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

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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Accuracy and Upgrade Rates of Percutaneous Breast Biopsy: The Surgeon's Role

The American Surgeon ◽

10.1177/000313481007601013 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1084-1087 ◽

Cited By ~ 3

Author(s):

Windy Olaya ◽

Won Bae ◽

Jan Wong ◽

Jasmine Wong ◽

Sharmila Roy-Chowdhury ◽

...

Keyword(s):

Needle Biopsy ◽

Breast Imaging ◽

Breast Biopsy ◽

Imaging Study ◽

Surgical Excision ◽

Core Size ◽

Image Guided ◽

Core Samples ◽

Limited Sampling ◽

The Impact

We sought to evaluate the impact of needle core size and number of core samples on diagnostic accuracy and upgrade rates for image-guided core needle biopsies of the breast. A total of 234 patients underwent image-guided percutaneous needle biopsies and subsequent surgical excision. Large-core needles (9 gauge or less) were used in 14.5 per cent of cases and the remainder were performed with smaller core needles. More than four core samples were taken in 78.9 per cent of patients. In 71.8 per cent of cases, needle biopsy pathology matched surgical excision pathology. After surgical excision, upgraded pathology was revealed in 10.7 per cent of cases. Of 11 patients (52.4%) with benign needle core pathology who had upgraded final pathology on surgical excision, 10 had a Breast Imaging Recording and Data System score 4 or 5 imaging study. Lesions smaller than 10 mm were more likely to be misdiagnosed ( P = 0.01) or have upgraded pathology ( P = 0.009). Other predictors of upgraded pathology were patient age 50 years or older ( P = 0.03) and taking four or fewer core samples ( P = 0.003). Needle core size did not impact accuracy or upgrade rates. Surgeons should exercise caution when interpreting needle biopsy results with older patients, smaller lesions, and limited sampling. Discordant pathology and imaging still mandate surgical confirmation.

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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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B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Cancers ◽

10.3390/cancers13215443 ◽

2021 ◽

Vol 13 (21) ◽

pp. 5443

Author(s):

Veronica Girardi ◽

Monica Guaragni ◽

Nella Ruzzenenti ◽

Fabrizio Palmieri ◽

Gianluca Fogazzi ◽

...

Keyword(s):

Breast Biopsy ◽

Ductal Carcinoma ◽

Surgical Excision ◽

Tumor Board ◽

Consecutive Series ◽

Single Center Experience ◽

Significant Difference ◽

B3 Lesions

The rate of upgrade to cancer for breast lesions with uncertain malignant potential (B3 lesions) diagnosed at needle biopsy is highly influenced by several factors, but large series are seldom available. We retrospectively assessed the upgrade rates of a consecutive series of B3 lesions diagnosed at ultrasound- or mammography-guided vacuum-assisted biopsy (VAB) at an EUSOMA-certified Breast Unit over a 7-year timeframe. The upgrade rate was defined as the number of ductal carcinoma in situ (DCIS) or invasive cancer at pathology after excision or during follow-up divided by the total number of B3 lesions. All lesions were reviewed by one of four pathologists with a second opinion for discordant assessments of borderline cases. Excision or surveillance were defined by the multidisciplinary tumor board, with 6- and 12-month follow-up. Out of 3634 VABs (63% ultrasound-guided), 604 (17%) yielded a B3 lesion. After excision, 17/604 B3 lesions were finally upgraded to malignancy (2.8%, 95% confidence interval [CI] 1.8–4.5%), 10/17 (59%) being upgraded to DCIS and 7/17 (41%) to invasive carcinoma. No cases were upgraded during follow-up. B3a lesions showed a significantly lower upgrade rate (0.4%, 95% CI 0.1–2.1%) than B3b lesions (4.7%, 95% CI 2.9–7.5%, p = 0.001), that had a 22.0 adjusted odds ratio for upgrade (95% CI 2.1–232.3). No significant difference was found in upgrade rates according to imaging guidance or needle caliper. Surveillance-oriented management can be considered for B3a lesions, while surgical excision should be pursued for B3b lesions.

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Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽

10.1159/000489096 ◽

2018 ◽

Vol 13 (5) ◽

pp. 364-368 ◽

Cited By ~ 4

Author(s):

Doris Leithner ◽

Benjamin Kaltenbach ◽

Petra Hödl ◽

Volker Möbus ◽

Volker Brandenbusch ◽

...

