Stereotactic core biopsy: Comparison of 11 gauge with 8 gauge vacuum assisted breast biopsy☆
Introduction
Stereotactic breast biopsy is a safe and accurate alternative to surgical biopsy for nonpalpable mammographically visible lesions. Initially performed with 14 gauge automated needles it is now increasingly performed with vacuum assisted biopsy (VAB) device. The advantages of vacuum assisted biopsy include improved retrieval of calcifications, ability to obtain contiguous samples with a single probe insertion, lower rebiopsy rates and fewer histological underestimations from atypical ductal hyperplasia (ADH) to ductal carcinoma in situ (DCIS) or DCIS to invasive carcinoma [1], [2], [3], [4].
Accurate percutaneous diagnosis of benign breast disease spares unnecessary surgical biopsy and accurate preoperative diagnosis of malignancy can decrease the number of operations needed for removal and treatment of a lesion [1], [5], [6]. However, histological underestimation has been reported with ADH in 10–27% and DCIS in 5–21% [7], [8], [9], [10], [11] of cases. Underestimation in ADH necessitates a surgical excision to exclude the presence of DCIS or invasive cancer. Likewise, underestimation of DCIS, when an invasive component is identified at surgery needs a second surgical procedure to assess axillary lymph nodes.
Numerous clinical investigations of 11 gauge vacuum assisted biopsy have been conducted demonstrating increased accuracy over 14 gauge automated needle biopsy [2], [3], [12], but there is very little published data comparing 11 gauge to an 8 gauge vacuum assisted biopsy. Two studies have found no difference in accuracy of breast cancer diagnosis between 8 and 11 gauge devices [13], [14]. In one of these studies, underestimation of ADH was not assessed [13] and in the other, only benign lesions that did not need excision were analyzed. Similarly no difference between 11 and 9 gauge biopsy devices have been determined [8], [9].
The purpose of our study was to compare the performance and ability to obtain a correct diagnosis on needle biopsy between 11 gauge and 8 gauge vacuum assisted biopsy devices.
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Materials and methods
The study was approved by the hospital institutional review board and was conducted in compliance with the Health Insurance Portability and Accountability Act policy. Waiver for informed consent was obtained from the institutional review board. All stereotactic core biopsies performed between January 2003 and December 2008 were retrospectively reviewed. The hospital's online medical records were accessed to obtain radiology, pathology, surgical and clinical notes.
Pathological analysis
The cores were placed into tissue processing cassettes (1–2 cores per cassette) and underwent standard overnight processing. Five micron sections were cut at two different levels of the paraffin block and stained with hematoxylin and eosin then reviewed by the attending pathologist. Additional levels from the block were examined if the core needle biopsy was performed for calcifications and none were seen in the original levels or if the biopsy was performed for a mass lesion and one was not
Results
A total of 912 biopsies were performed in 877 women (48.1%, 439/912 with 11 gauge and 51.9%, 473/912 with 8 gauge needle); 858 were for calcifications and 54 for focal mass lesions. The BIRADS classification of the target lesions was determined by the interpreting radiologist (Table 2) [15]. The average patient age was 55.4 years (range 25–86 years) in the 11 gauge and 56.2 years (range 31–88 years) in the 8 gauge group. The average lesion size was 8.9 mm (range 2–60 mm) in the 11 gauge and 9.1 mm
Discussion
Various series have shown the underestimation of ADH and DCIS on core biopsy ranges from 19 to 35% respectively and decrease in histological underestimation with the use of larger gauge as well as vacuum assisted devices [7], [8], [9], [10], [11], [16]. Underestimation of atypia and DCIS on core biopsy results in additional surgery for the patient. Identifying DCIS on surgical specimen in a core biopsy diagnosis of ADH may necessitate a second surgery to obtain clear margins. Presence of
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