Factors associated with upstaging of ductal carcinoma in situ diagnosed by core needle biopsy using imaging guidance.

PURPOSE: The aim of this study was to estimate the upstaging rate of ductal carcinoma in situ (DCIS) diagnosed by core needle biopsy (CNB) under imaging guidance and to identify factors related to upstaging. MATERIALS AND METHODS: During an 8-year period, pure DCIS was diagnosed by imaging-guided CNB followed by definitive surgery in 128 patients. Data on pathological, clinical, and radiological findings were obtained. RESULTS: DCIS upstaging in the present study was 24% (31 of 128 patients had invasive cancer in the final surgical specimen), and the rate was 41% if the cases with microinvasion were included. Factors significantly associated with any type of upstaging included radiological factors (BI-RADS category), factors related to CNB technique (modality of image guidance, size of the core needle, number of cores), and pathological factors (histological grading and presence of comedonecrosis). Multivariable analysis revealed that higher histological grade [odds ratio (OR) and 95% confidence interval (CI) were 2.50 (1.10-5.67)], smaller needle size (no. 14 vs. no. 11) [OR 3.57 (1.11-11.4)], and the presence of comedonecrosis [OR 3.78 (1.32-10.8)] were significantly and independently related to upstaging. CONCLUSION: High-grade DCIS, using a smaller needle, and the presence of comedonecrosis in the CNB specimen were associated with a higher risk for invasive carcinoma.

Diagnostic accuracy of vacuum-assisted stereotactic core needle biopsy for breast lesions.

OBJECTIVE: To evaluate the diagnostic accuracy of the vacuum-assisted stereotactic core needle biopsy (CNB) for breast lesions. MATERIAL AND METHOD: Sixty-four lesions that had undergone vacuum-assisted stereotactic CNB between January 2003 and December 2005 in Ramathibodi Breast diagnostic center were included in this study. Pathologic results of CNB were reviewed and correlated with pathologic results of subsequent open surgery. For benign lesions without surgery, the authors correlated the result of CNB with stability of the lesion at or more than 2-year interval follow-up. Agreement rate, high-risk under estimate rate, Ductal carcinoma in situ (DCIS) underestimate rate, false negative rate, and sensitivity were accessed RESULTS: The pathologic results for the CNB were malignancy in 20%, high-risk in 13%, and benign in 67%. The agreement rate was 93.8% (60 of 64). The under estimate rate for atypical ductal hyperplasia (ADH) was 50% (3 of 6). There was no underestimate for DCIS in the present study. Of 43 benign lesions, malignancy was found at subsequent open surgery in one lesion and false negative rate was 6%. Calculated sensitivity was 96%. CONCLUSION: Vacuum-assisted CNB is an accurate method for evaluating breast lesions. This procedure is an alternative to surgical excision for lesion assessments.

Positive predictive value of breast cancer in the lesions categorized as BI-RADS category 5.

OBJECTIVE: To determine positive predictive value (PPV) of the breast imaging reporting and data systems (BI-RADS) category 5 mammogram and ultrasound (US) in the diagnosis of breast cancer in the study center and correlation between clinical, mammographic and US findings, and breast cancer. MATERIAL AND METHOD: Four hundred and ninety seven patients with BI-RADS category 5 who underwent mammograms and US at the Breast diagnostic center, Ramathibodi Hospital from January, 1, 2002 to December 31, 2004 were enrolled into the present study. Selected clinical information, mammographic and US findings, and histopathological diagnosis were retrospectively reviewed. RESULTS: Breast cancer was found in 467 of 497 patients, giving a PPV of 94%. Invasive ductal carcinoma was the most common malignancy (89.5%). Fibrocystic change was the most common benign pathology found in the remaining patients. Discrete mass was the most frequently encountered lesion detected on mammography and US, followed by mass containing calcifications. Patients with advanced age, having a clinically palpable breast mass, with mammographic and US evidence of mass containing calcifications showed significant statistical association with breast cancer. CONCLUSION: PPV of BI-RADS category 5 lesions in the present study was comparable to other published studies. Although the probability of malignancy was very high, a small number of patients had benign pathologies. Preoperative histopathologic diagnosis is necessary before definitive treatment.

Breast cancer underestimation rate of atypical ductal hyperplasia diagnosed by core-needle biopsy under imaging guidance.

OBJECTIVE: To evaluate breast cancer underestimation rate of atypical ductal hyperplasia (ADH) diagnosed by core-needle biopsy (CNB) under imaging guidance in Ramathibodi Hospital and to determine the difference between the malignant and benign groups in terms of clinical and imaging characteristics. MATERIAL AND METHOD: The pathological records of 1521 patients who underwent CNB under imaging guidance were reviewed. Thirty-nine patients diagnosed with ADH were enrolled into the present study. Clinical data, imaging features, biopsy technique and result of excisional biopsy as well as follow-up data were retrospectively reviewed. RESULTS: Of 39 ADH cases, eight (20.5%) were found to have malignancy on subsequent excisional biopsy. The majority of these were ductal carcinoma in situ (DCIS) (62.5%). Lesion categorized as category 5 according to BI-RADS (Breast imaging reporting and data system) was the only feature which was statistically different between the benign and malignant groups. No statistically significant difference was found between the benign and malignant groups in terms of age, personal and family history of breast cancer, clinical finding, mammographic lesion type, size of lesion, image-guided technique and percentage of lesion removal. CONCLUSION: The underestimation rate of ADH in the present study was comparable to other studies. The finding of Bl-RADS category 5 in patients with ADH diagnosed from CNB is a strong indication for subsequent excisional biopsy.

Nondiagnostic core needle biopsy of the breast under imaging guidance: result of rebiopsy.

OBJECTIVE: To determine the rate and the clinical application of recommendation for repeat biopsy after core needle biopsy (CNB) under imaging guidance and to determine the result of rebiopsy. MATERIAL AND METHOD: A retrospective review was performed in 1,306 consecutive women who underwent core needle biopsy under imaging guidance at the breast diagnostic center, the Faculty of Medicine, Ramathibodi Hospital from October 1997 to March 2004. RESULTS: Among 1,306 patients, there were 44 patients (3.37%) who had undergone rebiopsy. The three most common reasons for recommendation of rebiopsy were discordant imaging and pathology, atypical ductal hyperplasia and inadequate specimen. The authors found 12 malignancies subsequently found in rebiopsy (27.3%). The most common reason for rebiopsy in this group was inadequate specimen. CONCLUSION: Core needle biopsy under imaging guidance is a minimally invasive diagnostic tool and promises high accuracy and reliability. However, some patients need rebiopsy to exclude hidden malignancy. The cooperation between the radiologists, surgeons and pathologists are prudent for giving the best care to the patients.