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. 2016 Jan-Feb;49(1):6-11.
doi: 10.1590/0100-3984.2014.0110.

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

Gustavo Machado Badan  1 , Decio Roveda Júnior  2 , Sebastião Piato  3 , Eduardo de Faria Castro Fleury  4 , Mário Sérgio Dantas Campos  5 , Carlos Alberto Ferreira Pecci  5 , Felipe Augusto Trocoli Ferreira  5 , Camila D'Ávila  6
Affiliations

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

Gustavo Machado Badan et al. Radiol Bras. 2016 Jan-Feb.

Abstract
in English, Portuguese

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.

Objetivo: Determinar o grau de subestimação diagnóstica de biópsias mamárias percutâneas estereotáxicas por agulha grossa (core biopsy) e assistidas a vácuo (mamotomia) em lesões não palpáveis, com resultados histopatológico de hiperplasia ductal atípica (HDA) ou carcinoma ductal in situ (CDIS) e que foram submetidas a exérese cirúrgica posteriormente. Como objetivo secundário, atribuiu-se a frequência de HDA e CDIS nos casos biopsiados.

Materiais e métodos: Foram revisados, retrospectivamente, 40 casos biopsiados com diagnóstico de HDA ou CDIS, entre fevereiro de 2011 e julho de 2013, e que posteriormente foram submetidos a cirurgia, cujo laudo histopatológico estava registrado no sistema interno de informações. Os resultados das biópsias foram comparados aos da cirurgia e a taxa de subestimação foi calculada de acordo com equações matemáticas específicas.

Resultados: A taxa de subestimação diagnóstica da core biopsy foi 50% para HDA e 28,57% para CDIS, e da mamotomia foi 25% para HDA e 14,28% para CDIS. As HDAs representaram 10,25% do total de casos biopsiados, enquanto 23,91% foram CDIS.

Conclusão: A taxa de subestimação diagnóstica é cerca de duas vezes maior na core biopsy em relação à mamotomia. A certeza do alvo atingido não é o único determinante para um diagnóstico preciso. Remover mais que 50% da lesão alvo poderá diminuir o risco de subestimação diagnóstica.

Keywords: Breast neoplasia; Core needle biopsy; Diagnostic techniques and procedures; Noninvasive intraductal carcinoma; Vacuum-assisted biopsy.

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Figures

Figure 1
Figure 1
A 57-year-old patient with mammographic finding of amorphous and clustered microcalcifications (BI-RADS 4B). The patient was submitted to core biopsy, whose histological result was DCIS. At surgery, there was diagnostic underestimation (IDC). A: Pre-triggering stereotactic image showing the biopsy needle correctly directed toward the lesion. B: Post-triggering stereotactic image demonstrating the target transfixion by the needle. C: Radiography of the fragments identifying the presence of calcifications.
Figure 2
Figure 2
A 60-year-old patient with mammographic finding of gross, heterogeneous and clustered microcalcifications (BI-RADS 4B). VABB revealed AHD. At surgery, there was diagnostic underestimation (DCIS). A: Pre-triggering stereotactic image showing the biopsy needle correctly directed toward the lesion. B: Post-triggering stereotactic image demonstrating the needle in the target. C: Post-procedural stereotactic image revealing less than 50% of the removed target lesion.
See this image and copyright information in PMC

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