Underestimation of Papillary Breast Lesions at Ultrasound-guided Breast Biopsy

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1 ACTA ACADEMIAE MEDICINAE SINICAE sina. com ACR BI-RADS % % % % % 18G 16G 17. 9% P = % P = G 18G R DOI /j. issn X A X Underestimation of Papillary Breast Lesions at Ultrasound-guided Breast Biopsy ZHOU Jie-yingTANG JieLUO Yu-kunFU ShuaiSONG QingXU Qing-hua Department of UltrasoundChinese PLA General Hospital BeijingChina Corresponding author TANG Jie Tel txiner@vip. sina. com ABSTRACT Objective To evaluate the underestimation of papillary breast lesions diagnosed at ultrasound-guided breast biopsy. Methods Totally 4453 ultrasound-guided visible breast lesions that were identified in the Department of UltrasoundChinese PLA General Hospitalfrom April 2005 to April 2012 were retrospectively reviewed. Of 207 papillary lesions that were detected by histologic findings of ultrasound-guided core needle biopsy US-CNB 90 underwent surgical excision110 were followed up for at least one yearand 7 were lost to follow-up. The histological findings of the US-CNB and the findings of surgical excision were compared to analyze the underestimation rates according to the Breast Imaging Reporting and Data System BI-RADS categories of American College of Radiology ACR and biopsy methods. Results Of the 90 papillary lesions underwent surgical excision % were underestimatedand 22 malignant lesions were underestimated 24. 4%. Of the 23 papillomata with atypical ductal hyperplasia IDP + ADH % were upgraded to malig Supported by the National Natural Sciences Foundation of China December2013

2 nant. Of the 137 benign intraductal papilloma IDP with concordance imaging-histologic findings8 lesions were underestimated 5. 8% whereas 10 out of % IDP with diacordant imaging-histologic findings were underestimated. In total17. 9% understimation were biopsied by 18G core needle biopsy CNB P = and 16. 0% by 16G CNB P = which were significantly higher than vacuum-assisted biopsy VAB. Conclusions VAB is more accurate than 16G or 18G CNB in detecting papillary breast lesions. For high underestimations of IDP + ADH and IDP with discordant imaging-histologic findingsvab or surgical excisions should be performed. Key words breast biopsy papillary lesion Ultrasound Acta Acad Med Sin % 1 Sequoia 512 Siemens-AcusonMountain View benign intraductal papilloma IDP atypical ductal 16G 18G 15 ~ 22 mm hyperplasiaadh ductal carcinoma in situdcis 15 mm 22 2 ~ % core needle biopsycnb VACORA CR CNB BardInc. CovingtonGAUSA 7G 10G 3-4 CNB ADH DCIS ADH DCIS a IDP 2 BI-RADS BI-RADS b /4c 5 IDP 2 BI-RADS ± ~ iu22 Philips UltrasoundBot hellwa L12-5 CA 15L8w 15 mm 1 1 BI-RADS 3 4a 1 IDP IDP + ADH 2 IDP IDP + ADH 3 BI-RADS SPSS Vol. 35 No

3 ± % 11 /23 IDP + ADH t 15 / P < ± ~ ± 0. 8 cm 0. 4 ~ cm 18G G BI-RADS 3 4a 77. 5% ± 2. 6 BI-RADS 4b /4c % % 16G BI-RADS % 18G G 16G 52 IDP23 IDP + ADH15 DCIS % 7 /52 IDP ADH % 29 / % 22 / % P = % P = G 18G P = % 11 / BI-RADS Table 2 Comparison of ultrasound-guided breast biopsy Table 1 Comparison of BI-RADS categories with the surgical and follow-up findings in 200 papillary lesions results and surgical histological findings of 90 papillary lesions Histologic findings at surgical excision BI-RADS Surgical results and follow-up Histologic findings at biopsy BI-RADS Category ADH DCIS Invasive Benign a Benign Total ADH Malignant carcinoma 3 Category 3 n = Benign a Category 4a n = ADH b /4c Category 4b /4c n = DCIS Category 5 n = Invasive carcinoma ADH 1 Total ADH atypical ductal hyperplasia a benign lesions included all lesions that were considered benign at either surgical or ultrasound follow-up at least 1 year DCIS DCIS ductal carcinoma in situ A. 1. 6cm B. 16G C. HE 40 D. HE 40 A. ultrasound of left breast shows a hypoechoic lesion sized 1. 6cm B. ultrasound-guided 16G CNB was performed on it C. the histologic finding of ultrasound-guided biopsy is benign intraductal papilloma with ADH HE 40 D. excisional specimen shows breast invasive ductal carcinoma with papillary ductal carcinoma in situ and atypical ductal hyperplasia HE BI-RADS 4a Fig 1 A 59-year-old womancategorized as category 4a according to BI-RADS 664 December2013

4 Table Comparison of underestimation rates of 16G /18G core needle biopsy and vacuum-assisted biopsy Methods Accuracy rate n % ADH Upgrade to ADH n Upgrade to malignant n Underestimation rate n % 18G CNB n = a 16G CNB n = b VAB n = CNB VAB VAB a P = b P = CNB core needle biopsy VAB vacuum-assisted biopsy a P = b P = compared with VAB % IDP % ADH % 4. 5% Liberman % Mercado % IDP + ADH 6% ~ 45% 8 IDP 32. 2% 29 /90 IDP + ADH 47. 8% IDP 34. 6% 18 / % 9 IDP + ADH 1Rosen ELBentley RCBaker JAet al. Imaging-guided core IDP 14% 17% Mercado 7 IDP 16G 18G Shin 11 Kim 12 1 needle biopsy of papillary lesions of the breast J. AJR Am J IDP Roentgenol Liberman 4 2Rosen PPHoda SADershaw DDet al. Breast pathology diagnosis by needle core biopsy M. 2nd ed. Philadelphia Lippincott Williams & Wilkins2006 xvi Reynolds HE. Core needle biopsy of challenging benign breast conditions a comprehensive literature review J. AJR Am J Roentgenol IDP 4Liberman LBracero NVuolo MAet al. Percutaneous largecore biopsy of papillary breast lesions J. AJR Am J Roent- 5. 8% IDP 40% genol IDP 5Tseng HSChen YLChen STet al. The management of Vol. 35 No

5 papillary lesion of the breast by core needle biopsy J. Eur J Surg Oncol Jaffer SNagi CBleiweiss IJ. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy J. Cancer Mercado CLHamele-Bena DSinger Cet al. Papillary lesions of the breast evaluation with stereotactic directional vacuum-assisted biopsy J. Radiology Arora NHill CHoda SAet al. Clinicopathologic features of papillary lesions on core needle biopsy of the breast predictive of malignancy J. Am J Surg Sydnor MKWilson JDHijaz TAet al. Underestimation of the presence of breast carcinoma in papillary lesions initially diagnosed at core-needle biopsy J. Radiology Jacobs TWConnolly JLSchnitt SJ. Nonmalignant lesions in breast core needle biopsies to excise or not to excise J. Am J Surg Pathol Shin HJKim HHKim SMet al. Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy comparison of sonographic features and biopsy methods J. AJR Am J Roentgenol Kim MJKim SIYouk JHet al. The diagnosis of non-malignant papillary lesions of the breast comparison of ultrasound-guided automated gun biopsy and vacuum-assisted removal J. Clin Radiol December2013