Atypical hyperplasia in the era of stereotactic core needle biopsy

Brown, Tommy A.; Wall, Joseph W.; Christensen, Erik Damgaard; Smith, D.L.; Holt, Charlene A.; Carter, Preston L.; Patience, Troy; Babu, Sankaran S.; Williard, William

doi:10.1002/(sici)1096-9098(199803)67:3<168::aid-jso5>3.0.co;2-7

Cited by 73 publications

(16 citation statements)

References 11 publications

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“…4,12,13 Previously, it has been recommended to perform open-breast biopsy in all cases with a high-risk diagnosis on large-core needle biopsy. 14 Some investigators classify large-core needle biopsies containing complex sclerosing lesions (radial scars) as high risk as well, because of their reported 40% risk of being malignant at excision biopsy.…”

Section: Data Handling and Analysismentioning

confidence: 99%

Diagnostic accuracy of stereotactic large‐core needle biopsy for nonpalpable breast disease: Results of a multicenter prospective study with 95% surgical confirmation

Verkooijen

2002

Intl Journal of Cancer

140

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Stereotactic large-core needle biopsy is increasingly applied for the diagnosis of nonpalpable breast disease. Our study examines whether this minimally invasive technique is sufficiently accurate to replace surgical breast biopsy. In a prospective multicenter study, 973 consecutive women with 1,029 nonpalpable breast lesions were offered stereotactic 14-gauge needle biopsy. If the needle biopsy yielded breast cancer, the patient was offered therapeutic surgery. Surgical biopsy was proposed in cases of needle biopsies without malignancy. An expert panel reviewed all discrepancies in histologic diagnosis between the needle biopsy and open biopsy. Forty-five patients withdrew from participation and 113 (11%) planned needle biopsy procedures were cancelled. Of the 871 successful biopsy procedures, 95% were confirmed surgically. In 13 cases (1.5%), insufficient material was obtained for histologic assessment. Fifty-five percent of the needle biopsies were diagnosed as malignant (290 invasive cancers, 190 ductal carcinoma in situ). Thirteen of the 322 lesions (4%, 95% CI 2-7%) with a benign needle biopsy diagnosis contained malignancy after surgery. Six of the 26 (23%, 95% CI 9 -44%) lesions with a high-risk diagnosis (atypical ductal or lobular hyperplasia or lobular carcinoma in situ) were diagnosed as malignant after surgery. Five of the 30 lesions containing normal breast tissue held malignancy (17%, 95% CI 6 -35%). Guidelines for the management of different categories of needle biopsy diagnoses were made. Application of these guidelines to the present findings resulted in sensitivity and specificity rates of 97% (95% CI 95-98%) and 99% (95% CI 97-100%), respectively. Stereotactic large-core needle biopsy is an accurate diagnostic instrument for nonpalpable breast disease. It may safely replace needle localised open-breast biopsy provided that high-risk and normal breast tissue diagnoses are followed by needle or openbreast biopsy.

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Section: Data Handling and Analysismentioning

confidence: 99%

Diagnostic accuracy of stereotactic large‐core needle biopsy for nonpalpable breast disease: Results of a multicenter prospective study with 95% surgical confirmation

Verkooijen

2002

Intl Journal of Cancer

140

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“…The presence of a borderline lesion in open breast biopsies indicates an elevated risk of breast cancer [3][4][5]. Previous studies have shown that finding a borderline lesion in large-core needle biopsies is an indication for open breast biopsy because in 23-50% of the cases the excision biopsy will yield malignancy [2,[6][7][8][9][10]. In cases of ductal carcinoma in situ or invasive breast cancer, surgery is required, including axillary dissection or sentinel node biopsy in cases of invasive breast cancer.…”

Section: (Statistical) Analysismentioning

confidence: 99%

Interobserver variability between general and expert pathologists during the histopathological assessment of large-core needle and open biopsies of non-palpable breast lesions

