Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: Results of surgical excision

OBJECTIVE. This investigation compares the frequency of histologic underest imation of breast carcinoma that occurs when a large-core needle biopsy rev eals atypical ductal hyperplasia or ductal carcinoma in situ with the autom ated lit-gauge needle, the Il-gauge directional vacuum-assisted biopsy devi ce, and the Ii-gauge directional vacuum-assisted biopsy device. SUBJECTS AND METHODS. Evaluation of 428 large-core needle biopsies yielding atypical ductal hyperplasia (139 lesions) or ductal carcinoma in situ (289 lesions) was performed. The results of subsequent surgical excision were r etrospectively compared with the needle biopsy results. RESULTS. For lesions initially diagnosed as ductal carcinoma in situ, under estimation of invasive ductal carcinoma was significantly less frequent usi ng the 11-gauge directional vacuum-assisted biopsy device when compared wit h the automated 14-gauge needle (10% versus 21%, p < 0.05) but was not sign ificantly less frequent when compared with the 14-gauge directional vacuum- assisted device (10% versus 17%. p > 0.1). For lesions diagnosed initially as atypical ductal hyperplasia, underestimation of ductal carcinoma in situ and invasive ductal carcinoma was significantly less frequent using the Ii -gauge directional vacuum-assisted biopsy device compared with the 14-gauge directional vacuum-assisted device (19% versus 39%, p = 0.025) and with th e automated 14-gauge needle (19% versus 44%, p = 0.01). CONCLUSION. The frequency of histologic underestimation of breast carcinoma in lesions initially diagnosed as atypical ductal hyperplasia or ductal ca rcinoma in situ using large-con needle biopsy is substantially lower with t he Ii-gauge directional vacuum-assisted device than with the automated 14-g auge needle and with the 14-gauge directional vacuum-assisted device.