scholarly journals Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

Breast Care ◽  
2014 ◽  
Vol 10 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Aykut Soyder ◽  
Füsun Taşkın ◽  
Serdar Ozbas
Keyword(s):  
Core Biopsy ◽  
Breast Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Breast Lesions ◽  
Core Needle ◽  
Ductal Carcinomas ◽  
Histological Results

Background: The objectives of this study were to determine the frequency of imaging-histological discordance and to compare the frequency of carcinoma between discordant lesions at ultrasound (US)-guided core needle biopsy. Materials and Methods: From November 2009 to June 2012, we performed US-guided 14-gauge core needle biopsies on 989 breast lesions in 961 women. We reviewed 58 (5.8%) cases that had imaging-histological discordance after percutaneous breast biopsy and underwent subsequent excisional biopsy. The clinical, radiological, and histological findings were reviewed for those 58 cases. Results: Among the 58 cases, subsequent excisions revealed 16 (27.5%) malignancies, which were categorized as 9 (15.5%) invasive ductal carcinomas, 4 (6.9%) malignant phyllodes tumors, and 3 (5.1%) ductal carcinomas in situ. Conclusion: The malignancy rate of 27.5% suggests that surgical excision should be performed in those cases presenting with imaging-histological discordance after US-guided core biopsy. Careful correlation of clinical, radiological, and histological results as well as appropriate follow-up are essential.

Ultrasound-guided core needle biopsy of non-palpable breast lesions: a prospective analysis in 204 cases

2005 ◽  
Vol 46 (7) ◽  
pp. 690-695 ◽  
Author(s):  
A. Vega BolÍvar ◽  
P. Alonso-Bartolomé ◽  
E. Ortega GarcÍa ◽  
F. Garijo Ayensa
Keyword(s):  
Core Needle Biopsy ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Core Biopsy ◽  
Breast Biopsy ◽  
Diagnostic Yield ◽  
Breast Lesions ◽  
Core Needle ◽  
Palpable Breast

Purpose: To assess the diagnostic value of ultrasound (US)-guided 14 G core needle breast biopsy in non-palpable suspicious breast lesions. Material and Methods: From August 1997 to April 2001, 198 patients with 204 suspicious non-palpable breast lesions underwent US-guided large core needle biopsy. Biopsies were performed with a free-hand technique using US equipment with a 7.5 MHz linear-array transducer; a minimum of three cores were obtained from each lesion. Pathological findings in US-guided core biopsy were correlated to findings in subsequent surgery or long-term (more than 2 years) imaging follow-up. Results: Among the 204 non-palpable breast lesions for which histopathological findings were obtained by US-guided core biopsy, 118 were malignant (114 carcinoma, 2 metastasis, 1 lymphoma, and 1 malignant phyllodes tumor) and 86 were benign (4 carcinoma and 82 benign lesions confirmed at surgery or after at least 2 years of follow-up). Sensitivity, specificity, positive predictive value, and negative predictive value for diagnosis of malignancy in our series were 97%, 100%, 100%, and 95%, respectively. Diagnostic yield with 1, 2, 3, and 4 specimens per lesion was 73.5%, 88%, 94%, and 97.5%, respectively. Conclusion: US-guided core needle biopsy is a sensitive percutaneous biopsy method for diagnosing non-palpable breast lesions. To achieve a high diagnostic yield, a minimum number of three cores per lesion is advisable.

Papillary Lesions on Core Breast Biopsy: Excisional Biopsy for All Patients?

