title: Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates.
abstract: OBJECTIVE
  To measure the effect of biopsy device, probe size, mammographic lesion type, lesion size, and number of samples obtained per lesion on the ductal carcinoma in situ (DCIS) underestimation rate.
  
  
  METHODS
  Nonpalpable breast lesions at 16 institutions received a histologic diagnosis of DCIS after 14-gauge automated large-core biopsy in 373 lesions and after 14- or 11-gauge directional vacuum-assisted biopsy in 953 lesions. The presence of histopathologic invasive carcinoma was noted at subsequent surgical biopsy.
  
  
  RESULTS
  By performing the chi(2) test, independent significant DCIS underestimation rates by biopsy device were 20.4% (76 of 373) of lesions diagnosed at large-core biopsy and 11.2% (107 of 953) of lesions diagnosed at vacuum-assisted biopsy (P <.001); by lesion type, 24.3% (35 of 144) of masses and 12.5% (148 of 1,182) of microcalcifications (P <.001); and by number of specimens per lesion, 17.5% (88 of 502) with 10 or fewer specimens and 11.5% (92 of 799) with greater than 10 (P <.02). DCIS underestimations increased with lesion size.
  
  
  CONCLUSIONS
  DCIS underestimations were 1.9 times more frequent with masses than with calcifications, 1.8 times more frequent with large-core biopsy than with vacuum-assisted biopsy, and 1.5 times more frequent with 10 or fewer specimens per lesion than with more than 10 specimens per lesion.
authors.affiliation: Depts of Radiology of Palo Alto Med Clinic, 795 El Camino Real, Palo Alto, CA 94301, USA. jackmanr@pamf.org
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: A A
authors.initials: AA
authors.lastname: Smid
authors.forename: H B
authors.initials: HB
authors.lastname: Borofsky
authors.forename: C H
authors.initials: CH
authors.lastname: Lee
authors.forename: H M
authors.initials: HM
authors.lastname: Goldstein
authors.forename: K J
authors.initials: KJ
authors.lastname: Schilling
authors.forename: A B
authors.initials: AB
authors.lastname: Wray
authors.forename: R F
authors.initials: RF
authors.lastname: Brem
authors.forename: T H
authors.initials: TH
authors.lastname: Helbich
authors.forename: D E
authors.initials: DE
authors.lastname: Lehrer
authors.forename: S J
authors.initials: SJ
authors.lastname: Adler
mesh_terms: D001365:Axilla; D001706:Biopsy / Q000295:instrumentation* / Q000379:methods; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D013048:Specimen Handling / Q000295:instrumentation