Core needle biopsy and subsequent excisional biopsy in patients with breast high-risk lesions

Percutaneous core needle biopsy (CNB) has become the standard of care for the pathological evaluation of clinically occult breast lesions.  While this minimally invasive method of diagnosis represents a practical approach for further surgical treatment planning, it also results in the identification of several non-malignant lesions whose management is less clear.  These include atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS).  We reviewed the pathology results of all patients who had a diagnosis of ADH, ALH, or LCIS on core needle biopsy who also had subsequent excisional biopsy.  Malignant disease was detected on excisional biopsy in 31% of patients with ADH (19 of 61), 16% of patients with ALH (3 of 19), and 25% of patients with LCIS (4 of 16).  The majority of patients with upgraded ADH had DCIS on final excisional specimen (14 of 19, 74%).  All 3 patients with upgraded ALH had invasive cancers (2 lobular, 1 mixed ductal and lobular).  The 4 patients with upgraded LCIS included 1 DCIS, 2 invasive ductal, and 1 invasive lobular.  The presence of a mass on mammographic images was associated with an increased upgrade rate to malignancy, while biopsies performed using vacuum-assisted devices, larger gauge biopsy needles, and greater number of cores were associated with a lower upgrade rate.  

In conclusion, our study suggest that excisional biopsy is warranted in all patients with a CNB diagnosis of ADH, ALH, or LCIS to exclude the presence of cancer

Bibliographic reference:

Margenthaler JA et al.: "Correlation between core biopsy and excisional biopsy in breast high-risk lesions", Am J Surg. 2006 Oct;192(4):534-7.

Julie Margenthaler

Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA