Minimizing underestimation rate of microcalcifications excised via vacuum-assisted breast biopsy: a blind study

The mammographic appearance of ductal carcinoma in situ (DCIS) is mostly observed as microcalcifications. Although stereotactic vacuum-assisted breast biopsy (VABB) is a reliable alternative to surgical biopsy for suspicious microcalcifications, underestimation of VABB-proven DCIS is inevitable in clinical practice. We therefore retrospectively analyzed the variables in the prediction of DCIS underestimation manifesting as microcalcifications only proved by stereotactic VABB. In 1147 consecutive VABB on microcalcification-only lesions from 2010 to 2016, patients diagnosed with DCIS were selected to evaluate the underestimation rate. The analyzed variables included clinical characteristics, mammographic features, VABB procedure, and biomarkers. Univariate and multivariate analyses were used, and a p value < 0.05 was considered statistically significant. Of the 131 VABB-proven DCIS, 108 cases were diagnosed with DCIS and 23 were upgraded to invasive ductal carcinoma (IDC) after subsequent surgery. The small extent of microcalcification, grouped microcalcifications distribution, nearly complete microcalcification removal, and non-calcified specimens without DCIS were low for DCIS underestimation. Among them, the results of non-calcified specimens with or without DICS were the only statistically significant variables by multivariate logistic regression. These results indicate that the histology of non-calcified specimens was highly predictive of DCIS underestimation. Specimens without DCIS had a low upgrade rate to IDC.

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Is zero underestimation feasible? Extended Vacuum-assisted breast biopsy in solid lesions – a blind study

World Journal of Surgical Oncology ◽

10.1186/1477-7819-5-53 ◽

2007 ◽

Vol 5 (1) ◽

Cited By ~ 16

Author(s):

George C Zografos ◽

Flora Zagouri ◽

Theodoros N Sergentanis ◽

Dimitra Koulocheri ◽

Afroditi Nonni ◽

...

Keyword(s):

Breast Biopsy ◽

Blind Study ◽

Solid Lesions

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Histological underestimation of a 9-gauge stereotactic vacuum-assisted breast biopsy system compared with surgical excision at a tertiary hospital in South Africa

South African Journal of Radiology ◽

10.4102/sajr.v20i1.818 ◽

2016 ◽

Vol 20 (1) ◽

Author(s):

Michael Pieters ◽

Susan Otto ◽

Gina Joubert

Keyword(s):

Breast Imaging ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Surgical Excision ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Cross Sectional ◽

Ductal Hyperplasia ◽

Underestimation Rate

Background: Breast cancer is a major cause of morbidity and mortality worldwide. Certain lesions encountered on mammography require histological assessment of biopsy samples to identify benign versus malignant disease. Stereotactic vacuum-assisted breast biopsy (SVAB) is a useful technique, especially for non-palpable microcalcific lesions, and was introduced at our institution in 2011.Objectives: To determine whether the histological underestimation from 9-gauge SVABs performed at our institution is within acceptable limits.Method: In this cross-sectional study, 9-gauge stereotactic biopsy histology results and breast imaging and reporting data system (BI-RADS) findings of 158 lesions (from 153 patients) were analysed and the histological findings compared with surgical excision histology results (54 lesions) to determine histological underestimation (upgrade rates).Results: One out of eight cases of ductal carcinoma in situ (DCIS) was underestimated, yielding a DCIS underestimation rate of 12.5%.Conclusion: The DCIS underestimation obtained from the present study in our institution was on a par with other authors’ findings and was therefore within acceptable limits. Atypical ductal hyperplasia underestimation could not be reliably obtained with the small study population.Keywords: Stereotactic vacuum assisted breast biopsy; histological underestimation; histological upgrade

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MR imaging-guided vacuum assisted breast biopsy: Radiological-pathological correlation and underestimation rate in pre-surgical assessment

European Journal of Radiology Open ◽

10.1016/j.ejro.2020.100244 ◽

2020 ◽

Vol 7 ◽

pp. 100244

Author(s):

Rosaria Meucci ◽

Adriana Pistolese Chiara ◽

Tommaso Perretta ◽

Gianluca Vanni ◽

Ilaria Portarena ◽

...

Keyword(s):

Mr Imaging ◽

Breast Biopsy ◽

Pathological Correlation ◽

Underestimation Rate

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Accuracy and upgrade rates of stereotactic vacuum-assisted breast biopsy: Impact of number of core samples taken on malignancy underestimation rates.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.20 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 20-20

Author(s):

J. A. Vossen ◽

S. D. Edwards ◽

M. Pronovost ◽

P. Reeser

Keyword(s):

Breast Biopsy ◽

Ductal Carcinoma ◽

Surgical Excision ◽

Accurate Information ◽

Breast Lesions ◽

Core Samples ◽

Significant Difference ◽

Stereotactic Vacuum Assisted Biopsy ◽

Underestimation Rate ◽

The Impact

20 Background: There are multiple options for the diagnostic evaluation of mammographic suspicious breast abnormalities. The therapeutic strategy is often based on lesion histopathological information obtained from stereotactic vacuum-assisted biopsy (VAB). Therefore, accurate information obtained by VAB is very important. This study was performed to evaluate the impact of the number of core samples obtain during VAB on malignancy underestimation rates for mammographically detected breast lesions. Methods: The pathologic results of 128 consecutive stereotactic biopsies (January 2010-December 2010) were retrospectively reviewed. All biopsies were performed using a 9-gauge needle. Pathologic results of core biopsies and surgical excision were compared. Underestimation rates of malignancy were calculated and correlation was made with the number of core samples obtained. Results: Surgical excision was performed on 41% (52/128) lesions; 4 benign, 19 indeterminate and 29 malignant. Overall malignancy underestimation rate was 19%. There were 8 cases of ductal carcinoma in situ (DCIS) on core biopsy that were proven to be invasive ductal carcinoma (IDC) on surgical excision. There was one case of benign microcalcifications that was proven to be lobular neoplasia (LN). There was one case of an atypical papillary lesion that was proven to be DCIS. There was a significant difference (p=0.02) between the mean number of core samples taken in the underdiagnosed lesions (8, range 6-12) and the concordant lesions (10, range 6-20). Conclusions: In the case of stereotactic VAB diagnosis of breast lesions, the underestimation rate of malignancy is more likely with a lower number of core samples obtained.

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