biopsy (group 1) and 54% (n ¼ 152) had either invasive disease with an accompanying DCIS component or DCIS only on core biopsy (group 2). The compromised margin rate for group 1 was 23% compared to 39% for group 2 (P ¼ 0.004). The rate of compromised margins increased progressively as the core biopsy DCIS component increased until a rate of 75% (n ¼ 18/24) was reached in patients with DCIS only on core biopsy. In patients with a DCIS component on core biopsy, the presence of necrosis (P ¼ 0.002), solid type architecture (P ¼ 0.008), high grade DCIS (P ¼ 0.007), calcification (P ¼ 0.003), and the relative proportion of DCIS present (Po0.001) were associated with compromised margins on univariate analysis. On multivariate analysis of this subgroup, the proportion of DCIS in this subgroup (P ¼ 0.048) was an independent predictor of compromised margins. The presence and relative proportion of DCIS on core biopsy provides important information as to whether patients are at risk of compromised margins. Documentation of these parameters may assist patient selection for breast-conserving surgery or identify patients who may benefit from wider margins at the time of initial operation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Image-guided Biopsymentioning

confidence: 99%

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

et al. 2008

View full text Add to dashboard Cite

show abstract

“…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].…”

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

View full text Add to dashboard Cite

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.

show abstract

“…The analysis of concordance was not straightforward. We initially sought to investigate imaging-histologic correlation in lung biopsy cases with the intent of emphasizing discordance as a method to prospectively identify missed carcinomas, as is done in breast imaging (8,(10)(11)(12)(13). However, we found that radiology reports varied significantly in diagnostic coverage and clarity depending on a radiologist's personal style, an observation also reported in the literature (20,21).…”

Section: Discussionmentioning

confidence: 99%

“…In mammography, with the adoption of the Breast ImagingReporting and Data System (BI-RADS), this notion of discordance fits naturally due to strict, unambiguous radiologic guidelines governing diagnostic conclusions. BI-RADS provides a framework that allows instances of discordance to receive special consideration such that ostensibly negative pathology in cases of high radiographic suspicion warrant prompt repeat biopsy (10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

Imaging–Histologic Discordance at Percutaneous Biopsy of the Lung

Arnold

Vangala

et al. 2015

Academic Radiology

View full text Add to dashboard Cite

Rationale and Objectives: The purpose of this study was to quantify the degree of imaging-histologic discordance in a cohort of patients undergoing computed tomography (CT)-guided lung biopsy for focal lung disease. Materials and Methods:A retrospective review was performed of 186 patients who underwent percutaneous lung biopsy of a parenchymal lesion at our institution between January and December 2009. Diagnostic radiology reports of CT or positron emission tomography-CTs performed before biopsy were used to classify the lesion as malignant or benign by five readers. Pathology reports of the biopsied lesions were classified by three readers. Inter-reader agreement and imaging-histologic concordance were quantified using kappa statistics. Discordant benign cases were then revisited to determine downstream effects.Results: Inter-reader agreement on report content was substantial or almost perfect with kappas >0.783. Kappas for concordance were as follows: malignant (0.448), primary lung cancer (0.517), metastatic disease to lung (0.449), benign (0.510), and overall agreement (0.381). Of the twelve discordant benign cases that were revisited, four were found to be false negatives, resulting in a delay in diagnosis.Conclusions: Our study of imaging-histologic discordance in percutaneous biopsy of lung lesions supports the need for imaging report standardization and improved integration and communication between the fields of radiology and pathology.

show abstract

The Accuracy of Ultrasound, Stereotactic, and Clinical Core Biopsies in the Diagnosis of Breast Cancer, With an Analysis of False-Negative Cases

Abstract: Ultrasound guidance should be used to perform core biopsies in evaluating all breast abnormalities visible on ultrasound. Adherence to principles of triple assessment following biopsy allows for early recognition of the majority of false-negative cases.

Cited by 112 publications

References 41 publications

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

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

Imaging–Histologic Discordance at Percutaneous Biopsy of the Lung

Contact Info

Product

Resources

About