Jessica B Weiss, MD, Woo S Do, MD, Dominic M Forte, MD, Rowan R Sheldon, MD, Charles K Childers, Andrew D Mosier, DO, Vance Y Sohn, MD. Madigan Army Medical Center, Tacoma, WA
Objectives: The increasing accuracy of large-bore (11- or 8-gauge) vacuum-assisted core needle biopsies (VACNB) has challenged the commonly-accepted practice that surgery is needed for definitive diagnosis when atypical ductal hyperplasia (ADH) is found on VACNB. The objective of this study was to demonstrate the impact of increased VACNB caliber on surgical upgrade rate for ADH.
Methods: Patients diagnosed with isolated ADH by VACNB who subsequently underwent surgical excision at our tertiary medical center were included for analysis in this retrospective study. Demographics, needle gauge, number of needle passes, and pathology results were analyzed.
Results: From June 1996 to June 2016, approximately 3,740 VACNB breast biopsies were performed. Of these, 137 patients were diagnosed with ADH on VACNB (17 by 11-gauge; 13 by 8-gauge) and subsequently underwent surgical excision. The average age of our patients at the time of biopsy was 58. Overall, 30 patients (22%) were upgraded to ductal carcinoma in-situ (DCIS) or invasive cancer (IC); 17 upgrades (20%) from 11-gauge vs. 13 upgrades (24%) from 8-gauge. These results are expectedly improved from our previously published series of 14-gauge CNB which revealed an upgrade rate of 36%.
Conclusion: Upsizing biopsy needles from 14- to 11-gauge reduced the risk of missing an underlying malignancy, but this risk was not further reduced by upsizing from 11- to 8-gauge. Regardless of needle size, surgical excision of ADH identified by CNB should always serve as an adjunct diagnostic procedure to exclude under sampling of a malignancy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88191
Program Number: MSS23
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium