Underestimation of Atypical Ductal Hyperplasia at Sonographically Guided Core Biopsy of the Breast

Abstract

1347or DCIS [5], and ADH lesions frequently coexist with DCIS or invasive carcinoma [6]. For these reasons, lesions determined to be ADH at core needle biopsy often are found to be malignant tumors at subsequent surgery [7,8]. Reports [9][10][11][12][13][14][15][16] indicate a 20-56% rate of underestimation of ADH at stereotactic 14-gauge automated core biopsy and a 11-27% rate at stereotactic 11-gauge vacuum-assisted biopsy. Because most lesions containing ADH have calcifications, underestimation at percutaneous biopsy is most common for calcific lesions examined with stereotactic biopsy [17]. Few reports have addressed the rate of underestimation of ADH and factors affecting this rate at sonographically guided core biopsy [18][19][20][21]. The purpose of this study was to determine the rate of underestimation of ADH at sonographically guided core biopsy of the breast and to identify the factors involved. AJR 2008; 191:1347-1351 0361-803X/08/1915-1347 © American Roentgen Ray Society S onographically guided per cu taneous biopsy of the breast is an established alternative to surgical excision. The advantages of sonog raphy as a guidance technique include lack of ionizing radiation, use of nondedicated equipment, and real-time visualization of the biopsy needle. For lesions amenable to stereotactic and sonographically guided biop sy, sonographically guided biopsy is pref er able in terms of patient comfort, procedure time, and cost [1][2][3]. Underestimation of Atypical Wo m e n's I m ag i ng • O r ig i n a l R e s e a rc hAtypical ductal hyperplasia (ADH) is the most common high-risk lesion of the breast. It is defined as a ductal hyperplastic lesion that has cellular atypia and structural rigidity suggesting ductal carcinoma in situ (DCIS) but involving only one duct profile or an area less than 2 mm in diameter [4]. Pathologists have considerable interobserver variability in terms of determining whether a lesion is ADH W O M E N ' S I M A G I N GOBJECTIVE. The purpose of this study was to determine the rate of underestimation of atypical ductal hyperplasia (ADH) at sonographically guided core biopsy of the breast and to identify the factors involved.MATERIALS AND METHODS. We retrospectively reviewed 3,563 lesions con secutively evaluated with sonographically guided core biopsy between January 2002 and June 2006. Histologic analysis yielded ADH in 60 of the 3,563 lesions (1.7%). The rate of underestimation of ADH was determined by dividing the number of lesions that proved to be carcinoma at surgical excision by 44, the total number of lesions evaluated with excisional biopsy. Clinical, sonographic, and core biopsy features were analyzed to identify factors that affect the rate of underestimation of ADH.RESULTS. The rate of underestimation of ADH was found to be 48% (21 of 44 lesions). Underestimation of ADH was significantly less frequent for lesions evaluated with 11-gauge vacuum-assisted biopsy than for lesions evaluated with 14-gauge automated gun biopsy (22% [four of 18 lesions] vs 65% [17 of 26 lesions]...

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

“…The underestimation rates of ADH and DCIS have been reported to be 6.25-65% and 16.1-66.7% at variable gauges US-guided biopsy or stereotactic biopsy (Table 4). And underestimations range from 23.1 to 65% for ADH and from 29 to 66.7% for DCIS diagnosed using US-guided 14-gauge CNB have been stated previously (Crystal et al, 2005;Jang et al, 2008;Youk at al., 2008;Chae et al, 2009).…”

“…Limited core sample specimen by CNB could miss atypical ductal hyperplasia (ADH) that include breast cancer portion within the breast lesion. Hence, surgical excisional biopsy or operation has been considered, even when ADHs are diagnosed at CNB because 23-65% of those lesions were upgraded to DCIS or IDC when revaluated after operation (Jang et al, 2008;Chae et al, 2009). And DCIS underestimation occurs in CNB, which means a lesion yields DCIS at percutaneous breast needle biopsy with revealing invasive cancer at surgery (Suh et al, 2012).…”

“…Previous studies have suggested underestimation rates ranging from 6.25% to 65% for ADH and the underestimation rates of DCIS were from 16% to 66% by using various guiding methods including CNB or breast biopsy with vacuum assisted device (Crystal et al, 2005;Jang et al, 2008;Suh et al, 2012;Lee et al, 2013). There has been several studies about correlation with underestimation rate and clinical condition or radiologic findings such as Breast US or mammogram.…”

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

“…The high-risk lesion underestimation rate was defined as the quotient of these upgraded lesions and all excised high-risk lesions diagnosed at MRgVABB [24,26].…”

“…When these lesions are diagnosed at image-guided biopsy, the presence of an underlying malignancy may be underestimated, yielding a challenge in clinical management [20][21][22]. The management of high-risk lesions diagnosed on stereotactic or ultrasound-guided VABB has been very well researched [23][24][25][26][27][28] and surgical excision is usually recommended. There are scanty data regarding underestimation rate at MRgVABB and management of high-risk lesions diagnosed at MRgVABB [11,12,29].…”