Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy.
Author(s): Suh YJ, Kim MJ, Kim EK, Moon HJ, Kwak JY, Koo HR, Yoon JH
Publication: Br J Radiol, 2012, Vol. 85, Page e349-56
PubMed ID: 22422382 PubMed Review Paper? No
Purpose of Paper
This paper compared the rate at which a diagnosis of ductal carcinoma in situ (DCIS) was upgraded to invasive carcinoma after surgical resection in 14-gauge core needle biopsies (CNB) versus 8 or 11-gauge vacuum assisted biopsies (VAB).
Conclusion of Paper
The rate of upgrading the diagnosis from DCIS to invasive carcinoma was comparable for 8-gauge and 11-gauge VAB but upgrading occurred for a larger percentage of lesions and patients biopsied by CNB than VAB (8- and 11-gauge combined). Significantly more sonographically-visualized masses and microcalcifications and also mammography-visualized microcalcifications biopsied with CNB were upgraded to a diagnosis of invasive carcinoma after resection than those obtained by VAB. Mass lesions were more likely than microcalcification lesions to be diagnosed as DCIS in the biopsy but invasive carcinoma in the resected specimen and microcalcified lesions were more likely to be biopsied by VAB than CNB.
Studies
-
Study Purpose
This study compared the rate at which a diagnosis of DCIS was upgraded to invasive carcinoma after surgical resection in 14-gauge CNB versus 8 or 11-gauge VAB. Ultrasound-guided 8-gauge or 11-gauge VAB was used to biopsy 16 and 40 lesions, respectively, which included intraductal lesions, lesions with heterogeneous characteristics, and microcalcifications without an associated mass. CNB was used for the remaining 138 lesions (132 patients). Lesion sizes were comparable between the VAB and CNB groups but the mean lesion size was significantly larger in the 8-gauge than 11-gauge VAB group (mean of 20.5 mm versus 11.9 mm, P=0.013). Methods used in the histological analysis were not specified.
Summary of Findings:
As expected, a larger percentage of lesions with microcalcification were biopsied by VAB than CNB (P<0.001). The mean number of cores obtained was lower for CNB than VAB (5.01 versus 11.8, P<0.0001) but was comparable between 8- and 11-gauge VAB specimens. Seventy-five of the 194 lesions (38.7%) and 75 of the 188 patients (39.9%) initially diagnosed as DCIS were found in the surgical specimen to contain invasive carcinoma. The rate of upgrading diagnosis from DCIS to invasive carcinoma was comparable for 8-gauge and 11-gauge VAB (18.8% versus 15%). A larger percentage of lesions and patients biopsied by CNB than VAB (8- and 11-gauge combined) were found to contain an invasive component in the surgical resection (47.8% versus 16.1%, P<0.001 and 48.5% versus 16.1%, P<0.001, respectively). Mass lesions were more likely than microcalcified lesions to be diagnosed as DCIS in the biopsy but invasive carcinoma in the resected specimen(43.4% versus 24.5%, P=0.029). Importantly, more lesions with sonographically-visualized masses and microcalcifications biopsied with CNB than VAB were upgraded to invasive carcinoma after resection (47.6% versus 15.8%, P=0.012 and 50% versus 16.2%, P=0.047, respectively). Lesions with calcifications, but not masses, visualized by mammography were more likely to be upgraded from a diagnosis of DCIS to invasive carcinoma when the initial biopsy was with CNB than VAB (48% versus 14.3%, P<0.001).
Biospecimens
Preservative Types
- Formalin
Diagnoses:
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform Morphology X-ray Morphology H-and-E microscopy Morphology Light microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition Core needle biopsy
Vacuum assisted biopsy
Surgical resection
Preaquisition Prognostic factor Microcalcified lesion
Mass
Biospecimen Acquisition Needle gauge 14-gauge CNB
8-gauge VAB
11-gauge VAB