Risk of Upgrade of Atypical Ductal Hyperplasia after Stereotactic Breast Biopsy: Effects of Number of Foci and Complete Removal of Calcifications

Kohr, Jennifer R.; Eby, Peter R.; Allison, Kimberly H.; DeMartini, Wendy B.; Gutierrez, Robert L.; Peacock, Sue; Lehman, Constance D.

doi:10.1148/radiol.09091406

Cited by 105 publications

(53 citation statements)

References 41 publications

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“…30.4 % (7/23) of the diagnoses of AEPDT in minimally invasive biopsy were not proved as atypical ductal hyperplasia (ADH) after excision surgery but were upgraded to a malignant diagnosis, mainly to DCIS diagnosis (85.7 %). Kohr et al concluded that surgical excision should be recommended even when ADH involves fewer than three foci and all mammographic calcifications have been removed by needle biopsy, because the upgrade rate was still 12 % [11]. Our results support that finding.…”

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confidence: 88%

Rates of Presurgical Underestimation of Breast Cancer after Standardized Assessment of Breast Calcifications

Timpe

Berkemeyer

Puesken

et al. 2015

Fortschr Röntgenstr

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Purpose: To determine the frequency of histopathological underestimation of breast cancer after vacuum-assisted biopsy (VAB) in standardized assessment of breast calcifications compared to postsurgical diagnosis. Materials and Methods: The retrospective study included acquired data of 506 consecutively examined women, who underwent VAB for the assessment of pure calcifications after standardized digital mammographic and sonographic imaging. 119/506 (24.5?%) women underwent further surgical procedures: 37 women had a surgical diagnostic excision biopsy, 82 women a surgical procedure based on a therapeutic concept. Presurgical results of VAB were compared with the postsurgical histopathological reports. Results: In 91/119 women (76.5?%) the final histology was malignant. The rate of ductal carcinoma in situ (DCIS) was 79.1?% (72/91) and the rate of invasive carcinoma was 20.9?% (19/91). In 9/37 women with diagnostic excision biopsy, the presurgical status of benign or uncertain changed to a postsurgical diagnosis of malignant (24.3?%). In eight cases underestimation included DCIS (21.6?%) and in one case invasive cancer (2.7?%). Seven of the nine underestimated cases (77.8?%) resulted from excision biopsy of atypical epithelial proliferation of ductal type (AEPDT, positive predictive value 30.4?% (7/23)). After surgery due to DCIS in 7/71 women invasive breast cancer was diagnosed (9.9?%). In 11/82 women with oncological surgery, invasive cancer was already diagnosed by VAB. Conclusion: Underestimation of invasive cancer in terms of presurgical DCIS diagnosis can be minimized by the standardized assessment protocol to about 10?%. Underestimation of DCIS is mainly related to presurgical diagnosis of AEPDT. Key Points: ??The standardized use of digital mammographic and sonographic imaging prior to vacuum-assisted biopsy is suitable for minimizing underestimation of invasive breast cancer. AEPDT represents a high risk diagnosis for underestimation of DCIS. Citation Format: ??Timpe L., Berkemeyer S., Puesken M. et?al. Rates of Presurgical Underestimation of Breast Cancer after Standardized Assessment of Breast Calcifications. Fortschr R?ntgenstr 2015; 187: 445???449

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confidence: 88%

Rates of Presurgical Underestimation of Breast Cancer after Standardized Assessment of Breast Calcifications

Timpe

Berkemeyer

Puesken

et al. 2015

Fortschr Röntgenstr

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“…In the literature, upgrade rate ranges from 0% to 17% (35). Kohr et al (36) found that there were no significant differences in upgrade rates based on whether the determinant mammographic calcifications were completely removed at stereotactic VABB. However, they found that upgrade to DCIS or invasive carcinoma was significantly less likely when ADH involved <3 foci than when it involved ≥3 foci.…”

Section: Discussionmentioning

confidence: 99%

Vacuum-assisted stereotactic breast biopsy in the diagnosis and management of suspicious microcalcifications

