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Imaging–histologic discordance at percutaneous breast biopsy
Author(s) -
Liberman Laura,
Drotman Michele,
Morris Elizabeth A.,
LaTrenta Linda R.,
Abramson Andrea F.,
Zakowski Maureen F.,
Dershaw D. David
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20001215)89:12<2538::aid-cncr4>3.0.co;2-#
Subject(s) - medicine , biopsy , radiology , percutaneous , breast biopsy , breast imaging , percutaneous biopsy , mammography , breast cancer , pathology , cancer
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. Cancer 2000;89:2538–46. © 2000 American Cancer Society.