Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy Journal Article


Authors: Liberman, L.; Holland, A. E.; Marjan, D.; Murray, M. P.; Bartella, L.; Morris, E. A.; Dershaw, D. D.; Wynn, R. T.
Article Title: Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy
Abstract: OBJECTIVE. The purposes of this study were to determine the frequency of diagnosis of atypical ductal hyperplasia (ADH) at MRI-guided 9-gauge vacuum-assisted breast biopsy and to assess the rate of underestimation of ADH at subsequent surgical excision. MATERIALS AND METHODS. We conducted a retrospective review of medical records of 237 lesions consecutively detected with MRI and then subjected to MRI-guided 9-gauge vacuum-assisted breast biopsy during a 33-month period. Underestimated ADH was defined as a lesion yielding ADH at vacuum-assisted biopsy and cancer at surgery. Scientific tables were used to calculate 95% CI. RESULTS. Histologic analysis of MRI-guided vacuum-assisted breast biopsy specimens yielded ADH without cancer in 15 (6%) of 237 lesions. Among 15 patients in whom vacuum-assisted breast biopsy yielded ADH, the median age was 52 years (range, 46-68 years). The median number of specimens obtained was nine (range, 8-18 lesions). Median MRI lesion diameter was 1.3 cm (range, 0.7-7.0 cm). Among 15 MRI lesions, 10 (67%) were nonmasslike enhancement and five (33%) were masses. Surgical excision was performed on 13 lesions. Surgical histologic findings were malignancy in five (38%) of the cases, all ductal carcinoma in situ; high-risk lesion in six (46%) of the cases, including ADH without other high-risk lesions (n = 2), ADH and lobular carcinoma in situ (LCIS) (n = 1), ADH, LCIS, and papilloma (n = 1), ADH and papilloma (n = 1), and LCIS (n = 1); and benign in two (15%) of the cases. These data indicated an ADH underestimation rate of 38% (95% CI, 14-68%). CONCLUSION. ADH without cancer was encountered in 6% of MRI-guided 9-gauge vacuum-assisted breast biopsies. ADH at MRI-guided vacuum-assisted breast biopsy is an indication for surgical excision because of the high (38%) frequency of underestimation of these lesions. © American Roentgen Ray Society.
Keywords: adult; clinical article; human tissue; aged; middle aged; retrospective studies; review; nuclear magnetic resonance imaging; magnetic resonance imaging; diagnostic accuracy; sensitivity and specificity; reproducibility of results; breast cancer; breast; prevalence; breast neoplasms; biopsy; women's imaging; biopsy, needle; false negative reactions; mri; breast biopsy; vacuum; carcinoma, ductal, breast; surgery, computer-assisted; breast hyperplasia; breast duct
Journal Title: American Journal of Roentgenology
Volume: 188
Issue: 3
ISSN: 0361-803X
Publisher: American Roentgen Ray Society  
Date Published: 2007-03-01
Start Page: 684
End Page: 690
Language: English
DOI: 10.2214/ajr.06.0809
PUBMED: 17312054
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 33" - "Export Date: 17 November 2011" - "CODEN: AJROA" - "Source: Scopus"
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MSK Authors
  1. D David Dershaw
    223 Dershaw
  2. Domagoj Marjan
    1 Marjan
  3. Laura Liberman
    172 Liberman
  4. Melissa P Murray
    121 Murray
  5. Elizabeth A Morris
    329 Morris
  6. Ralph Thomas Wynn
    2 Wynn