Esen

Tutar²,

Uras³

et al. 2016

Diagn Interv Radiol

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C urrently, the gold standard for breast biopsies is open excision of the suspected lesion. However, an excisional biopsy inevitably leaves a scar behind. The cost and morbidity associated with this procedure have prompted many physicians to evaluate less invasive and alternative procedures (1-3).Clustered suspicious microcalcifications can be a very early sign of malignancy, particularly typical for ductal carcinoma in situ (DCIS). Microcalcifications are usually detected on screening mammographies, and most of them cannot be identified on ultrasonography (US). Lesions detected only on mammography require stereotactic guidance for biopsy, and vacuum-assisted breast biopsy (VABB) is currently the biopsy method of choice for stereotactic biopsies. VABB is considered to be a safe procedure and is comparable to surgical biopsy for the characterization of microcalcifications (4, 5). Studies have shown that it is a very accurate biopsy method and is characterized by high-quality specimens, high calcification retrieval, and low rates of false-negative results (6-10). In case of microcalcifications, complete percutaneous excision is frequently possible, which leads to a decrease in sampling error as well as a decrease in upgrade rate, imaging-pathology discordance, and re-biopsy rate. The likelihood of subsequent growth on follow-up is also diminished. VABB is not a therapeutic procedure for malignant lesions; however, using VABB for diagnosis rather than surgical biopsy decreases the number of operations required (11-13).Vacuum biopsy can be used for the histopathologic diagnosis of all nonpalpable breast lesions; however, it is mostly reserved for mammographically detected lesions, mainly mi- BREAST IMAGING O R I G I N A L A R T I C L E PURPOSEWe aimed to present our biopsy method and retrospectively evaluate the results, upgrade rate, and follow-up findings of stereotactic vacuum-assisted breast biopsy (VABB) procedures performed in our clinic. METHODSTwo hundred thirty-four patients with mammographically detected nonpalpable breast lesions underwent VABB using a 9 gauge biopsy probe and prone biopsy table. A total of 195 patients (median age 53 years, range 32-80 years) with 198 microcalcification-only lesions with a follow-up of at least one year were included in the study. The location of the lesion relative to the needle was determined from the postfire images, and unlike the conventional technique, tissue retrieval was predominantly performed from that location, followed by a complete 360° rotation, if needed. RESULTSThe median core number was 8.5. Biopsy results revealed 135 benign, 24 atypical, and 39 malignant lesions. The total upgrade rate at surgery was 7.7% (6.1% for ductal carcinomas in situ and 10.5% for atypical lesions). Patients with benign lesions were followed up for a median period of 27.5 months, with no interval change. At the follow-up, scar formation was seen in 23 patients (17%); three of the scars were remarkable for resembling a malignancy. CONCLUSIONOur biposy method is fast and practica...

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“…Technical advances in percutaneous core needle biopsy, such as increasing needle diameter from 14-gauge to 11-gauge and adding a vacuum device, have allowed larger samples of tissue to be obtained (5,6), substantially improving the accuracy of diagnosis. Despite these improvements, the rate of underestimation for ADH has been reported as 10% to 26% for 11-gauge vacuum-assisted biopsy (VAB) (2,14,(21)(22)(23)(24)(25)(26)(27)(28). In this study, 11-gauge SVAB was associated with a lower rate of underestimation for ADH (20.6%), compared to USguided 14-gauge automated biopsy (41.7%) (P = 0.007).…”

Section: Discussionmentioning

confidence: 85%

Factors that impact the upgrading of atypical ductal hyperplasia

Gümüş

Mills²,

Gümüş³

et al. 2012

Diagn Interv Radiol

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Risk of Upgrade of Atypical Ductal Hyperplasia after Stereotactic Breast Biopsy: Effects of Number of Foci and Complete Removal of Calcifications

Abstract: The upgrade rate is significantly higher when ADH involves at least three foci. Surgical excision is recommended even when ADH involves fewer than three foci and all mammographic calcifications have been removed, because the upgrade rate is 12%.

Cited by 105 publications

References 41 publications

Rates of Presurgical Underestimation of Breast Cancer after Standardized Assessment of Breast Calcifications

Rates of Presurgical Underestimation of Breast Cancer after Standardized Assessment of Breast Calcifications

Vacuum-assisted stereotactic breast biopsy in the diagnosis and management of suspicious microcalcifications

Factors that impact the upgrading of atypical ductal hyperplasia

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