Keyword(s):

Needle Biopsy ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Statistical Tests ◽

Menopausal Status ◽

Surgical Excision ◽

Lesion Size ◽

Intraductal Papilloma ◽

Image Guided ◽

Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

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Histological Assessment of Breast Lesions Identified Exclusively by Magnetic Resonance

The American Surgeon ◽

10.1177/000313481408001007 ◽

2014 ◽

Vol 80 (10) ◽

pp. 944-947

Author(s):

Victoria O'connor ◽

Elizabeth Arena ◽

Joslyn Albright ◽

Nefertiti Brown ◽

Ryan O'connor ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Low Grade ◽

Breast Lesions ◽

Significant Family History ◽

Ductal Hyperplasia ◽

Significant Pathology

Radiologic–pathologic correlation of lesions diagnosed by magnetic resonance (MR) is precluded by insufficient data on histological characteristics of lesions suspicious on MR but not visible on concurrent mammogram or ultrasound. The objective of this study was to describe histological features of breast lesions diagnosed exclusively by MR. The participants underwent MR-guided breast biopsy between 2007 and 2012 for a suspicious lesion not identified by mammography or ultrasound. Histology slides were interpreted retrospectively by a breast pathologist. Of 126 patients (126 lesions), 34 (27%) had new breast cancer, 51 (40.5%) previous breast cancer, and 41 (32.5%) dense breasts or a significant family history of breast cancer. MR identified 23 (18.3%) invasive cancers: 20 were Grade 1 and 17 were ductal. Of the 126 lesions, 16 (13%) were ductal carcinoma in situ (DCIS), four were atypical ductal hyperplasia and atypical lobular hyperplasia (3%), and 68 (54%) were benign. Fifteen biopsies (12%) had no significant pathology. Five DCIS lesions were upgraded to T1 invasive cancers. Approximately 30 per cent of suspicious lesions detected exclusively by MR are invasive or in situ cancers that are predominantly low grade. Further studies are needed to determine if malignant lesions can be prospectively distinguished by MR characteristics.

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Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution

Radiologia Brasileira ◽

10.1590/0100-3984.2014.0110 ◽

2016 ◽

Vol 49 (1) ◽

pp. 6-11 ◽

Cited By ~ 9

Author(s):

Gustavo Machado Badan ◽

Decio Roveda Júnior ◽

Sebastião Piato ◽

Eduardo de Faria Castro Fleury ◽

Mário Sérgio Dantas Campos ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Surgical Excision ◽

Target Lesion ◽

Core Needle ◽

Ductal Hyperplasia ◽

Underestimation Rate

Abstract Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.

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Impact of margin status and re-excision on local control in patients undergoing breast-conservation therapy for ductal carcinoma in situ.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.57 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 57-57

Author(s):

Talha Shaikh ◽

Tianyu Li ◽

Fatima Sheikh ◽

Colin T. Murphy ◽

Nicholas Zaorsky ◽

...

Keyword(s):

Local Control ◽

Ductal Carcinoma In Situ ◽

Hormonal Therapy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Significant Difference ◽

The Impact

57 Background: The purpose of this study was to identify the impact of final surgical margin (SM) status, SM width, and re-excision on outcomes in patients with ductal carcinoma in situ (DCIS) undergoing breast conservation therapy (BCT). Methods: The study population consisted of women diagnosed with DCIS undergoing BCT between 1989-2014. All women received adjuvant whole breast radiation plus a boost. The primary endpoint was local control (LC) defined as an ipsilateral breast failure. A negative SM was defined as > 2 mm, close SM was defined as > 0 to < 2 mm, and a positive SM was defined as tumor at the inked SM. Cox proportional hazards model was used to determine predictors of outcomes on multivariate analysis (MVA). Actuarial incidence of LC was estimated using the Kaplan-Meier method. Results: A total of 498 patients were included. The median age was 58 (range 30-91) and the median follow-up was 8.3 years (3 months-27 years). A total of 400 patients had a final negative SM, 87 had a close SM, and 11 had a positive SM. A total of 172 patients received adjuvant hormonal therapy, 265 patients required at least one re-excision. Patients with positive or close SMs were more likely to receive a radiation dose > 60 Gy (p < 0.001) and undergo re-excision (p < 0.01). The 10-year LC rates were not significantly different between patients with a negative (93.5%), close (91.8%), or positive (100%) SM (p = 0.57). There was no difference in 10-year LC rates according to a SM width of 0-1 mm (100%), > 1 to 2 mm (88.5%), or > 2 mm (93.5%) (p = 0.85). On univariate analysis, there was no significant difference in LC when comparing negative versus close or positive (p = 1.0) SMs. There was no difference in LC in patients undergoing re-excision for initial close or positive SMs (p = 0.55). On MVA, after controlling for age, dose, hormonal therapy, comedo subtype, and grade, there were no factors associated with LC. Conclusions: This large single-institution experience demonstrates that risks of local failure remain poorly characterized. Re-excision and whole breast radiation plus boost resulted in excellent LC for women with DCIS. Our data suggests that trials aimed at personalized de-intensified local therapy are warranted.

