Histologic and Radiographic Analysis of Ductal Carcinoma In Situ Diagnosed Using Stereotactic Incisional Core Breast Biopsy

Objectives To investigate the risk of malignancy following stereotactic breast biopsy of calcifications classified as Breast Imaging Reporting and Data System (BI-RADS) 3, 4, and 5. Methods The study included women with pure calcifications (not associated with masses or architectural distortions) who underwent stereotactic breast biopsy at the Dutch Cancer Institute between January 2011 and October 2013. Suspicious calcifications (Breast Imaging Reporting and Data System 3, 4, or 5) detected on mammography were biopsied. All lesions were assessed by breast radiologists and classified according to the BI-RADS lexicon. Results Overall, 473 patients underwent 497 stereotactic breast biopsies. Sixty-six percent (326/497) of calcifications were classified B4, 30% (148/497) B3, and 4% (23/497) B5. Of the 226 (45%) malignant lesions, there were 182 pure ductal carcinoma in situ, 22 mixed ductal carcinoma in situ and invasive carcinomas (ductal or lobular), 21 pure invasive carcinomas, and one angiosarcoma. Malignancy was found in 32% (95% confidence interval [CI] 0.24 to 0.39) of B3, 49% (95% CI 0.43 to 0.54) of B4, and 83% (95% CI 0.61 to 0.95) of B5 calcifications. Conclusions Considering the high predictive value for malignancy in B3 calcifications, we propose that these lesions should be classified as suspicious (B4), especially in a screening setting.

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Is Ductal Carcinoma in Situ with “Possible Invasion” More Predictive of Invasive Carcinoma than Pure Ductal Carcinoma in Situ?

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2010.10.002 ◽

2012 ◽

Vol 63 (2) ◽

pp. 146-152 ◽

Cited By ~ 3

Author(s):

Tal Arazi-Kleinman ◽

Petrina A. Causer ◽

Sharon Nofech-Mozes ◽

Roberta A. Jong

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Clinical Indication ◽

Low Grade ◽

High Grade ◽

Sample Number

Objectives To compare the underestimation of ductal carcinoma in situ (DCIS) vs DCIS with “possible invasion” at breast biopsy and to determine if any factors related to clinical indication, imaging abnormality, biopsy, or DCIS-grade affected the likelihood of underestimation. Methods Of 3836 consecutive lesions that were biopsied by using a 14-gauge needle, 117 lesions revealed DCIS. Surgical pathology results of invasive carcinoma were compared with needle biopsy results of DCIS or DCIS with possible invasion. Clinical indication, imaging abnormality, biopsy guidance modality, sample number, and histologic grade were recorded. Yates corrected χ2 and Fisher exact tests were used to determine differences between groups. Results A total of 101 lesions were DCIS and 16 were DCIS with possible invasion at biopsy. Thirty-six of 117 lesions (31%) revealed invasive carcinoma at resection pathology. Invasive carcinoma was present more often when DCIS with possible invasion was diagnosed compared with pure DCIS (7/16 [44%] vs 29/101 [29%], P = .36). No factor, including clinical indication, imaging abnormality, biopsy guidance method, sample number, or grade, was found to significantly affect the likelihood of underestimation for lesions diagnosed as DCIS vs DCIS with “possible invasion.” The likelihood of pure DCIS underestimation significantly increased when lesions were high grade compared with either intermediate or low grade (18/44 [41%] vs 9/44 [21%] vs 2/10 [20%], P = .03). Conclusion For lesions biopsied by using a 14-gauge needle, there is a trend towards underestimation of the presence of invasive carcinoma when pathology reveals DCIS with possible invasion compared with pure DCIS. High-grade DCIS was significantly more likely to be underestimated.

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Image-guided core breast biopsy of ductal carcinoma in situ presenting as a non-calcified abnormality

European Journal of Radiology ◽

10.1016/s0720-048x(98)00020-5 ◽

1999 ◽

Vol 30 (3) ◽

pp. 231-236 ◽

Cited By ~ 10

Author(s):

Pamela J DiPiro ◽

Jack E Meyer ◽

Christine M Denison ◽

Thomas H Frenna ◽

Susan C Harvey ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Image Guided

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349 POSTER Avoiding inadequate excision margins by using harmonic scalpel and hook-wire localisation for non-palpable ductal carcinoma in situ after vacuum-assisted breast biopsy

European Journal of Surgical Oncology ◽

10.1016/s0748-7983(06)70784-3 ◽

2006 ◽

Vol 32 ◽

pp. S104

Author(s):

B. Szynglarewicz ◽

R. Matkowski ◽

P. Kasprzak ◽

P. Surowiak ◽

A. Maciejczyk ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Harmonic Scalpel ◽

Excision Margins ◽

Hook Wire

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A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-grade Ductal Carcinoma In Situ of the Breast

10.20944/preprints202111.0301.v1 ◽

2021 ◽

Author(s):

Luca Nicosia ◽

Anna Carla Bozzini ◽

Silvia Penco ◽

Chiara Trentin ◽

Maria Pizzamiglio ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Univariate Analysis ◽

Surgical Excision ◽

Low Grade ◽

Multivariable Model

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: 3100 VABBs were retrospectively reviewed among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients’ features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate analysis. Finally, we developed a predictive multivariable model based on the features which were significantly associated with the univariate analysis outcome. Results: the upgrade rate to invasive carcinoma was 10.8 %. At univariate analysis, the risk of upgrade was significantly lower in the absence of post- biopsy residual lesion (p<0.001), age > 50 (p=0.029), and in presence of low-grade DCIS only in specimens with microcalcifications (p=0.002). According to the final multivariable model, the predicted probability of diagnostic underestimation for a patient with all the three favourable features selected at univariate analysis was 1% (95% CI: 0.3%-4%). Conclusions: An easy to use predictive model of radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

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