2013 ◽  
Vol 79 (12) ◽  
pp. 1238-1242 ◽  
Author(s):  
Lee J. McGhan ◽  
Barbara A. Pockaj ◽  
Nabil Wasif ◽  
Marina E. Giurescu ◽  
Ann E. McCullough ◽  
...  
Keyword(s):  
Papillary Carcinoma ◽  
Breast Biopsy ◽  
Lobular Carcinoma ◽  
Significant Proportion ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Lesion Size ◽  
Papillary Lesions

Excisional biopsy has been recommended for papillary lesions diagnosed on core needle biopsy (CNB) because a significant proportion of cases are upstaged to in situ/invasive cancer after surgical excision. The study goals were to identify patients at lowest risk of upstaging in whom excisional biopsy may potentially be avoided. We retrospectively evaluated 46 patients with a papillary lesion on CNB. Six patients were upstaged overall (13%), to intraductal papillary carcinoma (7%), invasive papillary carcinoma (4%), and mixed invasive ductal/lobular carcinoma (2%). The upstaging rate for patients with atypia on CNB was higher than for patients without atypia (33 vs 3%, P = 0.011). No patient younger than 65 years was upstaged to in situ or invasive carcinoma, and the mean lesion size was also higher among patients who were upstaged ( P > 0.05). Patients younger than 65 years with small papillary lesions lacking atypia on CNB may therefore represent a low-risk group that may be offered close clinical and radiologic follow-up.

Is Excisional Biopsy Needed for Pure FEA Diagnosed on a Core Biopsy?

2020 ◽  
Vol 86 (9) ◽  
pp. 1088-1090
Author(s):  
Jennifer L. Miller-Ocuin ◽  
Brett B. Fowler ◽  
Daniel L. Coldren ◽  
Akiko Chiba ◽  
Edward A. Levine ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Core Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Invasive Cancer ◽  
Architectural Distortion ◽  
Core Needle ◽  
Ductal Hyperplasia

Background The management of flat epithelial atypia (FEA) on core needle biopsy remains controversial. The upstaging rates after surgical excision are variable. In this study, we seek to determine the upstaging rate of FEA at our institution. Methods Patients with a diagnosis of FEA were identified from the institution’s pathology database from 2009 to 2018. Patients were included in the study if FEA alone, without atypia or cancer, was identified on core needle biopsy. Patient demographics, imaging, management, and pathology characteristics were obtained. Statistical analysis performed using IBM SPSS 26.0 (Armonk, NY, USA). Results FEA was diagnosed on core needle biopsy in 235 patients from 2009 to December 2018. Forty-eight patients met the inclusion criteria. The majority of patients presented with calcifications on mammogram (n = 21, 64%) with the remainder as masses (n = 6, 18%) or architectural distortion (n = 6, 18%). Of those, 15 (31%) patients declined surgical excision, of which none developed cancer over a mean follow-up of 4.4 years. Of the 33 (69%) patients undergoing excisional biopsy, 17 (52%) confirmed FEA, 11 (33%) had benign findings, and 3 (9%) demonstrated atypical ductal hyperplasia on final pathology. One (3%) case revealed ductal carcinoma in situ (DCIS) and 1 (3%) was upgraded to invasive cancer for an overall upstaging rate of 4% (2/48). After a mean follow-up of 3.4 years, none of the excisional biopsy patients developed invasive breast cancer. Adjuvant therapy was used in the cases of DCIS and invasive cancer; however, chemoprevention with raloxifene or tamoxifen was not chosen by any of the remaining patients. Conclusion In our cohort, expectant management of FEA alone appears to be a safe option as our upstaging rate to DCIS or invasive cancer for FEA diagnosed on core biopsy was only 4%. Our study suggests that close follow-up is a safe and feasible option for pure FEA without a radiographic discordance found on core biopsy.

scholarly journals The accuracy of ultrasound guided 14–gauge core needle breast biopsy: Correlation with surgical excision or long term follow–up

