title: Rates of presurgical underestimation of breast cancer after standardized assessment of breast calcifications.
abstract: OBJECTIVE
  To determine the frequency of histopathological underestimation of breast cancer after vacuum-assisted biopsy (VAB) in standardized assessment of breast calcifications compared to postsurgical diagnosis.
  
  
  METHODS
  The retrospective study included acquired data of 506 consecutively examined women, who underwent VAB for the assessment of pure calcifications after standardized digital mammographic and sonographic imaging. 119/506 (24.5 %) women underwent further surgical procedures: 37 women had a surgical diagnostic excision biopsy, 82 women a surgical procedure based on a therapeutic concept. Presurgical results of VAB were compared with the postsurgical histopathological reports.
  
  
  RESULTS
  In 91/119 women (76.5 %) the final histology was malignant. The rate of ductal carcinoma in situ (DCIS) was 79.1 % (72/91) and the rate of invasive carcinoma was 20.9 % (19/91). In 9/37 women with diagnostic excision biopsy, the presurgical status of benign or uncertain changed to a postsurgical diagnosis of malignant (24.3 %). In eight cases underestimation included DCIS (21.6 %) and in one case invasive cancer (2.7 %). Seven of the nine underestimated cases (77.8 %) resulted from excision biopsy of atypical epithelial proliferation of ductal type (AEPDT, positive predictive value 30.4 % (7/23)). After surgery due to DCIS in 7/71 women invasive breast cancer was diagnosed (9.9 %). In 11/82 women with oncological surgery, invasive cancer was already diagnosed by VAB.
  
  
  CONCLUSIONS
  Underestimation of invasive cancer in terms of presurgical DCIS diagnosis can be minimized by the standardized assessment protocol to about 10 %. Underestimation of DCIS is mainly related to presurgical diagnosis of AEPDT.
  
  
  CONCLUSIONS
  • The standardized use of digital mammographic and sonographic imaging prior to vacuum-assisted biopsy is suitable for minimizing underestimation of invasive breast cancer. AEPDT represents a high risk diagnosis for underestimation of DCIS.
authors: Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Germany.
authors: L
authors: L
authors: Timpe
authors: Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Germany.
authors: S
authors: S
authors: Berkemeyer
authors: Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Germany.
authors: M
authors: M
authors: Puesken
authors: Department of Gynecology and Obstetrics, University Hospital Muenster, Germany.
authors: J
authors: J
authors: Tio
authors: Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Germany.
authors: W
authors: W
authors: Heindel
authors: Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Germany.
authors: S
authors: S
authors: Weigel
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D002114:Calcinosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005188:False Negative Reactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008327:Mammography / Q000592:standards* / Q000706:statistics & numerical data*; D008875:Middle Aged; D011182:Postoperative Care / Q000592:standards / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity