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Benign Ultrasound-Guided Breast Core Biopsy. Is Excision Necessary?
*Sirishma Kalli, *Sara Cohen, *Andrew Alexander, *Shital Makim, Roger Graham
Tufts Medical Center, Boston, MA

Objective: Indications for surgical excision following benign US-guided core biopsy include imaging discordance, the presence of high-risk lesions such as ADH, inadequate pathologic specimen, poor targeting, or patient preference. The purpose of this study is to determine whether benign ultrasound-guided core biopsies, discordant but determined to be well-targeted by US at a multidisciplinary breast conference, still require excision. Design: Retrospective chart review Setting: Tufts Medical Center outpatients Patients: All patients who underwent ultrasound-guided core breast biopsy followed by surgical excision performed between January 1, 2000 and December 31, 2013 at Tufts Medical Center. Interventions: None Main Outcome Measures: The main outcome is how often does surgical excision result in either a diagnosis of malignancy or a high-risk lesion that subsequently changes patient management. Results: A total of 76 cases were reviewed that resulted in a benign US-guided core biopsy followed by subsequent excision. Indications for surgical excision included the following: imaging discordance (53), atypia (10), inadequate tissue for diagnosis (2), poor targeting (1), phyllodes/intraductal papilloma (7) and patient preference (3). Out of the 53 lesions with imaging discordance, there were 4 cases of malignancy (3 invasive ductal carcinomas, 1 lymphoma). Additionally, out of the 53 lesions with imaging discordance, there were 5 resultant high-risk lesions on excision (3 atypia, 2 LCIS). Overall, a change in patient management occurred in 9 out of 53 lesions with imaging discordance (17%). Conclusions: Lesions that appear discordant by imaging necessitate excision, as a large percentage of these lesions may be upgraded on excision to either a high-risk lesion or invasive malignancy.

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