Diagnosing Atypical Ductal Hyperplasia—Which Size Needle Works Best?
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.
Methodology
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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Women's ImagingUniversity of California San Francisco, Department of Radiology
The overall goal of this program is to provide current information on the relevant use of imaging and interventional techniques in women with breast and gynecologic pathology. Core concepts and future directions are addressed, including cancer screening, breast intervention, and current status of breast and gynecologic MRI. Up to 20.75 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Women's Imaging
Imaging Review: Body, Bone & Breast
University of California, San Francisco, Department of Radiology
This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging, as well as an up-to-date assessment of the clinical uses of modern imaging modalities such as CT, MR and ultrasound. 20 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Imaging Review: Body, Bone & Breast
Results
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.
Conclusions
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
Reference:
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
Permalink: http://www.radiologydaily.com/?p=571
Tags: ADH, ALL, Atypical Ductal Hyperplasia, atypical lobular hyperplasia, biopsy, breast biopsy, cancer, CT, CTA, EFE, MI, needle biopsy, PE, rad, scanning, stereotactic, stereotactic biopsy, test, vacuum-assisted breast biopsy
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