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Role of ultrasound and sonographically guided core biopsy in the diagnostic evaluation of ductal carcinoma in situ (DCIS) of the breast

Apporto dell’ecografia e della biopsia percutanea con guida ecografica nella diagnosi del carcinoma duttale in situ (CDIS) della mammella

  • Breast Radiology Senologia
  • Published:
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Abstract

Purpose

The aim of this study was to evaluate the role of ultrasound (US)-guided core biopsy in the diagnosis of ductal carcinoma in situ (DCIS) and to correlate the histological results on percutaneous biopsy and surgical excision.

Materials and methods

Out of 2,423 consecutive core biopsies performed under US guidance, we evaluated 65 lesions with a histological diagnosis of DCIS. All patients underwent mammography, high-frequency broadband US and percutaneous breast biopsy with a 14-gauge needle and a mean number of five samples (range 4–7 passes). Surgical excision was performed in all cases, and the histological results on the surgical specimen were correlated with those on core biopsy samples. The sonographic features of DCIS lesions were described, comparing pure DCIS (those confirmed by definitive histology) and DCIS with invasive component at surgical excision.

Results

Twenty-seven out of 65 DCIS at core biopsy were found to have an invasive or microinvasive component at surgical excision, leading to rate of histological underestimation of core biopsy of 41.5%. The most frequent sonographic appearances were: (a) mass without microcalcifications (47.4% of pure DCIS, 63% of DCIS with invasive component); (b) mass with microcalcifications (23.7% of pure DCIS, 22% of DCIS with invasive component); (c) isolated microcalcifications (10.5% of pure DCIS); (d) ductal abnormalities (18.4% of pure DCIS, 15% of DCIS with invasive component).

Conclusions

Due to the high underestimation rate of core biopsy, caution is mandatory in the case of DCIS diagnosis on core biopsy. Although some histological features (such as stromal fibrosis, periductal inflammatory infiltrate, high nuclear grade) can suggest the presence of an invasive component, the sonographic appearance of DCIS cannot be used to predict the cases that are underestimated on US-guided core biopsy. Nevertheless, a sonographically detectable solid component, either inside dilatated ducts or associated with microcalcifications, and a size greater than 20 mm are frequently associated with the presence of an invasive component.

Riassunto

Obiettivi

Valutare l’apporto della biopsia percutanea ecoguidata nella diagnosi del carcinoma duttale in situ, correlando i risultati della biopsia percutanea con l’esame istologico definitivo sul pezzo chirurgico.

Materiali e metodi

Su 2423 core biopsy consecutive sono state valutate 65 lesioni con diagnosi istologica percutanea di carcinoma duttale in situ (CDIS). Tutte le pazienti hanno eseguito l’esame mammografico e successivamente ecografico con sonda ad alta frequenza a larga banda, e la biopsia percutanea con aghi da 14 G con un numero medio di 5 frustoli (range 4–7). Tutte le pazienti sono state sottoposte a intervento chirurgico; la diagnosi istologica definitiva (sul pezzo operatorio) è stata confrontata con la diagnosi bioptica percutanea. Sono stati descritti gli aspetti ecografici dei CDIS confrontando i CDIS puri (confermati cioè al successivo esame istologico definitivo) e i CDIS con componente invasiva alla verifica istologica definitiva dopo l’escissione chirurgica.

Risultati

Ventisette/65 lesioni con diagnosi bioptica percutanea di CDIS sono risultate associate a una componente infiltrante o microinfiltrante all’esame istologico definitivo, ottenendo pertanto una “sottostima istologica” della core-biopsy pari al 41,5%. Gli aspetti ecografici principali riscontrati più frequentemente sono stati: (a) massa senza microcalcificazioni (47,4% dei CDIS puri, 63% dei CDIS con componente invasiva); (b) massa con microcalcificazioni (23,7% dei CDIS puri, 22% dei CDIS con componente invasiva); (c) microcalcificazioni isolate (10,5% dei CDIS puri); (d) alterazioni duttali (18,4% dei CDIS puri, 15% dei CDIS con componente invasiva).

Conclusioni

L’elevata incidenza di sottostime istologiche alla core-biopsy impone un atteggiamento oltremodo prudente di fronte a una diagnosi di CDIS effettuata con la core-biopsy stessa. Sebbene alcune caratteristiche istologiche presenti nei frustoli bioptici prelevati (quali la fibrosi stromale, l’infiltrato infiammatorio periduttale, l’alto grado nucleare) possano suggerire la presenza di una componente invasiva, le caratteristiche ecografiche dei CDIS non possono essere utilizzate per predire i casi che vengono sottostimati alla biopsia percutanea eco-guidata. Tuttavia la presenza di una componente solida visibile ecograficamente, all’interno di immagini duttali o associata a calcificazioni, e le dimensioni superiori ai 20 mm possono talvolta far sospettare la presenza di una componente invasiva.

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Londero, V., Zuiani, C., Furlan, A. et al. Role of ultrasound and sonographically guided core biopsy in the diagnostic evaluation of ductal carcinoma in situ (DCIS) of the breast. Radiol med 112, 863–876 (2007). https://doi.org/10.1007/s11547-007-0183-z

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  • DOI: https://doi.org/10.1007/s11547-007-0183-z

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