Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: Can invasion be predicted?

PURPOSE: To determine whether mammographic or histologic features can be us ed to predict which cases diagnosed as ductal carcinoma in situ (DCIS) with out invasion by means of stereotactic core needle biopsy (SCNB) will have i nvasive disease at surgery. MATERIALS AND METHODS: From July 1992 to March 1999, DCIS without invasion was diagnosed by means of SCNB in 59 patients. Seventeen (29%) were found t o have invasive disease after surgery. The underestimation rate for SCNB wa s compared with that obtained by means of open surgical biopsy. Mammographi c and histologic features of cases with and those without invasion were com pared.: RESULTS: All patients had calcifications on mammograms. There was no signif icant difference (P = .26) between the underestimation rate for SCNB with t he Ii-gauge vacuum-assisted device and that for open surgical biopsy. No st atistically significant differences between cases with and those without in vasion were seen in patient age, mean number of core specimens, level of su spicion, size of lesion, distribution and morphology of the calcifications, presence of an associated mass or density, subtype of DCIS, nuclear grade, or presence of necrosis or desmoplasia. CONCLUSION: Mammographic and histologic features cannot be used reliably to predict cases that are underestimated with SCNB. However, SCNB with the 11 -gauge vacuum-assisted device was as reliable as open surgical biopsy for d iagnosing DCIS without invasion.