Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy
ABSTRACT The purposes of this study were to determine the frequency of diagnosis of atypical ductal hyperplasia (ADH) at MRI-guided 9-gauge vacuum-assisted breast biopsy and to assess the rate of underestimation of ADH at subsequent surgical excision.
We conducted a retrospective review of medical records of 237 lesions consecutively detected with MRI and then subjected to MRI-guided 9-gauge vacuum-assisted breast biopsy during a 33-month period. Underestimated ADH was defined as a lesion yielding ADH at vacuum-assisted biopsy and cancer at surgery. Scientific tables were used to calculate 95% CI.
Histologic analysis of MRI-guided vacuum-assisted breast biopsy specimens yielded ADH without cancer in 15 (6%) of 237 lesions. Among 15 patients in whom vacuum-assisted breast biopsy yielded ADH, the median age was 52 years (range, 46-68 years). The median number of specimens obtained was nine (range, 8-18 lesions). Median MRI lesion diameter was 1.3 cm (range, 0.7-7.0 cm). Among 15 MRI lesions, 10 (67%) were nonmasslike enhancement and five (33%) were masses. Surgical excision was performed on 13 lesions. Surgical histologic findings were malignancy in five (38%) of the cases, all ductal carcinoma in situ; high-risk lesion in six (46%) of the cases, including ADH without other high-risk lesions (n = 2), ADH and lobular carcinoma in situ (LCIS) (n = 1), ADH, LCIS, and papilloma (n =1), ADH and papilloma (n = 1), and LCIS (n = 1); and benign in two (15%) of the cases. These data indicated an ADH underestimation rate of 38% (95% CI, 14-68%).
ADH without cancer was encountered in 6% of MRI-guided 9-gauge vacuum-assisted breast biopsies. ADH at MRI-guided vacuum-assisted breast biopsy is an indication for surgical excision because of the high (38%) frequency of underestimation of these lesions.
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ABSTRACT: OBJECTIVE. The purpose of this article is to determine the underestimation rate of high-risk lesions diagnosed at MRI-guided breast biopsy. MATERIALS AND METHODS. This was a retrospective review of 446 MRI-guided breast biopsies from January 2006 through December 2010. Data were collected on examination indication, lesion size and type, and pathology results. Biopsies were performed with a 9-gauge vacuum-assisted device. Biopsy results of atypical ductal hyperplasia (ADH), papillary lesion, radial scar, lobular neoplasia, and atypia were identified and compared with final excisional pathology results. Underestimation rates were calculated and data were compared by patient and lesion characteristics using chi-square analysis. RESULTS. Of the 446 MRI-guided biopsies, 96 (21.5%) were high-risk lesions. Forty-two of 96 lesions (44%) were masses, and 54 (56%) showed nonmass enhancement. Twenty of 96 lesions (20.8%) were ADH, nine (9.4%) were lobular neoplasia, 27 (28.1%) were papillary lesions, 20 (20.8%) were radial scar, and 20 (20.8%) were other atypias. Sixty-nine of 96 lesions (71.9%) had surgical excisional pathology results available. Sixteen of 69 (23.2%) lesions were upgraded to malignancy; 11 of the 16 (68.8%) were upgraded to ductal carcinoma in situ (DCIS) and five (31.2%) were upgraded to invasive carcinoma. The underestimation rate was 31.6% (6/19) for ADH, 5.9% (1/17) for papillary lesions, 23.1% (3/13) for radial scar, 28.6% (2/7) for lobular neoplasia, and 30.8% (4/13) for other atypias (p = 0.43). There was no statistically significant difference in underestimation rate by lesion type, size, or history of newly diagnosed breast cancer. CONCLUSION. MRI-guided breast biopsy yielded high-risk lesions in 21.5% of cases, and the underestimation rate was 23.2%. No patient or lesion characteristics correlated with underestimation rate.American Journal of Roentgenology 09/2014; 203(3):682-6. DOI:10.2214/AJR.13.11905 · 2.74 Impact Factor
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ABSTRACT: Der zunehmende Einsatz der MRT in der Mammadiagnostik erhöht den Stellenwert geeigneter Biopsieverfahren für abklärungsbedürftige Befunde, die ausschließlich im MRT sichtbar werden. MR-gestützte Biopsieverfahren sind kostenaufwändig und zeitintensiv. Die standardisierte Qualität der indikationsstellenden MRT-Untersuchung ist deshalb von entscheidender Bedeutung für den sinnvollen Einsatz MR-gestützter Biopsieverfahren.Bei geeigneter Indikationsstellung ist die MR-geführte Vakuumbiopsie eine sehr sichere Abklärungsmethode, die auch bei kleinen Herdbefunden eine zuverlässige histopathologische Diagnose erlaubt. Bislang war der Biopsievorgang bei einer MR-geführten Vakuumbiopsie aufgrund der fehlenden Kompatibilität der Nadeln nicht der Bildgebung zugänglich. Besondere Sorgfalt gilt daher der Überprüfung der Repräsentativität der Probengewinnung durch postinterventionelle Aufnahmen und die histopathologische Korrelation der bildgebenden Befunde. Künftige Entwicklungen werden MR-kompatible Biopsienadeln in Herdlokalisation abbilden können und damit Lokalisationsunsicherheiten und Zeitaufwand der Methode weiter minimieren. Für die Abklärung von Zweitherden bei bereits bestehender Operationsindikation bleibt die MR-gestützte Nadelmarkierung ipsi- und kontralateraler Zweitherde eine technisch einfache und schnell durchführbare Methode.Der Radiologe 04/2008; 48(4). · 0.41 Impact Factor
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ABSTRACT: Purpose The aim of this study is to describe our initial experience with magnetic resonance (MR)-guided biopsy and to determine the malignancy rate of additional lesions identified by MR only in Korean women with breast cancer. Methods A retrospective review identified 22 consecutive patients with breast cancer who had undergone MR-guided vacuum-assisted biopsies (VAB) of MR-only identified lesions from May 2009 to October 2011.We evaluated the rate of compliance, the technical success for MR-guided VAB and the MR imaging findings of the target lesions. VAB histology was compared with surgical histology and follow-up imaging findings. Results The biopsy recommendations for MR-only identified lesions were accepted in 46.8% (22/47) of patients. One of 22 procedures failed due to the target's posterior location. Among 21 MR-guided VAB procedures, the target lesions were considered as a mass in 12 cases and a nonmass enhancement in nine cases. VAB histology revealed malignancies in 14% (3/21) of cases, high-risk lesions in 24% (5/21) and benign lesions in 62% (13/21). Eleven cases (52%, 11/21) had a positive surgical correlation, and one of them was upgraded from atypical ductal hyperplasia to invasive ductal carcinoma. In the remaining 10 lesions, follow-up breast ultrasound and mammography were available (range, 15-44 months; mean, 32.1 months) and did not show suspicious lesions. The final malignancy rate was 19% (4/21). Conclusion MR-guided VAB for MR-only identified lesions yielded a 19% malignancy rate in Korean women with breast cancer. MR-guided VAB helps surgeons avoid an unnecessary wide excision or additional excisional biopsy.Journal of Breast Cancer 09/2014; 17(3):270-8. DOI:10.4048/jbc.2014.17.3.270 · 1.32 Impact Factor