Limits...
Absence of Residual Microcalcifications in Atypical Ductal Hyperplasia Diagnosed via Stereotactic Vacuum-Assisted Breast Biopsy: Is Surgical Excision Obviated?

Youn I, Kim MJ, Moon HJ, Kim EK - J Breast Cancer (2014)

Bottom Line: The underestimation rate of ADH was also calculated.The underestimation rate of ADH on VABB was 33.3%.Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The purpose of our study was to evaluate the underestimation rate of atypical ductal hyperplasia (ADH) on vacuum-assisted breast biopsy (VABB), and to examine the correlation between residual microcalcifications and the underestimation rate of ADH.

Methods: A retrospective study was performed on 27 women (mean age, 49.2±9.2 years) who underwent additional excision for ADH via VABB for microcalcifications observed by using mammography. The mammographic findings, histopathologic diagnosis of all VABB and surgical specimens, and association of malignancy with residual microcalcifications were evaluated. The underestimation rate of ADH was also calculated.

Results: Of the 27 women with microcalcifications, nine were upgraded to ductal carcinoma in situ (DCIS); thus, the underestimation rate was 33.3% (9/27). There was no difference in age (p=0.40) and extent of microcalcifications (p=0.10) when comparing benign and malignant cases. Six of 17 patients (35.3%) with remaining calcifications after VABB were upgraded to DCIS, and three of 10 patients (30%) with no residual calcifications after VABB were upgraded (p=1.00).

Conclusion: The underestimation rate of ADH on VABB was 33.3%. Furthermore, 30% of patients with no remaining calcifications were upgraded to DCIS. Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.

No MeSH data available.


Related in: MedlinePlus

A 55-year-old woman with ductal carcinoma in situ. (A) Magnification view of mediolateral mammography reveals linear distributed linear branching calcifications measuring 18 mm at the longest dimension in left upper medial breast. Vacuum-assisted breast biopsy was performed with 11-gauge needle and the localizing clip was placed. (B) Radiography of the vacuum-assisted breast biopsy specimens revealed calcification and the diagnosis was atypical ductal hyperplasia. (C) Mediolateral mammography of the left breast obtained after 1 week shows localizing clip with remaining calcifications. After surgery, the pathologic diagnosis was ductal carcinoma in situ.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4197357&req=5

Figure 2: A 55-year-old woman with ductal carcinoma in situ. (A) Magnification view of mediolateral mammography reveals linear distributed linear branching calcifications measuring 18 mm at the longest dimension in left upper medial breast. Vacuum-assisted breast biopsy was performed with 11-gauge needle and the localizing clip was placed. (B) Radiography of the vacuum-assisted breast biopsy specimens revealed calcification and the diagnosis was atypical ductal hyperplasia. (C) Mediolateral mammography of the left breast obtained after 1 week shows localizing clip with remaining calcifications. After surgery, the pathologic diagnosis was ductal carcinoma in situ.

Mentions: The residual calcifications after VABB in the benign and malignant groups are presented in Table 3. On the basis of the results on mammograms after VABB, three patients (30%) were upgraded to DCIS among the patients without residual microcalcifications (Figure 1), whereas six of 17 patients with remaining microcalcifications (35.3%) were upgraded to DCIS (p=1.00) (Figure 2). Of the three patients with underestimation and in whom no remaining microcalcifications were observed on the mammogram after VABB, an 11-gauge needle was used in two patients and an 8-gauge needle in one patient. Among the patients classified as having BI-RADS category 4A lesions, three out of nine patients without residual calcifications (33.3%) were upgraded, whereas only one out of 11 patients with residual calcifications (9.1%) was upgraded. Among the patients classified with category 4B or 4C lesions, there were no upgraded patients without residual calcifications (0/1), whereas five out of six patients with residual calcifications (83.3%, 5/6) were upgraded.


Absence of Residual Microcalcifications in Atypical Ductal Hyperplasia Diagnosed via Stereotactic Vacuum-Assisted Breast Biopsy: Is Surgical Excision Obviated?

Youn I, Kim MJ, Moon HJ, Kim EK - J Breast Cancer (2014)

A 55-year-old woman with ductal carcinoma in situ. (A) Magnification view of mediolateral mammography reveals linear distributed linear branching calcifications measuring 18 mm at the longest dimension in left upper medial breast. Vacuum-assisted breast biopsy was performed with 11-gauge needle and the localizing clip was placed. (B) Radiography of the vacuum-assisted breast biopsy specimens revealed calcification and the diagnosis was atypical ductal hyperplasia. (C) Mediolateral mammography of the left breast obtained after 1 week shows localizing clip with remaining calcifications. After surgery, the pathologic diagnosis was ductal carcinoma in situ.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197357&req=5

Figure 2: A 55-year-old woman with ductal carcinoma in situ. (A) Magnification view of mediolateral mammography reveals linear distributed linear branching calcifications measuring 18 mm at the longest dimension in left upper medial breast. Vacuum-assisted breast biopsy was performed with 11-gauge needle and the localizing clip was placed. (B) Radiography of the vacuum-assisted breast biopsy specimens revealed calcification and the diagnosis was atypical ductal hyperplasia. (C) Mediolateral mammography of the left breast obtained after 1 week shows localizing clip with remaining calcifications. After surgery, the pathologic diagnosis was ductal carcinoma in situ.
Mentions: The residual calcifications after VABB in the benign and malignant groups are presented in Table 3. On the basis of the results on mammograms after VABB, three patients (30%) were upgraded to DCIS among the patients without residual microcalcifications (Figure 1), whereas six of 17 patients with remaining microcalcifications (35.3%) were upgraded to DCIS (p=1.00) (Figure 2). Of the three patients with underestimation and in whom no remaining microcalcifications were observed on the mammogram after VABB, an 11-gauge needle was used in two patients and an 8-gauge needle in one patient. Among the patients classified as having BI-RADS category 4A lesions, three out of nine patients without residual calcifications (33.3%) were upgraded, whereas only one out of 11 patients with residual calcifications (9.1%) was upgraded. Among the patients classified with category 4B or 4C lesions, there were no upgraded patients without residual calcifications (0/1), whereas five out of six patients with residual calcifications (83.3%, 5/6) were upgraded.

Bottom Line: The underestimation rate of ADH was also calculated.The underestimation rate of ADH on VABB was 33.3%.Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The purpose of our study was to evaluate the underestimation rate of atypical ductal hyperplasia (ADH) on vacuum-assisted breast biopsy (VABB), and to examine the correlation between residual microcalcifications and the underestimation rate of ADH.

Methods: A retrospective study was performed on 27 women (mean age, 49.2±9.2 years) who underwent additional excision for ADH via VABB for microcalcifications observed by using mammography. The mammographic findings, histopathologic diagnosis of all VABB and surgical specimens, and association of malignancy with residual microcalcifications were evaluated. The underestimation rate of ADH was also calculated.

Results: Of the 27 women with microcalcifications, nine were upgraded to ductal carcinoma in situ (DCIS); thus, the underestimation rate was 33.3% (9/27). There was no difference in age (p=0.40) and extent of microcalcifications (p=0.10) when comparing benign and malignant cases. Six of 17 patients (35.3%) with remaining calcifications after VABB were upgraded to DCIS, and three of 10 patients (30%) with no residual calcifications after VABB were upgraded (p=1.00).

Conclusion: The underestimation rate of ADH on VABB was 33.3%. Furthermore, 30% of patients with no remaining calcifications were upgraded to DCIS. Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.

No MeSH data available.


Related in: MedlinePlus