title: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?
abstract: OBJECTIVE
  To evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted.
  
  
  METHODS
  Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared.
  
  
  RESULTS
  Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p > 0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions.
  
  
  CONCLUSIONS
  Imaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision.
authors.affiliation: Division of Breast Imaging, Mount Sinai Hospital and University Health Network, 600 University Avenue, M5G 1X5, Toronto, ON, Canada. pavel.crystal@uhn.on.ca
authors.forename: Pavel
authors.initials: P
authors.lastname: Crystal
authors.forename: Arifa
authors.initials: A
authors.lastname: Sadaf
authors.forename: Karina
authors.initials: K
authors.lastname: Bukhanov
authors.forename: David
authors.initials: D
authors.lastname: McCready
authors.forename: Frances
authors.initials: F
authors.lastname: O'Malley
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Helbich
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity