Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy

Radiology. 1997 Aug;204(2):485-8. doi: 10.1148/radiology.204.2.9240540.


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.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Biopsy, Needle / instrumentation
  • Biopsy, Needle / methods*
  • Breast / pathology*
  • Breast Diseases / pathology*
  • Breast Neoplasms / pathology*
  • Carcinoma in Situ / pathology
  • Carcinoma, Ductal, Breast / pathology
  • Diagnosis, Differential
  • Female
  • Humans
  • Hyperplasia
  • Middle Aged
  • Retrospective Studies
  • Stereotaxic Techniques
  • Vacuum