Ali Riza Sever MD, Presenter: Nothing to Disclose

Philippa Mills MD, Abstract Co-Author: Nothing to Disclose

David Fish, Abstract Co-Author: Nothing to Disclose

Sue Ellen Jones, Abstract Co-Author: Nothing to Disclose

Peter A Jones MD, Abstract Co-Author: Nothing to Disclose

Atypical ductal hyperplasia (ADH) and in situ lobular neoplasia i.e. lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) characterize themselves with atypical cells at biopsy and further excision is usually recommended to rule out accompanying malignancy. Papillomas and radial scars may also contain atypical cells suggesting further excision. The purpose of this study was to assess the accuracy of core biopsies under stereotactic and ultrasound guidance and to determine which group of lesions contains the highest risk for accompanying malignancy.

During a 7-year period, 278 breast patients who had core biopsy with a result of atypia were identified. If the lesion was sonographically visible, biopsy was performed under ultrasound (US) guidance using 14-g spring loaded needle, and the remaining biopsies were performed under stereotactic guidance using 11-g vacuum assisted needle. Biopsy guidance, lesion type and final surgical outcome were studied.

From 1999 to 2006, 13% (133/1057) of stereotactic and 3% (145/4477) of US-guided biopsies showed atypical cells. Of the 117 ADH lesions, 22 (19%) had accompanying malignancy at surgical excision. Nine of the 70 (13%) stereotactic biopsies and 13 of the 47 (28%) US-guided biopsies were malignant. Of the 35 LCIS and ALH lesions, 5 (14%) had malignancy. Three of the 28 (11%) stereotactic and two of the seven (29%) US-guided biopsies were malignant. Four of the 43 radial scars (9%) and six of the 83 papillomas (7%) were proven to be malignant at further surgery. Of the radial scars, two of 18 (11%) stereotactic and two of 25 US-guided biopsies were malignant. Of the papillomas, one of 17 (6%) stereotactic and five of 66 (8%) of US-guided biopsies were malignant.

The lesions containing atypical cells at stereotactic or US guided biopsies may have malignant component and ADH carries the highest risk in this category. Stereotactic vacuum assisted 11-g biopsies have a slight advantage over 14-g US guided biopsies in accurately ruling out accompanying malignancies (11% vs. 15%). This accuracy is particularly higher for ADH, LCIS and ALH lesions.

Lesions containing atypical cells at biopsy may have accompanying malignancy at surgery, and the highest risk is for ADH lesions when biopsy is performed under US-guidance.  

Sever, A, Mills, P, Fish, D, Jones, S, Jones, P, Breast Lesions with Atypia: How Accurate Is My Biopsy in Ruling Out Cancer?.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8016142.html