Ductal Carcinoma In Situ Underestimation of Microcalcifications Only by Stereotactic Vacuum-Assisted Breast Biopsy: A New Predictor of Specimens without Microcalcifications

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

Modern Pathology ◽

10.1038/modpathol.3880497 ◽

2002 ◽

Vol 15 (2) ◽

pp. 95-101 ◽

Cited By ~ 25

Author(s):

Michelle Bonnett ◽

Tracy Wallis ◽

Michelle Rossmann ◽

Nat L Pernick ◽

Kathryn A Carolin ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Radiographic Analysis

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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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Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ as Revealed by Large-Core Needle Breast Biopsy

American Journal of Roentgenology ◽

10.2214/ajr.175.5.1751341 ◽

2000 ◽

Vol 175 (5) ◽

pp. 1341-1346 ◽

Cited By ~ 219

Author(s):

Marla L. Rosenfield Darling ◽

Darrell N. Smith ◽

Susan C. Lester ◽

Carolyn Kaelin ◽

Donna-Lee G. Selland ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Large Core ◽

Core Needle ◽

Ductal Hyperplasia

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Parity Differently Affects the Breast Cancer Specific Survival from Ductal Carcinoma In Situ to Invasive Cancer: A Registry-Based Retrospective Study from Korea

Breast Cancer Basic and Clinical Research ◽

10.1177/1178223418825134 ◽

2019 ◽

Vol 13 ◽

pp. 117822341882513 ◽

Cited By ~ 1

Author(s):

JungSun Lee ◽

Minkyung Oh ◽

SeungSang Ko ◽

Chanheun Park ◽

Eun Sook Lee ◽

...

Keyword(s):

Breast Cancer ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

P Value ◽

Age At First Birth ◽

Breast Cancer Specific Survival ◽

Cancer Specific Survival ◽

Cox Regression Analysis

Purpose: Multiparity might increase general mortality for women, but has inconclusive in patients with breast cancer. Here, we aim to discover their effect in terms of the breast cancer development hypothesis: from ductal carcinoma in situ to invasive carcinoma. Methods: We included 37 947 patients from the web-based breast cancer registration program of the Korean Breast Cancer Society and analyzed survivals using multivariate Cox regression analysis and whether the associations of these factors displayed linear trends. They were divided into the following groups: (1) pure ductal carcinoma in situ (DCIS), (2) invasive ductal carcinoma (IDC) mixed with intraductal component (DCIS-IDC), and (3) node negative pure IDC. Results: The mean age was 48.9 ± 9.9 years including premenopausal women was 61.8%. Although patients with parities of 1-3 had better prognosis compared with patients with nulliparous women, high parity (⩾4) increased the hazard ratio (HR) of overall survival (OS) (DCIS: HR, 1.52; 95% confidence interval [CI] 0.62-3.78; IDC: HR, 1.43, 95% CI 0.89-2.31; and DCIS-IDC: HR, 1.44, 95% CI 0.45-4.59) during 84.2 (±10.7) months. For breast cancer specific survival (BCSS), the HR of the IDC group ( P-value for trend = .04) increased along with increasing parity and was worse than nulliparous patients, and the HR of the DCIS-IDC group increased but was better than nulliparous patients ( P-value for trend = .02). Compared with nulliparous patients, any age at first birth (AFB) decreased HR of OS in the DCIS and IDC groups (DCIS: P = .01; IDC: P = .04). Conclusions: Parity show dual effects on OS of women with all ductal typed breast cancer but show different effects on BCSS in Korea.

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Isolated calcification on needle core breast biopsy: A potential pitfall for under diagnosis of ductal carcinoma in situ of the breast

The Breast Journal ◽

10.1111/tbj.12816 ◽

2017 ◽

Vol 23 (6) ◽

pp. 762-763

Author(s):

Aoife Doyle ◽

Ciara Ryan ◽

Ann O' Doherty ◽

Cecily Quinn

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Potential Pitfall

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Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade☆

Human Pathology ◽

10.1016/j.humpath.2010.06.011 ◽

2011 ◽

Vol 42 (1) ◽

pp. 41-50 ◽

Cited By ~ 40

Author(s):

Kimberly H. Allison ◽

Peter R. Eby ◽

Jennifer Kohr ◽

Wendy B. DeMartini ◽

Constance D. Lehman

Keyword(s):

High Risk ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Ductal Hyperplasia

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Simplifying Breast Imaging Reporting and Data System classification of mammograms with pure suspicious calcifications

Journal of Medical Screening ◽

10.1177/0969141317715281 ◽

2017 ◽

Vol 25 (2) ◽

pp. 82-87 ◽

Cited By ~ 1

Author(s):

Gisela LG Menezes ◽

Gonneke AO Winter-Warnars ◽

Eva L Koekenbier ◽

Emma J Groen ◽

Helena M Verkooijen ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Imaging ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Data System ◽

Risk Of Malignancy ◽

Stereotactic Breast Biopsy ◽

Invasive Carcinomas

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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Comparison of Radiation With or Without Concurrent Trastuzumab for HER2-Positive Ductal Carcinoma In Situ Resected by Lumpectomy: A Phase III Clinical Trial

Journal of Clinical Oncology ◽

10.1200/jco.20.02824 ◽

2021 ◽

pp. JCO.20.02824

Author(s):

Melody A. Cobleigh ◽

Stewart J. Anderson ◽

Kalliopi P. Siziopikou ◽

Douglas W. Arthur ◽

Rachel Rabinovitch ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Menopausal Status ◽

Eastern Cooperative Oncology Group ◽

Phase Iii ◽

Her2 Status ◽

P Value ◽

Her2 Positive

PURPOSE Preclinical studies report that trastuzumab (T) can boost radiotherapy (RT) effectiveness. The primary aim of the B-43 trial was to assess the efficacy of RT alone vs concurrent RT plus T in preventing recurrence of ipsilateral breast cancer (IBTR) in women with ductal carcinoma in situ (DCIS). PATIENTS AND METHODS Eligibility: Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, DCIS resected by lumpectomy, known estrogen receptor (ER) and/or progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2) status by centralized testing. Whole-breast RT was given concurrently with T. Stratification was by menopausal status, adjuvant endocrine therapy plan, and nuclear grade. Definitive intent-to-treat primary analysis was to be conducted when either 163 IBTR events occurred or all accrued patients were on study ≥ 5 years. RESULTS There were 2,014 participants who were randomly assigned. Median follow-up time as of December 31, 2019, was 79.2 months. At primary definitive analysis, 114 IBTR events occurred: RT arm, 63 and RT plus T arm, 51 (hazard ratio [HR], 0.81; 95% CI, 0.56 to 1.17; P value = .26). There were 34 who were invasive: RT arm, 18 and RT plus T arm, 20 (HR, 1.11; 95% CI, 0.59 to 2.10; P value = .71). Seventy-six were DCIS: RT arm, 45 and RT plus T arm, 31 (HR, 0.68; 95% CI, 0.43 to 1.08; P value = .11). Annual IBTR event rates were: RT arm, 0.99%/y and RT plus T arm, 0.79%/y. The study did not reach the 163 protocol-specified events, so the definitive analysis was triggered by all patients having been on study for ≥ 5 years. CONCLUSION Addition of T to RT did not achieve the objective of 36% reduction in IBTR rate but did achieve a modest but statistically nonsignificant reduction of 19%. Nonetheless, this trial had negative results. Further exploration of RT plus T is needed in HER2-positive DCIS before its routine delivery in patients with DCIS resected by lumpectomy.

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