Stereotactic fine needle aspiration in the management of mammographic abnormalities detected in breast screening

BACKGROUND: Fine needle aspiration (FNA) is used routinely in the management of palpable breast lumps; with the implementation of the stereotactic technique its use has been extended to the investigation of mammographic abnormalities. The advent of breast screening means that many mammographic abnormalities will be detected; because routine open biopsy is impractical and undesirable, stereotactic fine needle aspiration becomes the method of choice for investigation. METHOD: Within a 28 month interval, 81 Chinese women underwent stereotactic FNA in Kwong Wah Hospital, Hong Kong. RESULTS: Fifty-one women (62.9%) had a benign cytology result and no further investigations were required. Inconclusive results were obtained in 18.6% of the aspirates. Open biopsy was required in 16 women (19.8%). CONCLUSION: Stereotactic FNA is very useful in the exclusion of malignancy and the avoidance of open biopsy in asymptomatic women who have mammographic abnormalities.     

Stereotactic and ultrasound core needle breast biopsy performed by surgeons

BACKGROUND: The authors evaluated outcomes and treatment costs of stereotactic core needle biopsy (SCNB) and ultrasound core needle biopsy (UCNB), and needle localization biopsy (NLB) in managing patients with mammographic abnormalities presenting to the surgeon. METHODS: Data for all patients with mammographic lesions who underwent SCNB or UCNB since their introduction at this institution were prospectively collected over 17 months. Mean inclusive costs of the three procedures were accumulated and compared. RESULTS: Stereotactic core needle biopsy was performed for 342 lesions in 319 women, for a malignancy rate of 19%; UCNB was performed for 157 lesions in 144 patients, yielding a malignancy rate of 17%. With a mean follow-up of 13.5 months, 1 patient with in situ carcinoma was diagnosed late. Absolute cost savings for the period studied was $721,963. CONCLUSIONS: Minimally invasive breast biopsy procedures can safely and reliably be performed by surgeons in clinical practice with increased patient convenience and decreased costs.     

Stereotactic core biopsy of calcifications highly suggestive of malignancy

PURPOSE: To assess stereotactic core biopsy for evaluation of Breast Imaging Reporting and Data System (BI-RADS) category 5 calcifications (highly suggestive of malignancy). MATERIALS AND METHODS: Retrospective review of mammograms revealed 31 women (aged 34-86 years) with BI-RADS category 5 calcifications who underwent 14-gauge stereotactic core biopsy with an automated gun. Records were reviewed to determine the frequency with which stereotactic core biopsy obviated a surgical procedure. Cost savings were based on Medicare estimates of $472 for stereotactic core biopsy and $1,335 for surgical biopsy. RESULTS: Of 31 patients, stereotactic core biopsy revealed carcinoma in 19 (61%), atypical ductal hyperplasia (ADH) in eight (26%), and benign findings discordant with mammographic results in four (13%). Surgical biopsy was recommended for the 12 patients with ADH or benign but discordant core biopsy diagnoses. Of the 19 patients with carcinoma at stereotactic core biopsy, two chose to undergo a second biopsy surgically, two had small foci of ductal carcinoma in situ (DCIS) that would have been fully excised with surgical biopsy, one with DCIS at stereotactic core biopsy underwent axillary dissection after invasion was found at surgery, and one underwent excision but had tumor at lumpectomy margins. Thirteen (42%) of 31 patients were spared a surgical procedure, saving $100 per patient. CONCLUSION: Stereotactic core biopsy with an automated gun obviated a surgical procedure in 42% of patients with BI-RADS category 5 calcifications, resulting in modest cost savings in this group.     

New instrumentation allows for removal of nonpalpable breast lesions

Breast cancer is the second leading cause of cancer deaths in women. Approximately 90% of breast cancer is curable if it is diagnosed and treated early. Increasingly, women are participating in mammographic screenings, which result in earlier detection of nonpalpable lesions. In the past, surgical removal was not an option for small lesions, and frequent mammographic monitoring was required until patients' lesions were large enough for needle core biopsies or needle localization for open surgical biopsies. Technology now has combined stereotactic imaging with a minimally invasive biopsy system for removal of these nonpalpable lesions. This capability for accurate early diagnosis and intervention is essential in improving patients' survival rates.     

