Skip to main content

Advertisement

SpringerLink
Log in

Atypical Ductal Hyperplasia: Improved Accuracy with the 11-Gauge Vacuum-Assisted versus the 14-Gauge Core Biopsy Needle

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Percutaneous stereotactic core needle biopsy (CNB) has become the primary diagnostic modality for evaluating nonpalpable, mammographically detected breast lesions. Atypical ductal hyperplasia (ADH) uncovered by CNB confers a significant risk of harboring an occult malignancy in the excisional biopsy specimen; therefore, we sought to determine the benefits of upsizing biopsy needles from 14- to 11-gauge.

Methods

Patients with isolated ADH diagnosed by CNB were included for analysis in this retrospective review. Mammographic description, number of needle passes, pathology results, and follow-up data were analyzed and compared to our previously published institutional results with the 14-gauge needle.

Results

From June 1996 until July 2006, 4,579 CNBs were performed at our tertiary level medical facility. Seventy eight of 88 patients (89%) diagnosed with ADH on CNB with an 11-gauge vacuum-assisted needle underwent open surgical excision. Of these patients, nine (11%) were upgraded to ductal carcinoma in-situ (DCIS) while five (6%) had invasive cancer (IC), giving a total underestimation rate of 17%. These results differ from our previously published series of 14-gauge CNB which revealed an underestimation rate of 36%. Mean number of passes obtained at time of biopsy, mean age of patients, and characteristic radiographic abnormalities were similar for malignant and benign diagnoses.

Conclusion

11-gauge CNB technique reduces sampling error and improves accuracy, but does not eliminate the risk of missing an underlying malignancy. Surgical excision of ADH identified by CNB is required for definitive diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Smart CR, Byrne C, Smith RA, et al. Twenty-year follow-up of the breast cancers diagnosed during the Breast Cancer Detection Demonstration Project. CA Cancer J Clin 1997;47:134–49

    Article  PubMed  CAS  Google Scholar 

  2. Monsees BS. Evaluation of breast microcalcifications. Radiol Clin North Am 1995;33:1109–21

    PubMed  CAS  Google Scholar 

  3. Parker SH, Lovin JD, Jobe WE, et al. Stereotactic breast biopsy with a biopsy gun. Radiology 1990;176:741–7

    PubMed  CAS  Google Scholar 

  4. Parker SH, Lovin JD, Jobe WE, et al. Nonpalpable breast lesions: stereotactic automated large-core biopsies. Radiology 1991; 180:403–7

    PubMed  CAS  Google Scholar 

  5. Parker SH, Burbank F, Jackman RJ, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 1994; 193:359–64

    PubMed  CAS  Google Scholar 

  6. Page DL, Dupont WD, Rogers LW, et al. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer 1985;55:2698–708

    Article  PubMed  CAS  Google Scholar 

  7. Winchester DJ, Bernstein JR, Jeske JM, et al. Upstaging of atypical ductal hyperplasia after vacuum-assisted 11-gauge stereotactic core needle biopsy. Arch Surg 2003;138:619–22

    Article  PubMed  Google Scholar 

  8. Cangiarella J, Waisman J, Symmans WF, et al. Mammotome core biopsy for mammary microcalcification: analysis of 160 biopsies from 142 women with surgical and radiologic follow-up. Cancer 2001;91:173–7

    Article  PubMed  CAS  Google Scholar 

  9. Moore MM, Hargett CW 3rd, Hanks JB, et al. Association of breast cancer with the finding of atypical ductal hyperplasia at core breast biopsy. Ann Surg 1997;225:726–31

    Article  PubMed  CAS  Google Scholar 

  10. Jackman RJ, Burbank F, Parker SH, et al. Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy. Radiology 1997;204:485–8

    PubMed  CAS  Google Scholar 

  11. Wu YC, Chen DR, Kuo SJ. Personal experience of ultrasound-guided 14-gauge core biopsy of breast tumor. Eur J Surg Oncol 2006; 32:715–8

    Article  PubMed  Google Scholar 

  12. Pandelidis S, Heiland D, Jones D, et al. Accuracy of 11-gauge vacuum-assisted core biopsy of mammographic breast lesions. Ann Surg Oncol 2003;10:43–7

    Article  PubMed  Google Scholar 

  13. Rao A, Parker S, Ratzer E, et al. Atypical ductal hyperplasia of the breast diagnosed by 11-gauge directional vacuum-assisted biopsy. Am J Surg 2002;184:534–7

    Article  PubMed  Google Scholar 

  14. Adrales G, Turk P, Wallace T, et al. Is surgical excision necessary for atypical ductal hyperplasia of the breast diagnosed by Mammotome? Am J Surg 2000;180:313–5

    Article  PubMed  CAS  Google Scholar 

  15. Burak WE, Jr., Owens KE, Tighe MB, et al. Vacuum-assisted stereotactic breast biopsy: histologic underestimation of malignant lesions. Arch Surg 2000;135:700–3

    Article  PubMed  Google Scholar 

  16. Philpotts LE, Lee CH, Horvath LJ, et al. Underestimation of breast cancer with II-gauge vacuum suction biopsy. AJR Am J Roentgenol 2000;175:1047–50

    PubMed  CAS  Google Scholar 

  17. Brown TA, Wall JW, Christensen ED, et al. Atypical hyperplasia in the era of stereotactic core needle biopsy. J Surg Oncol 1998;67:168–73

    Article  PubMed  CAS  Google Scholar 

  18. Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology 2002;224:548–54

    Article  PubMed  Google Scholar 

  19. Burbank F, Parker SH, Fogarty TJ. Stereotactic breast biopsy: improved tissue harvesting with the Mammotome. Am Surg 1996; 62:738–44

    PubMed  CAS  Google Scholar 

  20. Lomoschitz FM, Helbich TH, Rudas M, et al. Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy. Radiology 2004;232:897–903

    Article  PubMed  Google Scholar 

  21. 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;172:1405–7

    PubMed  CAS  Google Scholar 

  22. Meyer JE, Smith DN, Lester SC, et al. Large-core needle biopsy of nonpalpable breast lesions. JAMA 1999;281:1638–41

    Article  PubMed  CAS  Google Scholar 

  23. Hillner BE, Bear HD, Fajardo LL. Estimating the cost-effectiveness of stereotaxic biopsy for nonpalpable breast abnormalities: a decision analysis model. Acad Radiol 1996;3:351–60

    Article  PubMed  CAS  Google Scholar 

  24. Lee CH, Egglin TK, Philpotts L, et al. Cost-effectiveness of stereotactic core needle biopsy: analysis by means of mammographic findings. Radiology 1997;202:849–54

    PubMed  CAS  Google Scholar 

  25. Liberman L, Fahs MC, Dershaw DD, et al. Impact of stereotaxic core breast biopsy on cost of diagnosis. Radiology 1995;195:633–7

    PubMed  CAS  Google Scholar 

  26. Liberman L, Sama MP. Cost-effectiveness of stereotactic 11-gauge directional vacuum-assisted breast biopsy. AJR Am J Roentgenol 2000;175:53–8

    PubMed  CAS  Google Scholar 

  27. Meyer JE, Smith DN, DiPiro PJ, et al. Stereotactic breast biopsy of clustered microcalcifications with a directional, vacuum-assisted device. Radiology 1997;204:575–6

    PubMed  CAS  Google Scholar 

  28. Philpotts LE, Shaheen NA, Carter D, et al. Comparison of rebiopsy rates after stereotactic core needle biopsy of the breast with 11-gauge vacuum suction probe versus 14-gauge needle and automatic gun. AJR Am J Roentgenol 1999;172:683–7

    PubMed  CAS  Google Scholar 

  29. Reynolds HE, Poon CM, Goulet RJ, et al. Biopsy of breast microcalcifications using an 11-gauge directional vacuum-assisted device. AJR Am J Roentgenol 1998;171:611–3

    PubMed  CAS  Google Scholar 

  30. Burbank F. Stereotactic breast biopsy: comparison of 14- and 11-gauge Mammotome probe performance and complication rates. Am Surg 1997;63:988–95

    PubMed  CAS  Google Scholar 

  31. Meloni GB, Becchere MP, Soro D, et al. Percutaneous vacuum-assisted core breast biopsy with upright stereotactic equipment. Indications, limitations and results. Acta Radiol 2002;43:575–8

    Article  PubMed  CAS  Google Scholar 

  32. 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

    PubMed  CAS  Google Scholar 

  33. Orel SG, Rosen M, Mies C, et al. MR imaging-guided 9-gauge vacuum-assisted core-needle breast biopsy: initial experience. Radiology 2006;238:54–61

    Article  PubMed  Google Scholar 

  34. Hameed O, Ghali VS, Tartter PI, et al. Immunohistochemical staining for cyclin D1 and Ki-67 aids in the stratification of atypical ductal hyperplasia diagnosed on breast core biopsy. Am J Clin Pathol 2005;124:862–72

    Article  PubMed  Google Scholar 

  35. Otterbach F, Bankfalvi A, Bergner S, et al. Cytokeratin 5/6 immunohistochemistry assists the differential diagnosis of atypical proliferations of the breast. Histopathology 2000;37:232–40

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Madigan Army Medical Center, Building 9040 Fitzsimmons Drive, Tacoma, Washington, USA

    Vance Sohn MD, Zachary Arthurs MD, Garth Herbert MD, Jason Perry MD, Matthew Eckert MD, Dean Fellabaum MD & Tommy Brown MD

  2. Department of Pathology, Madigan Army Medical Center, Tacoma, Washington, USA

    Joren Keylock MD

  3. Department of Radiology, Madigan Army Medical Center, Tacoma, Washington, USA

    Donald Smith MD

Authors
  1. Vance Sohn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zachary Arthurs MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Garth Herbert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joren Keylock MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason Perry MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew Eckert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dean Fellabaum MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Donald Smith MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tommy Brown MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vance Sohn MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sohn, V., Arthurs, Z., Herbert, G. et al. Atypical Ductal Hyperplasia: Improved Accuracy with the 11-Gauge Vacuum-Assisted versus the 14-Gauge Core Biopsy Needle. Ann Surg Oncol 14, 2497–2501 (2007). https://doi.org/10.1245/s10434-007-9454-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-007-9454-0

Keywords

Search

Navigation