Verkooijen

Peterse

Schipper

et al. 2003

European Journal of Cancer

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The purpose of this study was to assess whether general pathologists are able to make as accurate and reproducible a diagnosis on large-core needle biopsies as on open breast biopsy specimens. A total of 688 patients underwent a stereotactic large-core (14G) needle biopsy and subsequent surgical excision of 718 non-palpable breast lesions. Forty-two pathologists from 10 departments of pathology (generalists) made a diagnosis on both the needle and open biopsy specimens. Afterwards, three pathologists and two radiologists with extensive experience in breast pathology (experts) diagnosed all of the biopsy specimens. The general pathologists made a similar histological diagnosis as the experts in 632 (88%) of the needle biopsies and 649 (90%) of the open biopsy specimens. Accordingly, the interobserver agreement for the diagnosis of large-core needle biopsies between the general and experts pathologists was excellent (kappa 0.83) and not significantly different from the interobserver agreement for the diagnosis of open breast biopsies (kappa 0.86). However, many inconsistencies were observed in the category of borderline lesions: only 24% of the large-core needle biopsies and 43% of the open biopsies with an expert diagnosis of 'borderline' were diagnosed similarly by the general pathologists. Additionally, the risk of benign/malignant inconsistencies between general pathologists and experts was approximately 1 in 55 for both needle and open biopsies. #

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“…Several studies have already demonstrated that when ADH is diagnosed on large-core needle biopsy, the risk of malignancy at surgical biopsy is 33-52% (Liberman et al, 1995;Gadzala et al, 1997;Moore et al, 1997;Fuhrman et al, 1998). Similarly, histological diagnoses of radial scar, lobular carcinoma in situ and atypical lobular hyperplasia on large-core needle biopsy are often associated with invasive or in situ carcinomas (Lee et al, 1997;Liberman et al, 1997;Brown et al, 1998;Fuhrman et al, 1998), and therefore always an indication for surgical biopsy.…”

Section: Meta-analysis Of Diagnostic Accuracymentioning

confidence: 99%

Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis

Verkooijen¹,

Buskens

et al. 2000

Br J Cancer

133

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For the evaluation of non-palpable lesions of the breast, image-guided large-core needle biopsies are increasingly replacing needle-localized open breast biopsies. In this study, the diagnostic accuracy of this minimally invasive technique was evaluated by reviewing the available literature. Five cohort studies were included in a meta-analysis. Sensitivity rate, histological agreement between needle biopsy and subsequent surgery or long-term mammographic follow-up and clinical consequences for different disease prevalences were assessed. The sensitivity rate of large-core needle biopsy for the diagnosis of breast cancer was high (97%). The reclassified agreement rate between core biopsy and subsequent surgical biopsy or long-term mammographic follow-up was also high (94%). In case of 20% breast cancer prevalence among women referred after screening (as in the US), the risk of breast cancer despite benign large-core needle biopsy result is less than 1%. In European countries, however, prevalence of breast cancer among referred women is 60–70%. This would result in a risk of breast cancer despite benign large-core needle biopsy result of 4–6%. The results of this meta-analysis indicate that the image guided large-core needle biopsy is a promising alternative for the needle localized breast biopsy. However, additional research is needed to explore the limiting factors of the technique. Without such detailed knowledge, a benign histological diagnosis on large-core needle biopsy in countries with high prevalence of malignancy among referred women should be interpreted with caution. © 2000 Cancer Research Campaign

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Atypical hyperplasia in the era of stereotactic core needle biopsy

Cited by 73 publications

References 11 publications

Diagnostic accuracy of stereotactic large‐core needle biopsy for nonpalpable breast disease: Results of a multicenter prospective study with 95% surgical confirmation

Diagnostic accuracy of stereotactic large‐core needle biopsy for nonpalpable breast disease: Results of a multicenter prospective study with 95% surgical confirmation

Interobserver variability between general and expert pathologists during the histopathological assessment of large-core needle and open biopsies of non-palpable breast lesions

Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis

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