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Purpose: To measure the effect of biopsy device, probe size, mammographic lesion type, lesion size, and number of samples obtained per lesion on the ductal carcinoma in situ (DCIS) underestimation rate., Materials and Methods: Nonpalpable breast lesions at 16 institutions received a histologic diagnosis of DCIS after 14-gauge automated large-core biopsy in 373 lesions and after 14- or 11-gauge directional vacuum-assisted biopsy in 953 lesions. The presence of histopathologic invasive carcinoma was noted at subsequent surgical biopsy., Results: By performing the chi(2) test, independent significant DCIS underestimation rates by biopsy device were 20.4% (76 of 373) of lesions diagnosed at large-core biopsy and 11.2% (107 of 953) of lesions diagnosed at vacuum-assisted biopsy (P <.001); by lesion type, 24.3% (35 of 144) of masses and 12.5% (148 of 1,182) of microcalcifications (P <.001); and by number of specimens per lesion, 17.5% (88 of 502) with 10 or fewer specimens and 11.5% (92 of 799) with greater than 10 (P <.02). DCIS underestimations increased with lesion size., Conclusion: DCIS underestimations were 1.9 times more frequent with masses than with calcifications, 1.8 times more frequent with large-core biopsy than with vacuum-assisted biopsy, and 1.5 times more frequent with 10 or fewer specimens per lesion than with more than 10 specimens per lesion.

Purpose: To determine initial placement accuracy, long-term stability, and usefulness as a guide for wire localization for metallic marker clips placed percutaneously after stereotactic breast biopsy., Materials and Methods: One hundred forty-nine marker clips were placed percutaneously with a straight-needle or through-probe method, and clip positions were measured. The locations of 31 marker clips were followed up from deployment to first follow-up mammography. Thirty-six biopsy sites with marker clips were excised surgically and examined; 18 of these marker clips were targets for wire localization. The locations of 22 benign lesions were measured over time to calibrate the measurement system., Results: Baseline variability was 8 mm. Initial marker clip deployment averaged 5 mm above baseline from the center of the target lesion (P < or = .01). Compared with baseline variability, marker clips remained in place from initial deployment to first imaging follow-up (mean, 8.6 months). Potentially clinically meaningful misplacement rates (deployment > 24 mm from target lesion center) were 7% for the through-probe method and 11% for the straight-needle method (not significantly different; P = .33)., Conclusion: The marker clips appear to be useful targets for wire localization when the entire target lesion is removed at directional, vacuum-assisted breast biopsy. Upright, two-view mammography is recommended after deployment of the marker clip to document location.

Purpose: To compare histologic findings of atypical ductal hyperplasia (ADH) at 14-gauge, directional, vacuum-assisted breast biopsy (hereafter, vacuum-assisted biopsy) and at 14-gauge, automated, large-core breast biopsy (hereafter, large-core biopsy) with findings at histologic examination after surgical biopsy., Materials and Methods: Nonpalpable breast lesions were diagnosed as ADH at histologic examination after vacuum-assisted biopsy in 88 lesions in seven institutions and after large-core biopsy in 55 previously reported lesions. Histologic findings at subsequent surgical biopsy were compared for the presence of carcinoma., Results: On the basis of histologic findings of carcinoma at surgical biopsy, the diagnosis of ADH was not correct in 26 (48%) of 54 lesions sampled at large-core biopsy and in 13 (18%) of 74 lesions sampled at vacuum-assisted biopsy (Fisher exact test, P < .0004). More tissue specimens were obtained at vacuum-assisted biopsy (mean, 15.8 specimens) than at large-core biopsy (mean, 9.7 specimens). Individual specimens were twice as large at vacuum-assisted biopsy (mean, 34 mg) as at large-core biopsy (mean, 17 mg) (previously reported)., Conclusion: ADH was diagnosed 2.7 times more reliably at vacuum-assisted biopsy than at large-core biopsy (with no increase in complications) with most of the improvement as a result of acquisition of more than 10 specimens per lesion, but carcinoma was sufficiently underestimated with both methods to necessitate surgical biopsy.

Purpose: To evaluate stereotactic, percutaneous, directional, vacuum-assisted breast biopsy of atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS)., Materials and Methods: Percutaneous biopsy was followed by surgical excision in 113 ADH and DCIS lesions in 101 patients (mean age, 55.5 years). Fourteen-gauge, automated needle biopsy was performed in 73 of these 113 lesions; 14-gauge, directional, vacuum-assisted breast biopsy was performed in 40 lesions., Results: Eight of 18 lesions diagnosed with automated needle biopsy as ADH were determined at surgery to be breast cancer (DCIS or infiltrating ductal carcinoma). None of the eight ADH lesions diagnosed with directional, vacuum-assisted biopsy was determined at surgery to be breast cancer (P = .03, Fisher exact test). Nine of 55 lesions diagnosed with automated needle biopsy as DCIS were diagnosed as infiltrating ductal carcinoma at surgery. None of the 32 DCIS lesions diagnosed with directional, vacuum-assisted biopsy was diagnosed as infiltrating ductal carcinoma at surgery (P = .02, Fisher exact test)., Conclusion: Directional, vacuum-assisted biopsy resulted in statistically significantly fewer cases of ADH or DCIS underestimation of disease without clinical complications or the creation of postbiopsy mammographic lesions.

With the development of stereotactic or ultrasound-guided, large-core percutaneous breast biopsy and the evolution of mammotomy, radiologists are now able to render definitive diagnoses of breast lesions. To ensure success, however, there must be a commitment at the outset to put into place the required personnel and equipment. The radiologists involved must conscientiously adhere to standardized technique and be willing to assume clinical responsibility, including comprehensive follow-up methods. With these commitments, radiologists can substantially increase their contribution to the care of patients with a breast abnormality.

Purpose: To assess the reliability and reproducibility of automated large-core breast biopsy., Materials and Methods: A consortium of 20 institutions reported, in a standardized fashion, their core breast biopsy data. All biopsies were performed with "long-throw" (2.3-cm) automated core biopsy devices fitted with 14-gauge needles. Needle guidance was accomplished by means of either a dedicated, stereotaxic device, in which the patient lies in the prone position, or high-frequency electronically focused ultrasound equipment., Results: The data in 6,152 lesions were gathered. Clinical or surgical follow-up was available in 3,765 lesions; 1,363 of these lesions were subsequently surgically excised, and the core histologic study showed cancer in 910 lesions, mammary intraepithelial neoplasia in 173 lesions, and benign disease in 280 lesions. In these 280 lesions, there were 15 false-negative core biopsies., Conclusion: The data show that percutaneous large-core breast biopsy is a reproducible and reliable alternative to surgical biopsy.