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Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy.
AJR Am J Roentgenol. 1999 May; 172(5):1405-7.AA

Abstract

OBJECTIVE

This review was undertaken to determine the reliability of the histologic diagnosis of atypical ductal hyperplasia (ADH) made from tissue obtained by 11-gauge stereotactically guided directional vacuum-assisted biopsy of impalpable breast lesions.

MATERIALS AND METHODS

Four hundred twenty-two 11-gauge stereotactically guided vacuum-assisted breast biopsies were performed at our institution between November 5, 1996, and June 30, 1998. Biopsies were performed with the patient prone on a dedicated stereotactic biopsy table. A directional vacuum-assisted biopsy device was used. Eight to 24 cores (mean, 13.4) were harvested from each lesion. Radiography of core specimens was performed in cases in which the target lesion contained microcalcifications. Twenty (4.7%) of the 422 biopsies yielded a histopathologic diagnosis of ADH. Surgical excision of 16 of the 20 lesions was subsequently performed. We compared the histopathologic results of the core extracted and the corresponding surgically excised tissue.

RESULTS

Of the 16 surgically excised lesions, four (25.0%) retained the diagnosis of ADH. Four (25%) were upgraded to carcinoma: Two (12.5%) were ductal carcinoma in situ without comedonecrosis, one (6.3%) was invasive carcinoma, and one (6.3%) was tubular carcinoma. Of the remaining eight surgically excised lesions, six (37.5%) were interpreted as benign fibrocystic changes with ductal hyperplasia without atypia, and two (12.5%) were interpreted as lobular carcinoma in situ.

CONCLUSION

Because ADH was underdiagnosed in 25% of the lesions, we recommend that surgical excision be performed whenever ADH is found in tissue obtained from 11-gauge directional vacuum-assisted breast biopsy.

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Authors+Show Affiliations

Brem RF
The Russell H. Morgan Department of Radiology and Radiological Science, The Breast Imaging and Interventional Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Behrndt VS
No affiliation info available
Sanow L
No affiliation info available
Gatewood OM
No affiliation info available

MeSH

Biopsy, NeedleBreastBreast NeoplasmsCarcinoma in SituCarcinoma, Ductal, BreastFemaleHumansHyperplasiaMiddle AgedReproducibility of ResultsStereotaxic TechniquesVacuum

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10227526

Citation

Brem, R F., et al. "Atypical Ductal Hyperplasia: Histologic Underestimation of Carcinoma in Tissue Harvested From Impalpable Breast Lesions Using 11-gauge Stereotactically Guided Directional Vacuum-assisted Biopsy." AJR. American Journal of Roentgenology, vol. 172, no. 5, 1999, pp. 1405-7.
Brem RF, Behrndt VS, Sanow L, et al. Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy. AJR Am J Roentgenol. 1999;172(5):1405-7.
Brem, R. F., Behrndt, V. S., Sanow, L., & Gatewood, O. M. (1999). Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy. AJR. American Journal of Roentgenology, 172(5), 1405-7.
Brem RF, et al. Atypical Ductal Hyperplasia: Histologic Underestimation of Carcinoma in Tissue Harvested From Impalpable Breast Lesions Using 11-gauge Stereotactically Guided Directional Vacuum-assisted Biopsy. AJR Am J Roentgenol. 1999;172(5):1405-7. PubMed PMID: 10227526.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-gauge stereotactically guided directional vacuum-assisted biopsy. AU - Brem,R F, AU - Behrndt,V S, AU - Sanow,L, AU - Gatewood,O M, PY - 1999/5/5/pubmed PY - 1999/5/5/medline PY - 1999/5/5/entrez SP - 1405 EP - 7 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 172 IS - 5 N2 - OBJECTIVE: This review was undertaken to determine the reliability of the histologic diagnosis of atypical ductal hyperplasia (ADH) made from tissue obtained by 11-gauge stereotactically guided directional vacuum-assisted biopsy of impalpable breast lesions. MATERIALS AND METHODS: Four hundred twenty-two 11-gauge stereotactically guided vacuum-assisted breast biopsies were performed at our institution between November 5, 1996, and June 30, 1998. Biopsies were performed with the patient prone on a dedicated stereotactic biopsy table. A directional vacuum-assisted biopsy device was used. Eight to 24 cores (mean, 13.4) were harvested from each lesion. Radiography of core specimens was performed in cases in which the target lesion contained microcalcifications. Twenty (4.7%) of the 422 biopsies yielded a histopathologic diagnosis of ADH. Surgical excision of 16 of the 20 lesions was subsequently performed. We compared the histopathologic results of the core extracted and the corresponding surgically excised tissue. RESULTS: Of the 16 surgically excised lesions, four (25.0%) retained the diagnosis of ADH. Four (25%) were upgraded to carcinoma: Two (12.5%) were ductal carcinoma in situ without comedonecrosis, one (6.3%) was invasive carcinoma, and one (6.3%) was tubular carcinoma. Of the remaining eight surgically excised lesions, six (37.5%) were interpreted as benign fibrocystic changes with ductal hyperplasia without atypia, and two (12.5%) were interpreted as lobular carcinoma in situ. CONCLUSION: Because ADH was underdiagnosed in 25% of the lesions, we recommend that surgical excision be performed whenever ADH is found in tissue obtained from 11-gauge directional vacuum-assisted breast biopsy. SN - 0361-803X UR - https://www.unboundmedicine.com/medline/citation/10227526/Atypical_ductal_hyperplasia:_histologic_underestimation_of_carcinoma_in_tissue_harvested_from_impalpable_breast_lesions_using_11_gauge_stereotactically_guided_directional_vacuum_assisted_biopsy_ L2 - https://www.ajronline.org/doi/10.2214/ajr.172.5.10227526 DB - PRIME DP - Unbound Medicine ER -