Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy

Abstract

Objective: The objective of this study was to compare the underestimation rate of invasive carcinoma in cases with ductal carcinoma in situ (DCIS) at percutaneous ultrasound-guided core biopsies of breast lesions between 14-gauge automated coreneedle biopsy (ACNB) and 8-or 11-gauge vacuum-assisted biopsy (VAB), and to determine the relationship between the lesion type (mass or microcalcification on radiological findings) and the DCIS underestimation rate. Methods: We retrospectively reviewed imaging-guided biopsies of breast lesions performed from February 2003 to August 2008. 194 lesions were diagnosed as DCIS at ultrasound-guided core biopsy: 138 lesions in 132 patients by 14-gauge ACNB, and 56 lesions in 56 patients by 8-or 11-gauge VAB. The histological results of the core biopsy samples were correlated with surgical specimens. The clinical and radiological findings were also reviewed. The histological DCIS underestimation rates were compared between the two groups and were analysed for differences according to the clinical and radiological characteristics of the lesions. Results: The DCIS underestimation rate was 47.8% (66/138) for 14-gauge ACNB and 16.1% (9/56) for VAB (p,0.001). According to the lesion type on sonography, DCIS underestimation was 43.4% (63/145) in masses (47.6% using ACNB and 15.8% using VAB; p50.012) and 24.5% (12/49) in microcalcifications (50.0% using ACNB and 16.2% using VAB; p50.047). Conclusion:The underestimation rate of invasive carcinoma in cases with DCIS at ultrasound-guided core biopsies was significantly higher for ACNB than for VAB. Furthermore, this difference does not change according to the lesion type on ultrasound. Therefore, ultrasound-guided VAB can be a useful method for the diagnosis of DCIS lesions presented as either mass or microcalcification.

Ultrasound-guided cable-free 13-gauge vacuum-assisted biopsy of non-mass breast lesions

“…This result is identical to the rates reported by previous studies that used VAB (8-G or 10-G) devices and found that the DCIS underestimation rates decreased with larger acquired tissue samples, which were attributed to decreases in sampling errors [11, 16]. Furthermore, our underestimation rate with CCNB (28.2%) was lower than that of reported by previous studies (39%–67%) [11, 18–21]. Our routine CCNB practice involves the collection and review of >4 non-fragmented samples by a single, dedicated breast pathologist, which may explain our lower underestimation rate.…”

Risk predictors of underestimation and the need for sentinel node biopsy in patients diagnosed with ductal carcinoma in situ by preoperative needle biopsy

“…DCIS underestimation rates in patients diagnosed by CNB were about 10–40% 8, 10, 15, 16, which compared to the 5% of surgical excision and 13% of 11‐guaze VAB biopsy found in previous studies 16, 17. DCIS underestimation tends to decline as the retrieved volume of the specimen increases, which suggests that the retrieved volume of the specimen and the type of biopsy methods are important factors affecting the DCIS underestimation rate 18. In general, 8 or 11‐guage VAB is considered a more accurate tool in confirming benign or malignant lesions than 14‐guage CNB.…”

Non-mass-like lesions on breast ultrasound: classification and correlation with histology

“…One study has demonstrated that 95 % non-mass-like breast lesions on US also appeared as non-mass enhancement on magnetic resonance imaging (MRI), and it was also difficult for MRI to provide a differential diagnosis for these non-mass breast lesions [7]. Also, it has been reported that the histological agreement rate between US-guided core-needle biopsy and surgical histological diagnosis was significantly better for mass lesions than for non-mass-like lesions on US [8][9][10]. Therefore, an in-depth study of the US features of non-mass-like breast carcinoma appears to be of major importance.…”