The Finding of Invasive Cancer After a Preoperative Diagnosis of Ductal Carcinoma-In-Situ: Causes of Ductal Carcinoma-In-Situ Underestimates With Stereotactic 14-Gauge Needle Biopsy
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Background: For the evaluation of nonpalpable lesions of the breast, image-guided 14-gauge automated needle biopsy is increasingly replacing wire-localized excision. When ductal carcinoma-in-situ (DCIS) is diagnosed at core biopsy, invasive cancer is found in approximately 17% of excision specimens. These so-called DCIS underestimates pose a problem for patients and surgeons, because they generally cause extension of treatment. We evaluated DCIS underestimates in detail to assess reasons for missing the invasive component at core biopsy. This evaluation also included a histological comparison with true DCIS (DCIS at core biopsy and excision).
Methods: Between 1997 and 2000, DCIS was diagnosed at 14-gauge needle biopsy in 255 patients. In 41 cases (16%), invasive cancer was found at excision. We performed a thorough histopathological and radiological review of all these DCIS underestimates, including a histological comparison with core biopsy specimens of 32 true DCIS cases. We assessed the main reason for missing the invasive component at core biopsy.
Results: Causes for DCIS underestimates were categorized into “mainly radiological” (n = 20), “mainly histopathological” (n = 15), and “histological disagreements” (n = 6). High-grade DCIS and periductal inflammation in core biopsies made a DCIS underestimate 2.9 and 3.3 times more likely, respectively.
Conclusions: A variety of radiological and histopathological reasons contribute to the DCIS underestimate rate. Approximately half of these are potentially avoidable.
- Verkooijen HM, Peeters PH, Buskens E, et al. Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis. Br J Cancer 2000; 82: 1017–21. CrossRef
- Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998; 339: 941–6. CrossRef
- Feldman SM, Krag DN, McNally RK, Moor BB, Weaver DL, Klein P. Limitation in gamma probe localization of the sentinel node in breast cancer patients with large excisional biopsy. J Am Coll Surg 1999; 188: 248–54. CrossRef
- Jackman R, Burbank F, Parker S, et al. Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology 2001; 218: 497–502.
- King TA, Farr GH Jr, Cederbom GJ, et al. A mass on breast imaging predicts coexisting invasive carcinoma in patients with a core biopsy diagnosis of ductal carcinoma in situ. Am Surg 2001; 67: 907–12.
- Wahedna Y, Evans AJ, Pinder SE, Ellis IO, Blamey RW, Geraghty JG. Mammographic size of ductal carcinoma in situ does not predict the presence of an invasive focus. Eur J Cancer 2001; 37: 459–62. CrossRef
- Dinkel HP, Gassel AM, Tschammler A. Is the appearance of microcalcifications on mammography useful in predicting histological grade of malignancy in ductal cancer in situ? Br J Radiol 2000; 73: 938–44.
- Bagnall MJ, Evans AJ, Wilson AR, et al. Predicting invasion in mammographically detected microcalcification. Clin Radiol 2001; 56: 828–32. CrossRef
- Lagios MD, Westdahl PR, Margolin FR, Rose MR. Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer 1982; 50: 1309–14. CrossRef
- Holland R, Hendriks JH, Vebeek AL, Mravunac M, Schuurmans Stekhoven JH. Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet 1990; 335: 519–22. CrossRef
- Lagios MD. Duct carcinoma in situ. Pathology and treatment. Surg Clin North Am 1990; 70: 853–71.
- Renshaw AA. Predicting invasion in the excision specimen from breast core needle biopsy specimens with only ductal carcinoma in situ. Arch Pathol Lab Med 2002; 126: 39–41.
- Verkooijen HM. Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicenter prospective study with 95% surgical confirmation. Int J Cancer 2002; 99: 853–9. CrossRef
- Holland R, Peterse JL, Millis RR, et al. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol 1994; 11: 167–80.
- Liberman L, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD. The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol 1998; 171: 35–40.
- Darling ML, Smith DN, Lester SC, et al. Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol 2000; 175: 1341–6.
- Burak WE, Owens KE, Tighe MB, et al. Vacuum-assisted stereotactic breast biopsy: histologic underestimation of malignant lesions. Arch Surg 2000; 135: 700–3. CrossRef
- Carter D, Smith RR. Carcinoma in situ of the breast. Cancer 1977; 40: 1189–93. CrossRef
- Lee CH, Carter D, Philpotts LE, et al. Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted? Radiology 2000; 217: 466–70.
- Hoda SA, Rosen PP. Practical considerations in the pathologic diagnosis of needle core biopsies of breast. Am J Clin Pathol 2002; 118: 101–8. CrossRef
- Azzopardi JG, Laurini RN. Elastosis in breast cancer. Cancer 1974; 33: 174–83. CrossRef
- Fisher ER, Sass R, Fisher B, Wickerham L, Paik SM. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). I. Intraductal carcinoma (DCIS). Cancer 1986; 57: 197–208. CrossRef
- Prasad ML, Osborne MP, Giri DD, Hoda SA. Microinvasive carcinoma (T1mic) of the breast: clinicopathologic profile of 21 cases. Am J Surg Pathol 2000; 24: 422–8. CrossRef
- The Finding of Invasive Cancer After a Preoperative Diagnosis of Ductal Carcinoma-In-Situ: Causes of Ductal Carcinoma-In-Situ Underestimates With Stereotactic 14-Gauge Needle Biopsy
Annals of Surgical Oncology
Volume 10, Issue 7 , pp 748-753
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Breast cancer
- Ductal carcinoma-in-situ
- Large-core needle biopsy
- DCIS underestimate rate
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- 2. Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
- 3. Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- 4. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- 5. University Medical Center Utrecht, Department of Surgery (G04.228), Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands