Ductal Carcinoma In Situ Underestimation of Microcalcifications Only by Stereotactic Vacuum-Assisted Breast Biopsy: A New Predictor of Specimens without Microcalcifications.

Yun-Chung Cheung,Chi-Chang Yu,Shir-Hwa Ueng,Shin-Cheh Chen

doi:10.3390/jcm9092999

Abstract

The mammographic appearance of ductal carcinoma in situ (DCIS) is mostly observed as microcalcifications. Although stereotactic vacuum-assisted breast biopsy (VABB) is a reliable alternative to surgical biopsy for suspicious microcalcifications, underestimation of VABB-proven DCIS is inevitable in clinical practice. We therefore retrospectively analyzed the variables in the prediction of DCIS underestimation manifesting as microcalcifications only proved by stereotactic VABB. In 1147 consecutive VABB on microcalcification-only lesions from 2010 to 2016, patients diagnosed with DCIS were selected to evaluate the underestimation rate. The analyzed variables included clinical characteristics, mammographic features, VABB procedure, and biomarkers. Univariate and multivariate analyses were used, and a p value < 0.05 was considered statistically significant. Of the 131 VABB-proven DCIS, 108 cases were diagnosed with DCIS and 23 were upgraded to invasive ductal carcinoma (IDC) after subsequent surgery. The small extent of microcalcification, grouped microcalcifications distribution, nearly complete microcalcification removal, and non-calcified specimens without DCIS were low for DCIS underestimation. Among them, the results of non-calcified specimens with or without DICS were the only statistically significant variables by multivariate logistic regression. These results indicate that the histology of non-calcified specimens was highly predictive of DCIS underestimation. Specimens without DCIS had a low upgrade rate to IDC.

Highlights

Stereotactic vacuum-assisted breast biopsy (VABB) is the standard for the diagnosis of suspicious malignant breast microcalcifications
VABB is a promising technique for obtaining abundant tissues for microscopic evaluation [3,4], the underestimation of atypia lesions to ductal carcinoma in situ (DCIS) has been reported to range from 0% to 21% for flat epithelial atypia [5,6,7] and 10% to 29% for atypical ductal hyperplasia [8,9,10]
To provide an assessment to predict the underestimation of biopsied DCIS, we retrospectively reviewed the results of VABB in cases with breast microcalcifications only and analyzed the variables from patient characteristics, mammographic features, VABB procedural relationships, and biopsy biomarkers among the VABB-proven DCIS

Summary

Introduction

Stereotactic vacuum-assisted breast biopsy (VABB) is the standard for the diagnosis of suspicious malignant breast microcalcifications. There are no advanced imaging diagnostic modalities that can replace the histological diagnosis. This mammography-guided biopsy can be used to diagnose asymptomatic noninvasive or invasive cancers manifesting only with microcalcifications that have been proven to efficiently reduce the mortality of breast cancer [1]. Invasive percutaneous core needle biopsy is a cost-effective and reliable alternative to surgical biopsy for tissue sampling of suspicious breast lesions, regardless of the screening or clinical diagnostic context [2]. To avoid delayed treatment of early cancers, management with subsequent surgical biopsy should be recommended as guidance [11,12,13], and this has been universally accepted

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