title: Correlation of maximum breast carcinoma dimension on needle core biopsy and subsequent excisional biopsy: a retrospective study of 50 non-palpable imaging-detected cases.
abstract: OBJECTIVE
  There are scant data on the correlation of maximum tumor dimension (MTD) in needle core biopsy (NCB) and in subsequent excisional biopsy (EXB) with various pre-NCB imaging studies (VIS)-especially in the context of screen-detected invasive carcinoma (SIC).
  
  
  RESULTS
  Retrospectively studied were consecutive (2012-2013) non-palpable, SIC diagnosed on NCB with subsequent EXB. Data on MTD on VIS (either mammogram, or ultrasound, or MRI), NCB and EXC were analyzed. Mean MTD on VIS was 12.5mm (range: 0-45 mm). Mean MTD on NCB was 6.7 mm (range: 1-15 mm). Mean residual MTD on EXB was 12.9 mm (range: 0-40 mm). Mean number of NCB performed per SIC was 5 (range: 1-13). Overall, 81% of all NCB were involved by SIC. The difference between MTD at EXC and VIS was statistically not significant (p>0.05). Spearman correlation coefficient for MTD on VIS and EXC was r=0.8718 (p<0.0001) showing a significant correlation. The mean tissue volume procured on NCB-calculated by using Aperio whole slide scanning and NIH Image J image analysis was 95.5mm(3) (range: 4.3-887.5mm(3), median: 23 mm(3)). A Bland-Altman plot showed that MTD of ≥ 7 mm on EXB is a useful cut-off point predictive of (any) increase in MTD at EXB. Six of the 13 patients with MTD< 7mm on EXB showed a decrease in size; while no patient with MTD on EXB that was ≥ 7 mm showed any decrease in size. (Fisher's exact test, P=0.001, two-tailed). Overall 88% (44 out of 50 patients) of SIC showed no decrease in MTD on EXB, with an increase by ≥ 4 mm in size (sufficient to upstage "T") in MTD of ≥ 7mm on EXB in 75.6% (28 of 37 patients with MTD of ≥ 7 mm on EXB). 20.8% of SIC (5 of 24 patients) that were < 7 mm on NCB (with a mean combined Nottingham grade score of 5 {r: 4-6} showed decrease in MTD at EXB.
  
  
  CONCLUSIONS
  In this pilot study of SIC, (i) MTD on VIS was predictive of MTD on EXB, (ii) MTD of ≥ 7 mm on NCB was predictive of an increased MTD on EXB in most cases, with potential for "upstaging" tumors, and (iii) MTD of < 7 mm on NCB was predictive of decreased MTD on EXB in 20.8% of (mostly grade I) SIC. Procured tissue volume on NCB contributed to decrease in MTD on EXB in small, low-grade carcinomas.
authors.affiliation: Department of Pathology, Weill Cornell Medical College, New York, NY, USA. Electronic address: uozerdem1@gmail.com.
authors.forename: Ugur
authors.initials: U
authors.lastname: Ozerdem
authors.affiliation: Department of Pathology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Hoda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies
keywords: Breast; Cancer; Core biopsy; Image analysis; Tumor dimension; Volume calculation; Whole slide scanning