Nondiagnostic CT-guided stereotactic biopsies in a series of 407 cases: influence of CT morphology and operator experience

Nondiagnostic biopsies were analyzed in a consecutive series of 407 patients undergoing computerized tomography (CT)-guided stereotactic biopsies. These were categorized as either negative biopsies, when normal tissue or nonspecific pathology was found, or inconclusive, when a definitive diagnosis could not be made although representative tissue was obtained. Nineteen biopsies (4.7%) were negative and 10 (2.4%) were inconclusive, giving an overall nondiagnostic biopsy rate of 7.1% (29 of the 407 cases). Suspected neoplastic masses (390 cases) were classified on the basis of their CT morphology into four groups: Group 1 included purely hypodense nonenhancing masses; Group 2 included isodense nonenhancing masses; Group 3 included ring-enhancing masses; and Group 4 included mixed-density enhancing masses. Although a higher proportion of hypodense nonenhancing masses (six of 56, or 10.7%) yielded a negative result, there was no statistically significant difference in the negative biopsy rates for the different CT categories (p = 0.06). The negative biopsy rates for the 6 years of the study, 1987 to 1992 (1987 being an incomplete year) were as follows: 13.3%, 6%, 3.2%, 3%, 5.8%, and 2.7%. There was no significant decrease in the negative biopsy rate as experience with this procedure increased (p = 0.20). A total of eight surgeons independently performed the biopsies. There was no significant difference (p = 0.24) in the negative biopsy rate of the surgeon with the most experience (124 biopsies, 2.4% negative biopsy rate) compared with that of the seven other surgeons combined (283 biopsies; 5.7% negative biopsy rate). These findings suggest that the yield in a stereotactic biopsy is independent of the CT appearance of the mass. Adherence to certain basic principles in patient and target selection will ensure a reasonable percentage of positive yield with stereotactic biopsy procedures even if the surgeon is relatively inexperienced. There does not appear to be a learning curve in the performance of CT-guided stereotactic biopsies. The management of patients with nondiagnostic biopsies is discussed.     

Use of fine needle aspiration for solid breast lesions is accurate and cost-effective

BACKGROUND: Palpable breast tumors have traditionally been diagnosed with open biopsy or core biopsy. We propose fine needle aspiration biopsy (FNA) as a reliable, cost-saving initial procedure in these patients. METHODS: Eighty-five palpable solid breast masses of the breast in 85 patients were classified by a combination of physical examination, mammography, and/or ultrasound as probably benign, indeterminate, or highly suspicious for cancer. All tumors had FNA biopsies. All patients had either a confirmatory open biopsy (55) or close clinical follow-up (30) with a mean follow-up of 29 months (range 6 to 36). RESULTS: Thirty-four patients classified as clinically benign had a benign FNA biopsy. No cancers were detected in this group by either open surgical biopsy or clinical follow-up. Twenty patients were classified clinically as indeterminate. All had FNA biopsies, and 6 were either positive for cancer or suspicious for cancer. Fourteen patients had negative FNA biopsies. Five of the 6 abnormal biopsies had cancer on open biopsies. The 1 false-positive result occurred in a lactating patient. Thirty-one patients were classified clinically as highly suspicious for cancer. Twenty-three were confirmed as cancer with FNA biopsy. Eight needed open surgical biopsy to confirm cancer. All 31 patients clinically suspicious for cancer had cancer. In patients classified clinically as highly suspicious or probably benign, FNA was a reliable first diagnostic step (100% positive predictive value, 100% specificity, 87% sensitivity, and 89% negative predictive value). CONCLUSIONS: Fine needle aspiration biopsy of solid palpable breast lesions should be the diagnostic procedure of choice for those patients classified clinically as probably benign or clinically as highly suspicious for cancer. Cost analysis revealed elimination of an open biopsy in such cases would save $1,100 per patient. For highly suspicious cases, a negative fine needle aspiration should not deter an open surgical biopsy. For patients classified as indeterminate, fine needle aspiration biopsy results are not reliable enough to determine treatment.     

