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Underestimation of DCIS at MRI-guided vacuum-assisted breast biopsy Lee JM; Kaplan JB; Murray MP; Mazur-Grbec M; Tadic T; Stimac D; Liberman LAJR Am J Roentgenol 2007[Aug]; 189 (2): 468-74OBJECTIVE: The study objective was to assess the rate of underestimation of ductal carcinoma in situ (DCIS) at MRI-guided 9-gauge vacuum-assisted breast biopsy. MATERIALS AND METHODS: An institutional review board-approved retrospective review was performed of 373 consecutive lesions that had undergone MRI vacuum-assisted breast biopsy. In 34 lesions with subsequent surgery, vacuum-assisted breast biopsy yielded DCIS without frank microinvasion or invasion. DCIS underestimates were lesions for which vacuum-assisted breast biopsy yielded DCIS without frank microinvasion or invasion at biopsy and surgery yielded invasive cancer. Records and pathology findings were reviewed. RESULTS: Among 34 lesions, vacuum-assisted breast biopsy histology was DCIS in 29 and DCIS with possible microinvasion in five. Of 29 lesions yielding DCIS at MRI vacuum-assisted breast biopsy, surgical excision revealed invasive cancer in five (17%; 95% CI, 6-36%). The DCIS underestimation rate was significantly higher in lesions 6 cm or larger versus smaller lesions (60% vs 8%, p = 0.02). MRI lesion type, kinetics, number of specimens, menopausal status, and target sampling versus excision did not significantly affect underestimation. Of five lesions yielding DCIS with possible microinvasion at MRI vacuum-assisted breast biopsy, surgery revealed invasive carcinoma in four (80%; 95% CI, 28-99%). DCIS underestimation was significantly more likely if MRI vacuum-assisted breast biopsy showed possible microinvasion than if it did not (80% vs 17%, p =0.01). CONCLUSION: Underestimation occurred in 17% of lesions yielding DCIS and in 80% of lesions yielding DCIS with possible microinvasion at MRI vacuum-assisted breast biopsy. DCIS underestimation was significantly more likely in lesions measuring 6 cm or larger. No other patient or lesion factors significantly affected DCIS underestimation at MRI vacuum-assisted breast biopsy.|Adult[MESH]|Aged[MESH]|Biopsy/*instrumentation[MESH]|Breast Neoplasms/*pathology[MESH]|Carcinoma in Situ/*pathology[MESH]|Carcinoma, Ductal, Breast/*pathology[MESH]|Chi-Square Distribution[MESH]|False Negative Reactions[MESH]|Female[MESH]|Humans[MESH]|Magnetic Resonance Imaging, Interventional[MESH]|Middle Aged[MESH]|Retrospective Studies[MESH]|Vacuum[MESH] |
