Open AccessPredictors of Underestimation of Malignancy after Image‐Guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia
Author(s) -
Yu ChiChang,
Ueng ShirHwa,
Cheung YunChung,
Shen ShihChe,
Kuo WenLin,
Tsai HsiuPei,
Lo YungFeng,
Chen ShinCheh
Publication year - 2015
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.12389
Subject(s) - medicine , malignancy , atypia , biopsy , calcification , radiology , mammography , multivariate analysis , hyperplasia , univariate analysis , pathology , breast cancer , cancer
Flat epithelial atypia ( FEA ) and atypical ductal hyperplasia ( ADH ) are precursors of breast malignancy. Management of FEA or ADH after image‐guided core needle biopsy ( CNB ) remains controversial. The aim of this study was to evaluate malignancy underestimation rates after FEA or ADH diagnosis using image‐guided CNB and to identify clinical characteristics and imaging features associated with malignancy as well as identify cases with low underestimation rates that may be treatable by observation only. We retrospectively reviewed 2,875 consecutive image‐guided CNB s recorded in an electronic data base from January 2010 to December 2011 and identified 128 (4.5%) FEA and 83 (2.9%) ADH diagnoses (211 total cases). Of these, 64 (30.3%) were echo‐guided CNB procedures and 147 (69.7%) mammography‐guided CNB s. Twenty patients (9.5%) were upgraded to malignancy. Multivariate analysis indicated that age ( OR = 1.123, p = 0.002, increase of 1 year), mass‐type lesion with calcifications ( OR = 8.213, p = 0.006), and ADH in CNB specimens ( OR = 8.071, p = 0.003) were independent predictors of underestimation. In univariate analysis of echo‐guided CNB ( n = 64), mass with calcifications had the highest underestimation rate (p < 0.001). Multivariate analysis of 147 mammography‐guided CNB s revealed that age ( OR = 1.122, p = 0.040, increase of 1 year) and calcification distribution were significant independent predictors of underestimation. No FEA case in which, complete calcification retrieval was recorded after CNB was upgraded to malignancy. Older age at diagnosis on image‐guided CNB was a predictor of malignancy underestimation. Mass with calcifications was more likely to be associated with malignancy, and in cases presenting as calcifications only, segmental distribution or linear shapes were significantly associated with upgrading. Excision after FEA or ADH diagnosis by image‐guided CNB is warranted except for FEA diagnosed using mammography‐guided CNB with complete calcification retrieval.