Sitting or supine stereotaxic core biopsy of the breast? A comparison based on a randomized, prospective study

OBJECTIVE/MATERIAL AND METHODS: In a prospective randomized study, the techniques of stereotactic breast biopsies in prone and sitting position were compared. Part of the data has already been published. A total of 103 women underwent stereotactic breast biopsies, either prone (n = 51; using TRC-Mammotest, Sweden) or in the sitting position (n = 52; using Stereotix 2, General Electric Medical Systems, Milwaukee, Wisconsin, USA). With the help of pre- and post-biopsy questionnaires, anxiety, pain, and subjective experience were recorded in all patients. Vasovagal reactions were scored from 0 to 2 according to their severity. All biopsy results were verified by surgery. The specificities and sensitivities for the two positions were calculated and statistically compared. RESULTS: With regard to overall tolerance no statistically significant difference between biopsies performed in the sitting or the prone position was noted. Significantly more patients (p = 0.04) in the prone position stated they would prefer premedication prior to a repeat biopsy. Three patients (prone; n = 1; sitting; n = 2) fainted during the procedure. There was no statistically significant difference between the two biopsy positions regarding sensitivity (95%) and specificity (100%). CONCLUSIONS: More attention should be paid to patient care and, especially, preintervention information. Biopsies in the prone or sitting position are equally well tolerated. Somatic reactions are not a major problem during breast biopsy. Success and validity are independent of the biopsy position.     

Imaging-guided core biopsies in the breast

Screening mammography programs have contributed to an overall decline in breast cancer mortality. The screening process, however, also results in detection and biopsy of many nonpalpable lesions that eventually prove to be benign, contributing to the burden of costs to our health care system. Percutaneous imaging-guided core biopsy has proven to be a safe and accurate technique for obtaining a histologic diagnosis in most patients who have screening-detected lesions; it is done at lower cost with lower resultant morbidity to the patient compared with traditional surgical excisional biopsy. I review the indications, techniques, method of correlating the histology with mammographic findings, and accreditation requirements for imaging-guided core biopsies of the breast done under mammographic (ie, stereotactic) or sonographic guidance.     

Frozen section evaluation of stereotactic brain biopsies: diagnostic yield at the stereotactic target position in 188 cases

OBJECTIVE: Use of the image-guided stereotactic brain biopsy has facilitated the diagnosis of previously inaccessible lesions with both safety and reliability. However, few studies have assessed the diagnostic yield of frozen section evaluation of the initial stereotactic target (FS-0). We describe our experience with 188 stereotactic brain biopsies in order to evaluate the diagnostic yield of FS-0. DESIGN: Retrospective study of 188 stereotactic brain biopsies from 185 patients. SETTING: Tertiary referral center with a high volume of neurosurgical cases including image-guided stereotactic brain biopsies. PATIENTS: One hundred eighty-five patients who underwent imaged-guided stereotactic brain biopsy over a 58-month period. RESULTS: The patients studied included 107 males and 78 females (mean age 48 years). Eleven (6%) biopsies were nondiagnostic. Diagnoses from FS-0 included a neoplastic condition in 96 (73%) of 131 cases and a nonneoplastic condition in 23 (50%) of 46 cases. In 119 (67%) of 177 cases, a diagnosis was reached at FS-0. A correct diagnosis was made on subsequent frozen section in 28 (16%) of cases, including 21 (16%) of 131 neoplasms and 7 (15%) of nonneoplastic conditions. In 15 (54%) of 28 cases, the correct diagnosis was made on the second frozen section; in 25 (89%) of 28, the correct diagnosis was made by the fourth frozen section. In 14 (11%) of 131 neoplastic cases, a sampling error relative to the lesion resulted in an inaccurate diagnosis at FS-0. A significant error in diagnosis occurred in three cases (1.7%). CONCLUSIONS: We conclude that (1) because 58 (33%) of 177 diagnosed cases in our series would have been potentially misdiagnosed if only one biopsy had been taken at the stereotactic target, frozen section evaluation or cytologic examination of material at the time of surgery should be performed routinely to ensure that adequate tissue has been obtained for purposes of diagnosis; (2) taking up to four biopsies increases the diagnostic yield (from 67% to 89% in this series); and (3) neoplastic lesions are more likely to be definitively diagnosed at FS-0 than non-neoplastic lesions.     

