Abstract
ObjectiveTo 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 MethodsRetrospective 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.ResultsThe 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%.ConclusionThe 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.
Highlights
As demonstrated by large observational studies, the breast cancer mortality rate decreased by 31% over the last years, principally by the contribution from mammographic screening programs, which have led to early detection of the disease in a considerable number of cases[1,2], emphasizing the relevance of imaging methods approached by several recent studies published in the Brazilian literature[3,4,5]
Atypical ductal hyperplasia (ADH) is considered to be the most common high-risk proliferative breast lesion for breast cancer[11,12] and, because of the risk of diagnostic underestimation and likelihood of coexistence with Ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC), surgical resection is recommended after the histopathological diagnosis by means of percutaneous biopsy[13]
Fifteen (12.81%) breast lesions were considered to be at high risk for malignancy, as follows: one (0.85%) case of papilliferous lesion; 2 (1.71%) cases of complex sclerosing lesion; and 12 (10.25%) cases of ADH
Summary
As demonstrated by large observational studies, the breast cancer mortality rate decreased by 31% over the last years, principally by the contribution from mammographic screening programs, which have led to early detection of the disease in a considerable number of cases[1,2], emphasizing the relevance of imaging methods approached by several recent studies published in the Brazilian literature[3,4,5].Ductal carcinoma in situ (DCIS) is a precursor of invasive ductal carcinoma (IDC) and, previously to the introduction of mammography as a breast cancer screening method, it was rarely detected[6], with an increase in its incidence from 2% to 20% in that period[7,8] representing 15– 20% of all breast cancers, besides representing 25–56% os all detected non palpable lesions[8,9].DCIS is characterized by proliferation of malignant ductal epithelial cells, with no noticeable sign of basal membrane invasion[8], and the mammographic diagnosis is based on the presence of microcalcifications resulting from tissues necrosis and later calcification of debris and cellular secretion. Atypical ductal hyperplasia (ADH) is considered to be the most common high-risk proliferative breast lesion for breast cancer[11,12] and, because of the risk of diagnostic underestimation and likelihood of coexistence with DCIS and IDC, surgical resection is recommended after the histopathological diagnosis by means of percutaneous biopsy[13]. It is defined as an abnormal ductal proliferation that might present with all or almost all DCIS characteristics, but affecting only a duct, and measuring < 2.0 mm in diameter[11,14]. It is diagnosed by 2–11% of percutaneous biopsies performed in breasts with suspicious mammographic findings[13]
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