Journal article
Underestimation of malignancy of core needle biopsy for nonpalpable breast lesions
Revista Brasileira de ginecologia e obstetrícia, Vol.33(7), pp.123-131
07/01/2011
DOI: 10.1590/S0100-72032011000700002
PMID: 22012421
Abstract
PURPOSE: To determine the rate of underestimation of an image-guided core biopsy of nonpalpable breast lesions, with validation by histologic examination after surgical excision. METHODS: We retrospectively reviewed 352 biopsies from patients who were submitted to surgery from February 2000 to December 2005, and whose histopathologic findings were recorded in the database system. Results were compared to surgical findings and underestimation rate was determined by dividing the number of lesions that proved to be carcinomas at surgical excision by the total number of lesions evaluated with excisional biopsy. Clinical, imaging, core biopsy and pathologic features were analyzed to identify factors that affect the rate of underestimation. The degree of agreement between the results was obtained by the percentage of agreement and Cohen's kappa coefficient. The association of variables with the underestimation of the diagnosis was determined by the chi-square, Fisher exact, ANOVA and Mann-Whitney U tests. The risk of underestimation was measured by the relative risk (RR) together with the respective 95% confidence intervals (95%CI). RESULTS: Inconclusive core biopsy findings occurred in 15.6% of cases. The histopathological result was benign in 26.4%, a high-risk lesion in 12.8% and malignant in 45.2%. There was agreement between core biopsy and surgery in 82.1% of cases (kappa=0.75). The false-negative rate was 5.4% and the lesion was completely removed in 3.4% of cases. The underestimation rate was 9.1% and was associated with BI-RADS (R) category 5 (p=0,01), microcalcifications (p <0.001) and stereotactic guidance (p=0.002). All underestimated cases were less than 20 mm in diameter and there were at least five fragments. The underestimation rate of high-risk lesions was 31.1%, 41.2% for atypical ductal hyperplasia, 31.2% for papillary lesions, 16.7% for phyllodes tumor, and 41.9% for ductal carcinoma in situ. CONCLUSIONS: The core breast biopsy under image guidance is a reliable procedure but the recommendation of surgical excision of high-risk lesions detected in the core biopsy remains since it was not possible to assess clinical, imaging, core biopsy and pathologic features that could predict underestimation and avoid excision. Representative samples are much more important than number of fragments.
Details
- Title: Subtitle
- Underestimation of malignancy of core needle biopsy for nonpalpable breast lesions
- Creators
- Aline Valadao Britto Goncalves - UFS, Aracaju, SE, BrazilLuiz Claudio Santos Thuler - Univ Fed Estado Rio de Janeiro, INCA, Rio de Janeiro, RJ, BrazilFabiola Procaci Kestelman - Univ Estadual Campinas, Campinas, SP, BrazilPedro Aurelio Ormonde do Carmo - UFS, Aracaju, SE, BrazilCarlos Frederico de Freitas Lima - Univ Fed Fluminense, Niteroi, RJ, BrazilRosana Cipolotti - UFS, Aracaju, SE, Brazil
- Resource Type
- Journal article
- Publication Details
- Revista Brasileira de ginecologia e obstetrícia, Vol.33(7), pp.123-131
- Publisher
- Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo
- DOI
- 10.1590/S0100-72032011000700002
- PMID
- 22012421
- ISSN
- 0100-7203
- eISSN
- 1806-9339
- Number of pages
- 9
- Language
- Portuguese
- Date published
- 07/01/2011
- Academic Unit
- Radiology
- Record Identifier
- 9984318694802771
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