Imaging-histologic discordance at percutaneous breast biopsy: An indicator of missed cancer Journal Article

Authors: Liberman, L.; Drotman, M.; Morris, E. A.; Latrenta, L. R.; Abramson, A. F.; Zakowski, M. F.; David Dershaw, D.
Article Title: Imaging-histologic discordance at percutaneous breast biopsy: An indicator of missed cancer
Abstract: BACKGROUND. The purpose of the current study was to determine the frequency of imaging-histologic discordance at percutaneous breast biopsy and to assess the likelihood of carcinoma in these discordant lesions. METHODS. Percutaneous imaging guided breast biopsy was performed on 1785 consecutive lesions during a 7-year period under stereotactic (n = 1205) or sonographic (n = 580) guidance, using an automated needle (n = 1044) or directional vacuum-assisted probe (n = 741). Lesions were prospectively classified according to the Breast Imaging Reporting and Data System (BI-RADS) as Category 3 (probably benign), Category 4 (suspicious), or Category 5 (highly suggestive of malignancy). Imaging-histologic discordance was considered to have occurred when the percutaneous biopsy histology did not provide a sufficient explanation for the imaging features; in such cases, repeat biopsy was recommended. Medical records, imaging studies, and histologic findings were reviewed. RESULTS. Imaging-histologic discordance was present in 56 of 1785 (3.1%) lesions. The frequency of discordance was significantly higher in our first 2 years of experience with percutaneous biopsy than in later years (18 of 361 = 5.0% vs. 38 of 1424 = 2.7%; P < 0.04) and was significantly higher for lesions that were BI-RADS Category 5 rather than BI-RADS Category 4 (20 of 416 = 4.8% vs. 36 of 1366 = 2.6%; P < 0.04). The frequency of discordance was significantly lower with the 11-gauge vacuum-assisted probe than other devices for calcifications (7 of 414 = 1.7% vs. 16 of 251 = 6.8%; P = 0.001) but not for masses (6 of 161 = 3.7% vs. 26 of 959 = 2.7%; P = 0.44). Repeat biopsy, performed in 45 discordant lesions revealed carcinoma in 11 (24.4%; 95% confidence intervals, 12.9-39.5%). The frequency of carcinoma was significantly higher among discordant BI-RADS Category 5 than discordant BI-RADS Category 4 lesions (7 of 16 = 43.8% vs. 4 of 29 = 13.7%; P < 0.04). CONCLUSIONS. Imaging-histologic discordance occurred in 3.1% of lesions that had percutaneous breast biopsy. Imaging-histologic discordance was an indication for surgical excision because of the high (24.4%) prevalence of carcinoma in these lesions. © 2000 American Cancer Society.
Keywords: controlled study; human tissue; middle aged; major clinical study; cancer diagnosis; diagnosis, differential; breast; prevalence; breast neoplasms; biopsy; mammography; diagnostic value; breast carcinoma; echography; needle biopsy; intermethod comparison; carcinoma, intraductal, noninfiltrating; percutaneous biopsy; breast biopsy; carcinoma, ductal, breast; humans; human; female; priority journal; article
Journal Title: Cancer
Volume: 89
Issue: 12
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2000-12-15
Start Page: 2538
End Page: 2546
Language: English
DOI: 10.1002/1097-0142(20001215)89:12<2538::aid-cncr4>;2-#
PUBMED: 11135213
PROVIDER: scopus
Notes: Export Date: 18 November 2015 -- Source: Scopus
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MSK Authors
  1. D David Dershaw
    170 Dershaw
  2. Laura Liberman
    165 Liberman
  3. Elizabeth A Morris
    242 Morris
  4. Maureen F Zakowski
    275 Zakowski