DOI:10.2214/AJR.07.3264
AJR 2008; 190:W272
© American Roentgen Ray Society
Lobular Neoplasia in Vacuum-Assisted Breast Biopsy: Extended Protocols and Underestimation
George C. Zografos,
Flora Zagouri and
Theodoros N. Sergentanis
Hippokratio Hospital University of Athens Athens, Greece
WEB—This is a Web exclusive article.
In the October 2006 issue of the AJR, Mahoney et al.
[1] described their experience
with lobular neoplasia diagnosed by vacuum-assisted breast biopsy. In this
letter, we present our experience, exhibiting points of convergence but also
of divergence from those by Mahoney et al.
In our series of 680 vacuum-assisted breast biopsy procedures, 29 cases of
lobular neoplasia were diagnosed (4.26%; 95% CI, 2.87–6.07%). This
percentage is higher than that reported by Mahoney et al.
[1] (27/1,819 vs 29/680;
Pearson's chi-square test = 17.47; p < 0.001). For the optimal
interpretation of the discrepancy, it should be stressed that in our setting,
a larger number of cores were excised in the context of an "extended
protocol" [2,
3]. More specifically, at first
the cases were allocated randomly to the standard (two or three offsets,
24–36 cores) and to the extended (eight offsets, 96 cores) protocols;
subsequently, the extended protocol has been used in most cases. In the
studied period, 11 cases were diagnosed by the standard protocol and 18 cases
by the extended protocol. An interesting question arises: In the context of 13
cores, as excised by Mahoney et al. (range, 11–19 cores), might some
lobular neoplasia diagnoses be underestimated and allocated to benign lesions,
or can this discrepancy be attributed to particularities of the local
population?
With respect to the crucial issue of underestimation, Mahoney et al.
[1] reported a rate of 19%
(five of 27 cases). In our sample, the respective percentage was relatively
lower (two of 29 cases for a rate of 6.9%; 95% CI, 0.8–22.8%). As
reflected by the CI, the difference between our results and those of Mahoney
et al. is not statistically significant (p = 0.244, Fisher's exact
test). In any case, the sample size is too small to yield conclusive results.
The subanalysis in our population, with respect to the two protocols, did not
reach statistical significance either (two of 11 in the standard protocol and
none of 18 in the extended protocol; p = 0.138, Fisher's exact
test).
In conclusion, excision of more cores seems to lead to interesting
divergences from the results presented by Mahoney et al.
[1]. Nevertheless, further
studies on larger samples are needed to examine the crucial and rather
underinvestigated issue of lobular neoplasia diagnoses by vacuum-assisted
breast biopsy.
References
- Mahoney MC, Robinson-Smith TM, Shaughnessy EA. Lobular neoplasia at
11-gauge vacuum-assisted stereotactic biopsy: correlation with surgical
excisional biopsy and mammographic follow-up. AJR2006; 187:949
-954[Abstract/Free Full Text]
- Zografos GC, Zagouri F, Sergentanis TN, et al. Is zero
underestimation feasible? Extended vacuum-assisted breast biopsy in solid
lesions—a blind study. World J Surg Oncol2007; 5:53[CrossRef][Medline]
- Zografos GC, Zagouri F, Sergentanis TN, et al. Minimizing
underestimation rate of microcalcifications excised via vacuum-assisted breast
biopsy: a blind study. Breast Cancer Res Treat2007
Jul 26;[Epub ahead of print]
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