Atypical Ductal Hyperplasia: Improved Accuracy with the 11-Gauge Vacuum-Assisted versus the 14-Gauge Core Biopsy Needle

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

“…While the present study identified five factors associated with underestimation in multivariate analysis, no single factor could define a subset with a \2% possibility of carcinoma at follow-up surgical excision. Consistent with these findings, while other series have identified factors associated with malignancy, no single clinical, radiological or pathological factor could identify lesions that could be safely followed rather than surgically excised [10,12].…”

“…Several studies have examined whether certain clinical, radiological or pathological factors exist which may predict the likelihood of malignancy [10][11][12]. A lesion can be considered ''probably benign'' if there is a \2% possibility of carcinoma, as indicated by the definition of category 3 in the Breast Imaging Reporting and Data System (BI-RADS) lexicon of the American College of Radiology [13].…”

Surgical excision of intraductal breast papilloma diagnosed on core biopsy

“…An argument can be made to use an 11‐gauge vacuum‐assisted biopsy needle instead because the gauge of the biopsy device and the size of the lesion are the two most significant predictors of histological underestimation 20 . However, this may still be not enough, as can be inferred from a previous study where although the histological underestimation of ADH was reduced when an 11‐gauge, rather than a 14‐gauge, biopsy needle was used, the possibility of missing a malignancy was still too high to recommend omitting surgical excision 21 . Increasing the number of cores obtained also failed to improve the detection of malignancy in papillary lesions 14 .…”

“…20 However, this may still be not enough, as can be inferred from a previous study where although the histological underestimation of ADH was reduced when an 11-gauge, rather than a 14-gauge, biopsy needle was used, the possibility of missing a malignancy was still too high to recommend omitting surgical excision. 21 Increasing the number of cores obtained also failed to improve the detection of malignancy in papillary lesions. 14 Taken together, these observations suggest that core biopsy cannot adequately exclude the presence of malignancy in papillary lesions.…”

Hyperplasie épithéliale atypique du sein : bilan des connaissances et pratique clinique

“…Toutes ces séries montrent un taux de sous-estimation de 17 à 38 %. Malgré l'augmentation de la taille des aiguilles à 11 G, voire à 9 G, qui améliore le taux de faux-négatifs, celui-ci reste trop important et une exérèse chirurgicale secondaire reste indispensable [46][47][48][49][50][51][52]. Certains auteurs ont étudié de manière rétrospective les séries de biopsies percutanées corrélées à l'exérèse chirurgicale secondaire : il apparaît que le nombre de foyers d'HCA inférieur à deux (voire trois) à la biopsie percutanée permet de ne pas avoir de sousestimation de CCIS ou CI [53][54][55] ; ces auteurs ajoutent parfois, comme critères de non reprise, la taille lésionnelle radiologique (inférieure à 6 mm) ou l'absence de microcalcifications résiduelles [53][54][55].…”