Prediction of the underestimation of ductal carcinoma in situ by ultrasound guided 14 gauge core needle biopsy of breast masses prior to operation

Abstract

[한글]

[영문]

The purpose of this study was to determine the underestimation rate of ductal carcinoma in situ (DCIS) diagnosed after an ultrasound guided 14-gauge core-needle biopsy (US-14G-CNB) of breast masses and to compare the clinical and imaging characteristics between DCIS lesions and underestimated DCIS lesions identified following surgical excision. Among 3124 US-14G-CNBs performed for breast masses, 69 lesions in 60 patients were pathologically determined as pure DCIS. We classified patients with these lesions according to the final pathology after surgical excision as patients with invasive ductal carcinoma (IDC) (upgrade group) and DCIS (non-upgrade group). We retrospectively reviewed and compared the clinical and imaging characteristics between the patients in the two groups. The imaging characteristics analyzed included ultrasound findings according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon and mammographic findings. Of the 69 lesions, 21 lesions were upgraded to invasive carcinoma and the underestimation rate was 30.4%. There were no statistically significant differences for the mammographic findings, sonographic findings, size, age or clinical symptoms except for the presence of pathological axillary lymph nodes as detected on ultrasound. Lesions in two patients in the non-upgrade group (2/41, 4.9%) and five patients in the upgrade group (5/19, 26.3%) were associated with pathological lymph nodes as detected on axillary ultrasound and this finding was statistically significant (p = 0.016). The DCIS underestimation rate after a US-14G-CNB of breast masses was 30.4% in this study. The presence of pathological lymph nodes as detected on axillary ultrasound may be useful to predict underestimation preoperatively.