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Histologic Underestimation of Malignant Lesions

William E. Burak, Jr, MD; Kerry E. Owens, MD; Mary Beth Tighe, PhD; Lisa Kemp, RN, LNP; Susan A. Dinges, MD; Charles L. Hitchcock, MD, PhD; John Olsen, MD

Arch Surg. 2000;135:700-703.

Hypothesis  The histopathologic correlation between stereotactic core needle biopsy and subsequent surgical excision of mammographically detected nonpalpable breast abnormalities is improved with a larger-core (11-gauge) device.

Design  Retrospective medical record and histopathologic review.

Setting  University-based academic practice setting.

Patients  Two hundred one patients who underwent surgical excision of mammographic abnormalities that had undergone biopsy with an 11-gauge vacuum-assisted stereotactic core biopsy device.

Main Outcome Measure  Correlation between stereotactic biopsy histologic results and the histologic results of subsequent surgical specimens.

Results  Results of stereotactic biopsy performed on 851 patients revealed atypical hyperplasia in 46 lesions, ductal carcinoma in situ (DCIS) in 89 lesions, and invasive cancer in 73 mammographic abnormalities. Subsequent surgical excision of the 46 atypical lesions revealed 2 cases of DCIS (4.3%) and 4 cases of invasive carcinoma (8.7%). Lesions diagnosed as DCIS on stereotactic biopsy proved to be invasive carcinoma in 10 (11.2%) of 89 patients on subsequent excision. Stereotactic biopsy completely removed 21 (23.6%) of 89 DCIS lesions and 20 (27.4%) of 73 invasive carcinomas.

Conclusions  In summary, 11-gauge vacuum-assisted core breast biopsy accurately predicts the degree of disease in the majority of malignant lesions; however, understaging still occurs in 11% to 13% of lesions showing atypical hyperplasia or DCIS.

From the Departments of Surgery (Drs Burak and Owens and Mss Tighe and Kemp), Pathology (Dr Hitchcock), and Radiology (Dr Olsen), James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus; and St Rita's Medical Center, Lima, Ohio (Dr Dinges).

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