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Stereotactic Breast Biopsy of Nonpalpable Lesions: Determinants of Ductal Carcinoma in Situ Underestimation Rates¹

¹ From the Depts of Radiology of Palo Alto Med Clinic, 795 El Camino Real, Palo Alto, CA 94301 (R.J.J.); Mission Breast Care Center, Mission Viejo, Calif (F.B.); Sally Jobe Breast Center, Englewood, Colo (S.H.P.); Susan G. Komen Breast Center, Dallas, Tex (W.P.E.); Park Nicollet Med Center, Minneapolis, Minn (M.C.L.); Fresno Breast Center, Calif (T.R.R.); Women’s Center Breast Care Clinic of Cox Health Systems, Springfield, Mo (A.A.S.); Mills-Peninsula Breast Center, San Mateo, Calif (H.B.B.); Yale Univ School of Medicine, New Haven, Conn (C.H.L.); South Texas Radiology Group, San Antonio (H.M.G.); Boca Raton Community Hosp, Fla (K.J.S.); Eastern Idaho Regional Med Center, Idaho Falls (A.B.W.); Johns Hopkins Med Institutions, Baltimore, Md (R.F.B.); Univ of Vienna, Austria (T.H.H.); CERIM, Buenos Aires, Argentina (D.E.L.); and Virginia Mason Med Center, Seattle, Wash (S.J.A.). From the 1998 RSNA scientific assembly. Received Aug 19, 1999; revision requested Oct 14; final revision received May 2, 2000; accepted May 22. Supported in part by an educational grant from Biopsys Medical to the Palo Alto Medical Foundation. Address correspondence to R.J.J. (e-mail: jackmanr@pamf.org).

PURPOSE: To measure the effect of biopsy device, probe size, mammographic lesion type, lesion size, and number of samples obtained per lesion on the ductal carcinoma in situ (DCIS) underestimation rate.

MATERIALS AND METHODS: Nonpalpable breast lesions at 16 institutions received a histologic diagnosis of DCIS after 14-gauge automated large-core biopsy in 373 lesions and after 14- or 11-gauge directional vacuum-assisted biopsy in 953 lesions. The presence of histopathologic invasive carcinoma was noted at subsequent surgical biopsy.

RESULTS: By performing the ² test, independent significant DCIS underestimation rates by biopsy device were 20.4% (76 of 373) of lesions diagnosed at large-core biopsy and 11.2% (107 of 953) of lesions diagnosed at vacuum-assisted biopsy (P < .001); by lesion type, 24.3% (35 of 144) of masses and 12.5% (148 of 1,182) of microcalcifications (P < .001); and by number of specimens per lesion, 17.5% (88 of 502) with 10 or fewer specimens and 11.5% (92 of 799) with greater than 10 (P < .02). DCIS underestimations increased with lesion size.

CONCLUSION: DCIS underestimations were 1.9 times more frequent with masses than with calcifications, 1.8 times more frequent with large-core biopsy than with vacuum-assisted biopsy, and 1.5 times more frequent with 10 or fewer specimens per lesion than with more than 10 specimens per lesion.

Index terms: Biopsies, technology, 00.1261, 00.1262 • Breast, biopsy, 00.1261, 00.1262 • Breast, diseases, 00.324, 00.719 • Breast, ducts, 00.324, 00.719 • Breast neoplasms, diagnosis, 00.126, 00.324, 00.719

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