Abstract
Background: Breast cancer is a major cause of morbidity and mortality worldwide. Certain lesions encountered on mammography require histological assessment of biopsy samples to identify benign versus malignant disease. Stereotactic vacuum-assisted breast biopsy (SVAB) is a useful technique, especially for non-palpable microcalcific lesions, and was introduced at our institution in 2011.Objectives: To determine whether the histological underestimation from 9-gauge SVABs performed at our institution is within acceptable limits.Method: In this cross-sectional study, 9-gauge stereotactic biopsy histology results and breast imaging and reporting data system (BI-RADS) findings of 158 lesions (from 153 patients) were analysed and the histological findings compared with surgical excision histology results (54 lesions) to determine histological underestimation (upgrade rates).Results: One out of eight cases of ductal carcinoma in situ (DCIS) was underestimated, yielding a DCIS underestimation rate of 12.5%.Conclusion: The DCIS underestimation obtained from the present study in our institution was on a par with other authors’ findings and was therefore within acceptable limits. Atypical ductal hyperplasia underestimation could not be reliably obtained with the small study population.Keywords: Stereotactic vacuum assisted breast biopsy; histological underestimation; histological upgrade
Highlights
The most common malignancy in women globally is breast cancer.[1]
The diagnosis of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) on percutaneous biopsy is an indication for subsequent therapeutic surgical excision because of the risk of carcinoma and invasive carcinoma residing within these lesions.[3]
All patients with ADH, DCIS or invasive ductal http://www.sajr.org.za carcinoma (IDC) on Stereotactic vacuum-assisted breast biopsy (SVAB) are routinely booked for surgical excision at our institution
Summary
The most common malignancy in women globally is breast cancer.[1]. Screening mammography reduces breast cancer mortality, but numerous benign abnormalities that cannot be distinguished from malignancy[2] are detected on mammography. DCIS underestimation occurs when a lesion characterised as DCIS yields infiltrating carcinoma on surgical biopsy. ADH underestimation occurs when a lesion characterised as ADH on percutaneous biopsy yields carcinoma on subsequent surgery.[3] A small sample of a DCIS lesion may be interpreted as ADH by the pathologist.[3] Histologic underestimation in lesions containing both ADH and DCIS as well as lesions containing both DCIS and infiltrating ductal carcinoma may be attributed to sampling error.[3] The diagnosis of ADH or DCIS on percutaneous biopsy is an indication for subsequent therapeutic surgical excision because of the risk of carcinoma and invasive carcinoma residing within these lesions.[3]. Certain lesions encountered on mammography require histological assessment of biopsy samples to identify benign versus malignant disease. Stereotactic vacuum-assisted breast biopsy (SVAB) is a useful technique, especially for non-palpable microcalcific lesions, and was introduced at our institution in 2011
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