Are dysfunctional attitudes in depressive disorder trait or state dependent?

BACKGROUND: Fifty-one cases of de novo fibroadenoma in women aged 35 years and older were found during an analysis of 117,729 visits to the Wesley Breast Clinic from 1990 to 1996. METHODS: The clinical, mammographic and ultrasound diagnosis of fibroadenoma was confirmed by either fine needle aspiration cytology or histology of an open biopsy specimen. In all cases there was a well-documented previous visit available for review, at which there was no clinical or radiological evidence of the fibroadenoma. RESULTS: Thirty-seven of the de novo fibroadenomas were palpable, the remainder satisfying strict mammographic and/or ultrasound criteria. Four of the new fibroadenomas were in women aged 50-52. CONCLUSIONS: This study provides information about the natural history of fibroadenomas, confirming that they can appear for the first time in middle-aged women. This has important clinical implications, since new lesions appearing in women over 35 have tended to be automatically categorized as suspicious of carcinoma. However, a multidisciplinary approach involving clinical examination, mammography, ultrasound, and fine needle aspiration cytology or core biopsy can result in a confident diagnosis of fibroadenoma. This will allow some women with new lesions to be managed conservatively rather than by open biopsy.     

Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients

BACKGROUND: Few controlled studies have compared laparoscopic transabdominal adrenalectomy (LA) to conventional open posterior adrenalectomy (PA). METHODS: Five patients have undergone successful LA at our institution between 1992 and 1996. A matched case-control study of 50 PA patients was performed during a similar time period. RESULTS: Follow-up was complete in 82% of patients with a mean follow-up time of 25 months. There were no statistically significant differences between the LA and PA groups with regard to the following demographic features: age, gender, endocrine disorder, side and size of tumor, and body habitus. Statistically significant differences (p < 0.05), however, were present (LA vs PA) when we compared the following results: mean hospital stay (3.1 versus 5.7 days), narcotic equivalents (28 versus 48), return to normal activity (3.8 versus 7 weeks), patient satisfaction (9 versus 7 [scale 1 to 10, 10 being most satisfied]), late morbidity (0 versus 54%), and operating room time (167 versus 127 minutes). Median hospital charges ($7,000 versus $6,000) were slightly higher in the LA group (p = 0.05). CONCLUSIONS: Although LA is technically more demanding and slightly more expensive to perform, advances appear to exist for LA with regard to patient comfort, patient satisfaction, hospital stay, and return to normal daily activities. Late incisional complications are dramatically less in the LA group.     

The occurrence of late asthmatic response to exercise after allergen challenge

OBJECTIVES: To evaluate the correlation between the pathological findings of stereotactic core needle biopsy (SCNB) and the prebiopsy mammographic findings, as well as the pathological findings of lesions that were subsequently removed by surgical excision. DESIGN: A retrospective review of 97 consecutive patients who underwent 100 SCNBs of suspicious nonpalpable mammographic lesions. The criterion standard is surgical excisional biopsy with needle localization. Mammographic findings were graded according to the American College of Radiology Breast Imaging Reporting and Data System. The pathological findings of SCNB were categorized into 4 groups: benign and specific, benign and nonspecific, premalignant, and malignant. Surgical excision of the lesion was performed if the pathological finding on SCNB was nonconcordant with the prebiopsy mammogram and when premalignant or malignant lesions were found. The pathological findings of lesions that were subsequently removed by surgical excision were compared with those of SCNB. SETTING: Community-based private multispecialty ambulatory practice. PATIENTS: A population-based sample composed of 97 patients who had grade III, IV, or V lesions on routine screening mammograms. INTERVENTION: Stereotactic core needle biopsy of nonpalpable mammographic lesions. MAIN OUTCOME MEASURES: Percentage of patients whose SCNB results were concordant with the mammographic findings and the pathological findings on subsequent surgical excision. RESULTS: Concordance between SCNB and mammography occurred in 97% of biopsy specimens. Concordance between the pathological findings of SCNB and those of surgically excised lesions occurred in 92.5% of biopsy specimens. We had 1 false-negative result. We had no false-positive diagnosis of cancer with SCNB. CONCLUSION: On the basis of accumulating literature and our own initial experience, SCNB is a promising, safe, and cost-effective procedure.     

