title: Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution.
abstract: OBJECTIVE
  To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy.
  
  
  METHODS
  Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations.
  
  
  RESULTS
  The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%.
  
  
  CONCLUSIONS
  The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.
authors.affiliation: PhD Fellow, Physician Assistant II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Gustavo Machado
authors.initials: GM
authors.lastname: Badan
authors.affiliation: PhD, Coordinator for the Sector of Breast Imaging, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Decio
authors.initials: D
authors.lastname: Roveda Júnior
authors.affiliation: PhD, Full Professor at School of Medical Sciences, Santa Casa de São Paulo, Chief of Medical Practice at Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Sebastião
authors.initials: S
authors.lastname: Piato
authors.affiliation: PhD, Physician Assistant II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Eduardo de Faria Castro
authors.initials: Ede F
authors.lastname: Fleury
authors.affiliation: Imaging Diagnosis Specialists, Physician Assistants II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Mário Sérgio Dantas
authors.initials: MS
authors.lastname: Campos
authors.affiliation: Imaging Diagnosis Specialists, Physician Assistants II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Carlos Alberto Ferreira
authors.initials: CA
authors.lastname: Pecci
authors.affiliation: Imaging Diagnosis Specialists, Physician Assistants II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Felipe Augusto Trocoli
authors.initials: FA
authors.lastname: Ferreira
authors.affiliation: Imaging Diagnosis Specialist, MD, Resident in General Radiology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: D'Ávila
keywords: Breast neoplasia; Core needle biopsy; Diagnostic techniques and procedures; Noninvasive intraductal carcinoma; Vacuum-assisted biopsy