US-guided 14G Core Needle Biopsy: Comparison Between Underestimated and Correctly Diagnosed Breast Cancers

Kim, Hana; Youk, Ji Hyun; Kim, Jeong Ah; Gweon, Hye Mi; Jung, Woo Hyun; Son, Eun Ju

doi:10.7314/apjcp.2014.15.7.3179

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…One of the limitations of CNB is the histologic underestimation of breast malignancy, which means that lesions found to be high-risk or DCIS by a percutaneous breast biopsy are upgraded to DCIS or invasive cancer after surgical excision. In previous studies, the underestimation rates ranged from 6.25% to 65% for ADH and from 16% to 66% for DCIS using CNB or vacuum-assisted biopsy [ 13 , 32 - 35 ]. Our underestimation rates were 24.5% for high-risk lesions (79 of 322) and 33.6% for DCIS (111 of 330), comparable with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience

et al. 2018

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PurposeThis study assessed the outcomes of ultrasound (US)-guided core needle biopsies (CNBs) of breast lesions with at least 2 years of follow-up to determine the false-negative rate and to evaluate the diagnostic accuracy of CNB.MethodsWe retrospectively analyzed 13,254 consecutive US-guided 14-gauge CNBs for breast lesions. We excluded biopsies if non-malignant biopsy result was not confirmed by surgical excision or US-guided vacuum-assisted biopsy, or fewer than 2 years of follow-up data were available. A total of 4,186 biopsies were excluded, and 9,068 breast masses from 7,039 women were included. The pathologic findings from each CNB were assessed using the standard diagnostic reference, defined based on the results of surgical excision, vacuum-assisted biopsy, or at least 2 years of long-term imaging follow-up. The false-negative rate and underestimation rate were calculated.ResultsOf the 9,068 CNBs, benign pathology was found in 64.2%, high-risk results in 3.5%, and malignant results in 32.3%. Of the 5,821 benign CNBs, an additional malignancy was found at excision in 63 lesions, leading to a false-negative rate of 2.0% (63 of 3,067). The underestimation rate was 33.6% (111 of 330) for ductal carcinoma in situ and 24.5% (79 of 322) for high-risk results at surgical excision. Most false-negative diagnoses (84.1%, 53 of 63) were recognized through imaging-histology correlations, and immediate rebiopsies were performed. Ten malignancies (15.9%, 10 of 63) had delayed diagnoses and showed progression in follow-up US imaging.ConclusionUS-guided 14-gauge CNB provided optimal diagnostic information. Imaging-histology correlations and appropriate imaging follow-up should be performed to avoid delayed diagnoses.

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Section: Discussionmentioning

confidence: 99%

Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience

et al. 2018

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Isolated Flat Epithelial Atypia: Upgrade Outcomes After Multidisciplinary Review–Based Management Using Excision or Imaging Surveillance

Xie

Whitman

Middleton

et al. 2023

Journal of Breast Imaging

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Objective To compare flat epithelial atypia (FEA) upgrade rates after excision versus surveillance and to identify variables associated with upgrade. Methods This single-institution retrospective study identified isolated FEA cases determined by percutaneous biopsy from April 2005 through July 2022 with excision or ≥2 years surveillance. All cases were recommended for excision or surveillance based on multidisciplinary discussion of clinical, imaging, and pathologic variables with emphasis on sampling adequacy and significant atypia. Truth was determined by pathology at excision or the absence of cancer on surveillance. Upgrade was defined as cancer occurring ≤2 cm from the biopsy site. Demographic, imaging, and biopsy variables were compared between those that did and did not upgrade. Results Among 112 cases of isolated FEA, imaging findings included calcifications in 81.3% (91/112), MRI lesions in 11.6% (13/112), and distortions or masses in 7.1% (8/112). Excision was recommended in 12.5% (14/112) and surveillance in 87.5% (98/112) of cases. Among those recommended for excision, 28.6% (4/14) of cases were upgraded, all to ductal carcinoma in situ. In those recommended for surveillance, 1.0% (1/98) were upgraded to invasive cancer. Overall, FEA had a 4.5% (5/112) upgrade rate, and 2.7% (3/112) also developed cancer >2 cm from the FEA. There were no significant differences in demographic, imaging, and biopsy variables between those that did and did not upgrade to cancer. Conclusion Multidisciplinary management of isolated FEA distinguishes those at higher risk of upgrade to cancer (28.6%) in whom surgery is warranted from those at low risk of upgrade (1.0%) who can be managed non-operatively.

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The appropriate number of preoperative core needle biopsy specimens for analysis in breast cancer

et al. 2021

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Ultrasound (US)-guided core needle biopsy (CNB) has been recognized as a crucial diagnostic tool for breast cancer. However, there is a lack of guidance for hospitals that are not equipped with adjunctive US. The aim of this study was to assess the sensitivity, specificity, and experience of freehanded CNB in the outpatient department, and to determine the minimum number of tissue strips required to obtain concordance for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), and tumor grade with the excised specimen. A prospective study was performed on 95 patients undergoing CNB and subsequent surgical procedures. The reliability of immunohistochemical assessments of the pathological type, tumor grade, ER, PR, and HER2 status in CNBs was compared with that of surgical specimens. Concordance between the CNBs and surgical samples was estimated as a percentage agreement, and analyzed using the chi-square test. A P < .05 was considered significant. The concordance rates of ER, PR, and HER2 status and tumor grade status between CNBs and surgically excised specimens were 97.9%, 91.6%, 82.1%, and 84.2%, respectively. The reliability of taking 2 tissue strips was similar to that of taking six tissue strips in distinguishing malignancy from benignancy, and determining the pathological type without the aid of US. Four tissue strips obtained by CNB showed good accuracy comparable to those obtained by surgical specimens in assessing ER, PR, and HER2 status and tumor grade. Two tissue strips obtained by CNB showed good accuracy in differentiating malignancy from benignancy, while at least 4 strips are recommended to obtain overall conformity of pathological biomarkers.

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US-guided 14G Core Needle Biopsy: Comparison Between Underestimated and Correctly Diagnosed Breast Cancers

Cited by 3 publications

References 15 publications

Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience

Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience

Isolated Flat Epithelial Atypia: Upgrade Outcomes After Multidisciplinary Review–Based Management Using Excision or Imaging Surveillance

The appropriate number of preoperative core needle biopsy specimens for analysis in breast cancer

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