2011 ◽  
Vol 1 (3) ◽  
pp. 222-226 ◽  
Author(s):  
Sumaporn Makkun ◽  
Jenjeera Prueksadee ◽  
Jatuporn Chayakulkheeree ◽  
Darunee Boonjunwetwat
Keyword(s):  
Breast Biopsy ◽  
Surgical Excision ◽  
Ultrasound Guided ◽  
Core Needle ◽  
Long Term Follow Up

scholarly journals The growing fibroadenoma

2015 ◽  
Vol 4 (4) ◽  
pp. 204798161557227 ◽  
Author(s):  
Linda M Sanders ◽  
Rana Sara
Keyword(s):  
Young Women ◽  
Retrospective Review ◽  
Core Biopsy ◽  
Surgical Excision ◽  
Know How ◽  
Phyllodes Tumors ◽  
Stereotactic Guidance ◽  
Risk Of Cancer

Background Fibroadenomas (FAs) are the most common tumors of the breast clinically and pathologically in adolescent and young women but may be discovered at any age. With increasing use of core biopsy rather than excision for diagnosis, it is now commonplace to follow these lesions with imaging. Purpose To assess the incidence of epithelial abnormalities (atypia, in situ or invasive, ductal or lobular malignancies) in FAs diagnosed by core biopsy and to re-evaluate the management paradigm for any growing FA. Material and Methods A retrospective review of the senior author’s pathology results over 19 years identified 2062 nodular FAs (biopsied by ultrasound or stereotactic guidance). Eighty-three core biopsied FAs were identified which subsequently enlarged. Results Twelve of 2062 of core biopsied nodules demonstrated atypia, in situ, or invasive malignancy (ductal or lobular) within or adjacent to the FA (0.58%). Eighty-three FAs enlarged and underwent either surgical excision ( n = 65), repeat core biopsy ( n = 9), or imaging follow-up ( n = 9). The incidence of atypia, in situ or invasive malignancy was 0/83 (0%). Two enlarging FAs were subsequently surgically diagnosed as benign phyllodes tumors (PT). Conclusion Malignancy in or adjacent to a core biopsied FA is rare. The risk of cancer in a growing FA is even rarer; none were present in our series. FAs with abnormal epithelial abnormalities require excision. Otherwise, FAs without epithelial abnormality diagnosed by core biopsy need no specific follow-up considering the negligible incidence of conversion to malignancy. The breast interventionalist must know how to manage discordant pathology results.

scholarly journals Pure Radial Scars Do Not Require Surgical Excision When Concordant and Benign at Image-guided Breast Biopsy

2021 ◽  
Author(s):  
Maria Piraner ◽  
Kelly D’Amico ◽  
Lawrence L Gilliland ◽  
Mary S Newell ◽  
Michael A Cohen
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Breast Imaging ◽  
Breast Biopsy ◽  
Surgical Excision ◽  
Study Cohort ◽  
Core Needle ◽  
Imaging Characteristics

Abstract Objective To determine the best management option (surgical excision versus imaging surveillance) following the diagnosis of pure radial scars (RSs) and RSs with associated additional high-risk lesions (HRLs) encountered on percutaneous core-needle breast biopsy. Methods An IRB–approved retrospective review of the breast imaging reporting system database was performed to identify all cases of pure RS alone or RS plus an additional HRL (papilloma, atypia, lobular neoplasia) diagnosed on core-needle biopsy, from 2007 to 2016, at four breast centers in our institution. Cases with associated malignancy, discordant radiologic-pathologic results, or those lost to follow-up were excluded. The remaining cases were evaluated to determine results of either subsequent surgical excision or long-term follow-up imaging (minimum of two years). Additional data recorded included clinical presentation, breast density, personal and family history of breast cancer, lesion imaging characteristics, and biopsy method. Results The study cohort included 111 patients with 111 lesions: 56.8% (63/111) with RS alone (pure) and 43.2% (48/111) with RS plus additional HRL(s). Out of the 63 radiologic-pathologic concordant pure RSs, there were no upgrades to malignancy in 51 subsequent surgical excisions or 12 long-term surveillance cases (0/63, 0%). Out of the 48 RSs plus additional HRL(s), there were 2 upgrades to malignancy (2/48, 4.2%). Conclusion Cases of radiologic-pathologic concordant pure RS diagnosed at core-needle biopsy do not require surgical excision. On the other hand, surgical excision should be considered for RS plus additional HRLs diagnosed at core-needle biopsy.

