In a nutshell
This study (2011) addressed the issue of understaging of invasive breast cancer using core-needle biopsy (CNB). Main findings: in this analysis of trials, about one in four diagnoses of ductal carcinomas in situ (DCIS) at CNB represented understaged invasive breast cancer.
Some background
CNB is a diagnostic procedure in which cells are removed (with a large “core” needle) from a suspicious area to check for the presence of breast cancer. It is often guided by ultrasonography (US). Understaging is an underestimate of how advanced a given cancer is. Understaging is a known outcome of CNB. However, studies evaluating its frequency and contributing factors are lacking. This leaves physicians without a clear understanding of the prevalence and causes of understaging. Furthermore, cancer understaging may lead to a wrong treatment plan.
Methods & findings
The authors analyzed 52 studies with a total of 7350 DCIS diagnoses done via core-needle biopsy. Out of these 7350 cases of DCIS there were 1736 underestimates (23.6%), that turned out to be invasive breast cancer at excision.
The following factors were found to be associated with understaging: US-guided biopsy; larger tumors found on imaging; presence of a palpable tumor; use of a large automated biopsy device; a mammogram showing a mass with features suggestive of a malignancy (e.g. high density).
The use of a vacuum-assisted biopsy device guided by stereotaxis (use of medical imaging to precisely locate in 3D a site to which the core needle is directed) was associated with a lower risk for understaging.
The bottom line
In summary, DCIS understaging was a common finding in this study. Modern imaging techniques may help increase the diagnostic accuracy of CNB.
The fine print
The main limitation of this study was the oversight of patient-related factors that may affect understaging.
What’s next?
If you are diagnosed with DCIS, talk to your doctor about your chances of understaging.
Published By :
Radiology
Date :
Jul 01, 2011
