title: Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy.
abstract: OBJECTIVE
  To compare histologic findings of atypical ductal hyperplasia (ADH) at 14-gauge, directional, vacuum-assisted breast biopsy (hereafter, vacuum-assisted biopsy) and at 14-gauge, automated, large-core breast biopsy (hereafter, large-core biopsy) with findings at histologic examination after surgical biopsy.
  
  
  METHODS
  Nonpalpable breast lesions were diagnosed as ADH at histologic examination after vacuum-assisted biopsy in 88 lesions in seven institutions and after large-core biopsy in 55 previously reported lesions. Histologic findings at subsequent surgical biopsy were compared for the presence of carcinoma.
  
  
  RESULTS
  On the basis of histologic findings of carcinoma at surgical biopsy, the diagnosis of ADH was not correct in 26 (48%) of 54 lesions sampled at large-core biopsy and in 13 (18%) of 74 lesions sampled at vacuum-assisted biopsy (Fisher exact test, P < .0004). More tissue specimens were obtained at vacuum-assisted biopsy (mean, 15.8 specimens) than at large-core biopsy (mean, 9.7 specimens). Individual specimens were twice as large at vacuum-assisted biopsy (mean, 34 mg) as at large-core biopsy (mean, 17 mg) (previously reported).
  
  
  CONCLUSIONS
  ADH was diagnosed 2.7 times more reliably at vacuum-assisted biopsy than at large-core biopsy (with no increase in complications) with most of the improvement as a result of acquisition of more than 10 specimens per lesion, but carcinoma was sufficiently underestimated with both methods to necessitate surgical biopsy.
authors.affiliation: Department of Radiology, Palo Alto Medical Clinic, CA 94301, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Jackman
authors.forename: F
authors.initials: F
authors.lastname: Burbank
authors.forename: S H
authors.initials: SH
authors.lastname: Parker
authors.forename: W P
authors.initials: WP
authors.lastname: Evans
authors.forename: M C
authors.initials: MC
authors.lastname: Lechner
authors.forename: T R
authors.initials: TR
authors.lastname: Richardson
authors.forename: I
authors.initials: I
authors.lastname: Tocino
authors.forename: A B
authors.initials: AB
authors.lastname: Wray
mesh_terms: D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008875:Middle Aged; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D014618:Vacuum