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Papillary Breast Lesions: Association with Malignancy and Upgrade Rates on Surgical Excision

The American Surgeon ◽

10.1177/000313481708301134 ◽

2017 ◽

Vol 83 (11) ◽

pp. 1294-1297 ◽

Cited By ~ 4

Author(s):

Hanh-tam Tran ◽

Asma Mursleen ◽

Sahar Mirpour ◽

Omar Ghanem ◽

Maen J. Farha

Keyword(s):

Carcinoma In Situ ◽

Breast Lesion ◽

Ductal Carcinoma ◽

Surgical Excision ◽

Intraductal Papilloma ◽

Breast Lesions ◽

Aggressive Approach ◽

Papillary Lesions ◽

Benign Papilloma

Intraductal papilloma falls under the category of benign breast mass. However, recent studies show that it can harbor occult carcinoma. The management of benign intraductal papilloma remains controversial because of its nonspecific radiologic and histological findings, as well as its association with surrounding malignant pathology. The purpose of this study is to investigate upgrade rates of a benign intraductal papilloma on surgical excision and the need for surgical excision of papillary lesions diagnosed at core needle biopsy. A retrospective review of a single institution's pathology database between 2011 and 2015 identified 43 core biopsies with benign papilloma. We followed the upgrade rates of these lesions on surgical excision. There were 90 biopsies with the diagnosis of benign intraductal papilloma. The average age was 55.2 (range from 24–87 years old). Forty-three had benign intraductal papilloma; 28 of the 43 core biopsies had surgical excision. Two (7.1%) had an upgrade from benign intraductal papilloma to intraductal papilloma with atypia. One (3.6%) had an upgrade to ductal carcinoma in situ. None had invasive cancer. Surgical findings were in agreement with core biopsies in 25 (89.3%) of 28 cases (κ = 0.80, P < 0.0001). Core biopsies have a statistically significant correlation with pathologies on surgical excision in detecting atypia in breast lesion as demonstrated by κ = 0.80. However, the study shows benign intraductal papillomas on core biopsy have an upgrade rate of 10.7 per cent after undergoing surgical excision. As such, we recommend a more aggressive approach including surgical excision of all benign intraductal papillary lesions.

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Discordance Between Pathologic and Radiologic Tumor Size on Breast MRI May Contribute to Increased Re-excision Rates

The American Surgeon ◽

10.1177/000313481107701020 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1361-1363 ◽

Cited By ~ 3

Author(s):

Lindi H. Vanderwalde ◽

Catherine M. Dang ◽

Catherine Bresee ◽

Edward H. Phillips

Keyword(s):

Tumor Size ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Mri ◽

Breast Cancers ◽

Breast Center ◽

Significant Difference ◽

Preoperative Breast Mri ◽

The Impact

Preoperative breast MRI does not decrease re-excision rates in patients who undergo lumpectomy. We evaluated concordance of tumor size on MRI and pathologic size in patients who underwent re-excision of margins after lumpectomy. A retrospective review of patients at the Cedars-Sinai Breast Center who received breast MRI was performed. We found that MRI was performed before lumpectomy in 136 patients. Mean age was 55.2 years (standard deviation ± 12.6). Re-excision occurred in 34 per cent (n = 46). Of those undergoing re-excision, 35 per cent (16/46) were re-excised for ductal carcinoma in situ (DCIS) at the lumpectomy margin. There was no significant difference between radiologic and pathologic size of the tumor (1.94 vs 2.12 cm; P = 0.159). In those who underwent re-excision, the radiologic size was underestimated compared with the pathologic size (2.01 vs 2.66 cm; P = 0.032). Patients with pure DCIS lesions (n = 9) also had smaller radiologic tumor size compared with pathologic (0.64 vs 2.88 cm; P = 0.039), and this difference trended toward significance in those who underwent re-excision (0.55 vs 3.50 cm; P = 0.059). Discordance between tumor size on MRI and pathologic size may contribute to re-excisions in patients who undergo lumpectomy. The limitations of breast MRI to evaluate the extent of DCIS surrounding many breast cancers, and the impact on re-excision rates, should be further evaluated.

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Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions

Breast Cancer ◽

10.1007/s12282-020-01149-1 ◽

2020 ◽

Author(s):

Aikaterini E. Micha ◽

Victoria Sinnett ◽

Kate Downey ◽

Steve Allen ◽

Briony Bishop ◽

...

Keyword(s):

Guide Wire ◽

Positive Margin ◽

Lesion Size ◽

Ease Of Use ◽

Breast Lesions ◽

Continuous Variables ◽

Patient Anxiety ◽

Significant Difference ◽

Clinician Satisfaction ◽

The Impact

Abstract Background Guide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques. Methods A single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes. Results 168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4). Conclusions This is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.

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