Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted 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.