Purpose
BACKGROUNDAn ultrasound-guided core needle biopsyis an invaluable tool for the diagnosis of breast lesions.However, the possibility of inaccurate sampling with histologic underestimation of lesions, such as ductal carcinoma in situ (DCIS) has been unavoidable. Underestimation of DCIS occurs when a lesion is determined to be DCIS after a percutaneous breast biopsy and is subsequently shown to be invasive carcinoma following surgical excision.In a review of the literature, most prior studies of underestimating DCIS have been performed using stereotactic devices, However, underestimating DCIS after a US-CNB...
Methods and Materials
I. CASE SELECTIONBetween July 2005 and July 2007, 3124 ultrasound guided-14 gauge core needle biopsies (US-14G-CNBs) of breast masses were performed at the breast imaging center at our institution. Among the lesions, 78 lesions were pathologically-determined to be DCIS.Inclusion criteria was a histopathologically-proven pure DCIS without signs of micro-invasion or invasive cancer, as determined by the use of light microscopy.DCIS with micro-invasion was defined as tumor cells, singly or inclusters, that infiltrated the periductal stroma or were seen as a projection of neoplastic cells through...
Results
I. UNDERESTIMATION RATEAll 60 patients were women (age range, 24–88 years; mean age, 47.5 ± 11.3 years). Of the 69 DCIS lesions diagnosed after a US-14G-CNB, invasive carcinoma was diagnosed in 21 lesions in 19 patients following surgical excision (underestimated group). Thus, the rate of underestimation of DCIS in this study was 30.4% (95% confidence interval, 17.4%–38.0%).II.COMPARISONS OF THE UNDERESTIMATED AND NON-UNDERESTIMATED GROUPSTable 1. Comparisons of clinical findings in the underestimated and non- underestimated groupsClinical findingsUnderestimatedn = 21(%)Non-underestimatedn = 48(%)p-valueAge (mean ± standard deviation)50.7 ±...
Conclusion
It would be useful to identify the pre-operative factors that could predict the presence of occult invasion within DCIS lesions. The ability to identify patients pre-operatively who have a high possibility of having a co-existing invasive carcinoma might allow sentinel lymph node mapping and needle aspiration or a biopsy to be performed prior to the initial surgical excision. In conclusion, the rate of underestimating DCIS for the use of a US-14G-CNB of breast masses in this study was 30.4%. Based on our results, it would...
References
Berry CC. A tutorial on confidence intervals for proportions in diagnostic radiology. AJR Am J Roentgenol 1990;154:477-480.Vassallo P, Wernecke K, Roos N, et al. Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 1992;183:215-220.Liberman L, Feng TL, Dershaw DD, et al. US-guided core breast biopsy: use and cost-effectiveness. Radiology 1998;208:717-723.Liberman L, Smolkin JH, Dershaw DD, et al. Calcification retrieval at stereotactic, 11-gauge, directional, vacuum-assisted breast biopsy. Radiology 1998;208:251-260.Jackman RJ, Nowels KW, Rodriguez-Soto J, et al. Stereotactic, automated, large-core needle biopsy of...