Is Excisional Biopsy and Chemoprevention Warranted in Patients with Atypical Lobular Hyperplasia on Core Biopsy?

2015 ◽  
Vol 81 (9) ◽  
pp. 876-878 ◽  
Author(s):  
Shelby Allen ◽  
Edward A. Levine ◽  
Nadja Lesko ◽  
Marissa Howard-Mcnatt
Keyword(s):  
Breast Cancer ◽  
Core Biopsy ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Patient Characteristics ◽  
Current Treatment ◽  
Final Pathology ◽  
Atypical Lobular Hyperplasia

The management of atypical lobular hyperplasia (ALH) on core biopsy remains controversial. The upstaging rates after surgical excision vary. We reviewed our upgrade rates and use of chemoprevention for ALH. Patients were identified through our pathology database for ALH from 2006 to 2013. Patients were included in the study that had a diagnosis only of ALH on core needle biopsy. Tumor and patient characteristics and final pathology were analyzed. ALH was identified in 56 patients since 2006. Sixteen patients met the inclusion criteria. All the patients underwent surgical excision. Final pathology of the excised specimens confirmed ALH in 62 per cent (n = 11). Two cases contained lobular carcinoma in situ. The upgrade rate on excisional biopsy was 18.75 per cent (n = 3) to invasive cancer. Chemopreventative treatment was taken by 44 per cent of the patients. After a mean follow-up of three years, none of the patients who received chemoprevention developed breast cancer. One patient who refused tamoxifen developed breast cancer. This is one of the few studies to examine the current treatment of ALH. We noted a significant upstaging rate after excision. We recommend women to undergo surgical excision. Patients should also consider chemoprevention to reduce their risk for developing breast cancer.

Stereotaxic core needle aspiration biopsy with multiple passes in nonpalpable breast lesions

1998 ◽  
Vol 39 (4) ◽  
pp. 389-394 ◽  
Author(s):  
A. Vega Bolivar ◽  
E. Ortega García ◽  
F. Garijo Ayensa
Keyword(s):  
Core Biopsy ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Breast Lesions ◽  
Breast Carcinomas ◽  
Core Needle ◽  
Invasive Carcinomas ◽  
Noninvasive Carcinoma ◽  
Nonpalpable Breast Lesions

Objective: To compare the grade of histologic agreement between stereotaxic core needle aspiration biopsy (SCNAB) with multiple passes, and surgical excision. Methods: A total of 180 patients with 182 nonpalpable breast lesions underwent SCNAB with multiple passes in an upright add-on stereotaxic device using a manual 1.8-mm needle (15 G). In this group, 125 patients underwent subsequent surgical excision. Results: A SCNAB result indicative of malignancy (invasive or noninvasive carcinoma) was obtained in 68 (87%) of the 78 breast carcinomas (14 noninvasive and 64 invasive) and definitive surgical therapy with a one-stage procedure was performed. Complete or partial agreement between core biopsy and surgery was observed in 19 (86%) of 22 invasive or noninvasive carcinomas discovered by microcalcifications, 40 (97.5%) of 41 invasive carcinomas discovered by a mass, and 9 (60%) of 15 invasive or noninvasive carcinomas discovered by architectural distortion. Six (33%) of the 18 patients whose core biopsies showed noninvasive carcinoma had an invasive or microinvasive component at subsequent surgery. Atypical hyperplasia or benign core biopsy was observed in 6 (8%) and 4 (5%) breast carcinomas respectively. Conclusion: SCNAB with multiple passes is a reliable method for identifying nonpalpable lesions in patients with noninvasive or invasive carcinomas discovered by respectively microcalcifications or mass.

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