What''s new in cosmetic surgery of the hand? Technical notes]

INTRODUCTION: Any breast lesion/abnormality detected at mammography must be characterized as (non)-neoplastic before surgery. Fine needle aspiration cytology (FNAC) permits a precise diagnosis in over 70% of cases but exhibits many inadequate, false negatives or questionable findings. This makes surgical biopsy mandatory in many cases. An alternative is offered by fine needle biopsy (FNB: 16-18 G needles) or by large core biopsy (LCB: 14 G needles), which procedures can reduce the number of questionable diagnoses with no major discomfort or side-effects for the patient. MATERIAL AND METHODS: January, 1996, to October, 1997, we performed 422 microhistologic biopsies on breast lesions at the Unità Integrata di Senologia, Azienda Ospedaliera Careggi, Florence, Italy. 383 of these lesions were nonpalpable. FNB was performed in 221 cases and LCB in 201. Most biopsies (65%) were carried out under US guidance and some others (25%) under stereotactic guidance. RESULTS: Microhistologic biopsy allowed accurate lesion characterization in most cases, even though LCB obviously performed much better. Samples were inadequate in 5.88% of cases with FNB and only in 2.98% of cases with LCB. The false negative rate was 1.92% for FNB and 0.99% for LCB. Surgical biopsy was needed for an unquestionable diagnosis only in 9.5% of FNB and 3.9% of LCB cases. CONCLUSIONS: Our results confirm the literature data on how LCB can be considered a valid alternative to surgical biopsy (and, to some extent, to FNAC); in particular, its advantages are: moderate invasiveness, little patient discomfort and high diagnostic accuracy. Moreover, the procedure is short (5-10 minutes) and costs much less than surgical biopsies (1/2 to 1/4).     

Contrast medium assisted dynamic MR-mammography after diagnostic and therapeutic interventions on the breast

In a retrospective study, the authors evaluated the signal behavior of 150 patients after intervention in the breast (40 fine-needle biopsies, 10 core biopsies, 50 open biopsies, 50 tumor-ectomies with additional irradiation therapy). The MR imaging was performed on 1.5-Tesla whole-body scanners using T1-WI GRE sequences in 2D FLASH technique before and 5 times after i.v. application of 0.1 mmol gadopentetate-dimeglumine per kg body weight. There was no signal enhancement after fine-needle biopsy. Hematoma due to core biopsy caused signal increase in every 5th patient. Enhancement after open biopsy was no more visible 6 months postoperatively. 12 months after tumorectomy and radiation therapy, most patients showed no more signal enhancement. In conclusion, MR mammography can be performed after fine-needle biopsy without problems. In case of core biopsy, hematoma should be excluded by sonography before. MR mammography should not be performed within 6 months after open biopsy, or within 12 months after tumorectomy and radiation therapy.     

Metabolic risk factors in patients with first-time and recurrent stone formations as determined by comprehensive metabolic evaluation

OBJECTIVES: To determine whether patients with recurrent calcium stone formation have more significant metabolic abnormalities compared with patients with first-time stone formation as determined by a comprehensive metabolic evaluation. METHODS: We investigated metabolic abnormalities in 37 patients (14 men, 23 women) with first-time and 136 patients (83 men, 53 women) with recurrent calcium stones, stratified according to sex. Calcium oxalate supersaturation indexes of Tiselius (1991) and Ogawa (1996) were also compared between the groups. In addition to the specific metabolic abnormalities, we analyzed the total number of such defects for each group. RESULTS: In men, the average number of metabolic abnormalities in each patient was greater in patients with recurrent stones (2.20+/-0.86) than in those with first-time stones (1.46+/-1.27). Such a difference could only be demonstrated for women if low urine volume was excluded as a specific abnormality. Although the frequency of each abnormality was higher in patients with recurrent stones, a statistically significant difference was only noted in the frequency of hypocitraturia between women with first-time and recurrent stone formation (11.1% versus 37.8%, P < 0.05). There were no significant differences in the calcium oxalate supersaturation indexes between first-time and recurrent stone formation in either men or women. CONCLUSIONS: Women with recurrent stones have a higher prevalence of hypocitraturia than women with first-time stones. Potassium citrate therapy for prevention of urolithiasis may be especially useful for this patient population.     

