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Diagnosing Atypical Ductal Hyperplasia—Which Size Needle Works Best?

May 19, 2009
Written by: , Filed in: Breast Imaging
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A recent study was conducted to determine the frequency of diagnosis and upgrade rate of atypical ductal hyperplasia (ADH) at stereotactic 9-gauge vacuum-assisted breast biopsy, and to compare these results with those of 11-gauge vacuum-assisted breast biopsy.

All stereotactic biopsy procedures performed over a 5-year period were identified. Those performed with an 11-gauge biopsy needle and a 9-gauge biopsy needle were included in the study.

Other variables recorded included indication for biopsy, patient age, length of time between stereotactic biopsy and surgical biopsy, and histopathology results.

A comparison was made between histopathology results at surgical excision and those at stereotactic biopsy.

Lesions were included if the pathology report indicated simply ADH without the mention of in situ or invasive cancer. Lesions were included if ADH was also associated with other noncancerous lesions such as radial scar or atypical lobular hyperplasia.


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For biopsies performed with a 9-gauge stereotactic vacuum-assisted mechanism, 83 lesions were included in the study. Of these, 92.8% were surgically excised. The histopathologic results of the surgical excisions yielded cancer in 21.6% of lesions. For the biopsies performed with an 11-gauge stereotactic vacuum-assisted mechanism, 58 lesions were included for study. Of these, 89.7% were surgically excised. Of lesions with histopathologic records of surgical excision, 20.4% were upgraded to carcinoma.

When comparing 9- versus 11-gauge biopsy results, the difference in upgrade rate was not determined to be statistically significant based on a chi-square test.

Reviewer’s Comments
This is a counter-intuitive result if one subscribes to the idea that the larger the sample weight of the biopsy, the greater the chance of encountering a focus of carcinoma.

Prior research has shown a statistically significant improvement from 14-gauge to 11-gauge; however, the improvement in the upgrade rate from 11-gauge to 9-gauge is starting to appear marginal.

Author: Basil Hubbi, MD

Eby PR, Ochsner JE, et al. Frequency and Upgrade Rates of Atypical Ductal Hyperplasia Diagnosed at Stereotactic Vacuum-Assisted Breast Biopsy: 9-Versus 11-Gauge. AJR; 2009;192 (January): 229-234

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