Diagnostic Biopsy for DCIS

  • Stereotactic core-needle or vacuum-assisted biopsy:
    • Is the preferred method for diagnosing DCIS
  • Calcifications that appear faint on mammogram or that are deep in the breast and close to the chest wall:
    • May be difficult to target with stereotactic biopsy
  • In addition, use of stereotactic biopsy in patients above the weight limit of the stereotactic system (about 150 kg) and in patients with very small breasts:
    • May be impossible
  • Patients who cannot remain prone or who cannot cooperate for the duration of the procedure:
    • Are also not good candidates for stereotactic biopsy
  • Bleeding disorders and the concomitant use of anticoagulants:
    • Are relative contraindications
  • Biopsy specimens:
    • Should be radiographed to document the sampling of suspicious microcalcifications
  • Care should be taken to mark the biopsy site with a metallic clip:
    • In the event that all microcalcifications are removed with the biopsy procedure
  • In the final biopsy procedure report:
    • It is important to report the:
      • Needle gauge used
      • How many cores were obtained
      • An estimate as to what percentage of the calcifications was removed
  • Because stereotactic core-needle and vacuum-assisted biopsy specimens represent only a sample of an abnormality observed on mammography:
    • The results are subject to sampling error
  • Invasive carcinoma:
    • Is found on excisional biopsy in 20% of patients:
      • In whom DCIS was diagnosed by a stereotactic core-needle biopsy
  • Thus, if the core-needle biopsy results are discordant with the findings of imaging studies:
    • A wire- or seed-localized excisional biopsy can be performed to establish the diagnosis
  • After diagnosis using stereotactic core-needle biopsy:
    • Approximately 20% to 30% of patients with ADH, up to 20% of patients with radial scar, approximately 5% to 10% of patients with flat epithelial atypia (FEA):
      • Are found to have a coexistent carcinoma near the site of the biopsy:
        • When complete excision is performed
    • Therefore, when the final pathologic studies from core-needle biopsy procedures indicate either of these diagnoses (ADH, radial scar, FEA):
      • Consideration should be made for excisional biopsy:
        • Though in the case of pure FEA:
          • There is some evidence to suggest that surgical excision is not necessary if all calcifications are removed at the time of biopsy (Calhoun et al., 2015)
  • Patients who are not candidates for stereotactic biopsy or who have stereotactic biopsy results that are inconclusive or discordant with the mammographic findings:
    • Should undergo excisional biopsy:
      • This technique is performed with the assistance of preoperative wire or seed localization of the mammographic abnormality in conjunction with the previously placed metallic clip marking the biopsy site
      • Postexcision specimen radiograph:
        • Is essential to confirm the removal of microcalcifications or targeted lesion
      • The excisional biopsy should be performed with the aim of obtaining a margin-negative resection:
        • That can serve as the definitive surgery

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #BreastCancer #LCIS #DCIS #DuctalCarcinomaInsitu #LobularNeoplasia #LobularCarcinomaInsitu #Surgeon #Teacher #Miami #Mexico #MSMC #MountSinaiMedicalCenter

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