This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoorntje, L. E. Articles by Borel Rinkes, I. H. M. Search for Related Content PubMed PubMed Citation Articles by Hoorntje, L. E. Articles by Borel Rinkes, I. H. M. Related Collections Diagnosis

The Finding of Invasive Cancer After a Preoperative Diagnosis of Ductal Carcinoma-In-Situ: Causes of Ductal Carcinoma-In-Situ Underestimates With Stereotactic 14-Gauge Needle Biopsy

From the Department of Surgery (LEH, IHMBR), Department of Pathology (MEIS, FB), Clinical Epidemiology, Julius Center for Health Sciences and Primary Care (LEH, PHMP), and Department of Radiology (LEH, RKS), the University Medical Center Utrecht, Utrecht, The Netherlands.

Correspondence: Address correspondence and reprint requests to: I. H. M. Borel Rinkes, MD, PhD, University Medical Center Utrecht, Department of Surgery (G04.228), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Fax: 31-30-254-1944; E-mail: i.h.m.borelrinkes{at}azu.nl

Background: For the evaluation of nonpalpable lesions of the breast, image-guided 14-gauge automated needle biopsy is increasingly replacing wire-localized excision. When ductal carcinoma-in-situ (DCIS) is diagnosed at core biopsy, invasive cancer is found in approximately 17% of excision specimens. These so-called DCIS underestimates pose a problem for patients and surgeons, because they generally cause extension of treatment. We evaluated DCIS underestimates in detail to assess reasons for missing the invasive component at core biopsy. This evaluation also included a histological comparison with true DCIS (DCIS at core biopsy and excision).

Methods: Between 1997 and 2000, DCIS was diagnosed at 14-gauge needle biopsy in 255 patients. In 41 cases (16%), invasive cancer was found at excision. We performed a thorough histopathological and radiological review of all these DCIS underestimates, including a histological comparison with core biopsy specimens of 32 true DCIS cases. We assessed the main reason for missing the invasive component at core biopsy.

Results: Causes for DCIS underestimates were categorized into "mainly radiological" (n = 20), "mainly histopathological" (n = 15), and "histological disagreements" (n = 6). High-grade DCIS and periductal inflammation in core biopsies made a DCIS underestimate 2.9 and 3.3 times more likely, respectively.

Conclusions: A variety of radiological and histopathological reasons contribute to the DCIS underestimate rate. Approximately half of these are potentially avoidable.

Key Words: Breast cancer • Ductal carcinoma-in-situ • Large-core needle biopsy • Nonpalpable • DCIS underestimate rate

This article has been cited by other articles:

				F. J. Dominguez, M. Golshan, D. M. Black, K. S. Hughes, M. A. Gadd, R. Christian, B.-A. Lesnikoski, M. Specht, J. Michaelson, and B. L. Smith Sentinel Node Biopsy is Important in Mastectomy for Ductal Carcinoma In Situ Ann. Surg. Oncol., January 1, 2008; 15(1): 268 - 273. [Abstract] [Full Text] [PDF]

				E A Rakha and I O Ellis An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens J. Clin. Pathol., December 1, 2007; 60(12): 1300 - 1306. [Abstract] [Full Text] [PDF]

				M. Morrow The Certainties and the Uncertainties of Ductal Carcinoma In Situ J Natl Cancer Inst, March 17, 2004; 96(6): 424 - 425. [Full Text] [PDF]

				D. R. McCready Quality Assurance: The Value of Data and the Will to Improve Ann. Surg. Oncol., October 1, 2003; 10(8): 837 - 838. [Full Text] [PDF]