Cost-effectiveness of ultrasound-guided liver biopsy

The risk of a major complication from "blind" percutaneous liver biopsy is reported to be in the range of 0.24% to 3.8%. In a recent randomized trial, patients whose liver biopsies were performed with ultrasonography had a significant reduction in complications requiring hospitalization compared with patients without ultrasound-guided biopsies (0.5% vs. 2.2%, P < .05). Despite this, routine use of ultrasonography for liver biopsies has not been implemented because of controversies with respect to cost-effectiveness. The aim of our study was to analyze the relative cost-effectiveness of performing ultrasound-guided liver biopsies using decision analysis. A decision tree was constructed to compare a strategy of liver biopsy using ultrasonography with a strategy without ultrasonography. The major outcomes included were minor complications such as pain requiring analgesics and major complications, which require hospitalization. Costs included were direct medical costs from the payer's perspective. In our baseline model, the cost from complications per patient with and without ultrasonography was $62 and $129, respectively. The marginal effectiveness expressed as the number of major complications avoided was 1.2/100 liver biopsies. The incremental cost to avoid one major complication was $2,731. The model was most sensitive to the frequency of major complications and the additional cost of ultrasonography. Our decision analysis model suggests that ultrasound-guided liver biopsy is cost-effective. Future studies assessing the efficacy of image-guided liver biopsies should be conducted.     

Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis?

Endometriotic deposits are not uncommon in the large bowel of women. Because the symptoms produced by endometriosis may lead to investigation by colorectal endoscopic biopsy, the aims of this study were to assess the range of mucosal abnormalities that may occur and to determine whether this could represent a significant potential diagnostic problem. We found mucosal changes in eight of 10 cases of colorectal endometriosis; however, the abnormalities (ulceration, gland architectural disturbance, crypt abscess formation, increased inflammatory cell presence, and smooth muscle fibers between glands in the mucosa) were focal and directly related to endometrial deposits. In one case an abnormal colonic biopsy specimen from a patient with endometriosis supported the erroneous clinical diagnosis of Crohn's disease. Comparing a group of women with endometriosis to a group with adenomyosis of the uterus showed that although more women with endometriosis have endoscopic large bowel biopsies, there was no significant excess of biopsy specimens showing inflammatory changes. Our conclusion is that the endometriosis of the large bowel can masquerade as inflammatory bowel disease or ischemic changes and the possibility should be borne in mind, particularly in cases with atypical clinical features or very focal histological changes.     

Endometrial thickness is predictive of histologic endometrial maturation in women undergoing hormone replacement for ovum donation

OBJECTIVE: To determine if ultrasonographic endometrial pattern or thickness is predictive of histologic endometrial maturation in women undergoing hormone replacement for ovum donation. DESIGN: Ultrasonographic endometrial thickness and pattern were determined and compared with histologic assessment of endometrial maturation. PATIENTS: Forty-six women underwent 52 preparatory cycles for ovum donation. Transvaginal ultrasound (US) was performed after 14 days of E2 replacement and, after 12 days of P, an endometrial biopsy was performed. In 12 cycles, a continuous dose of 2 mg/d E2 was administered. In cycles with out-of-phase biopsies (dated earlier than day 24) and in the last 34 cycles, all women received an escalating dose of E2 before initiation of P. Additionally, the 46 women underwent 55 ETs with USs performed on cycle day 15. RESULTS: Six women had abnormal biopsies in their first preparatory cycle on the continuous E2 protocol, which normalized with the escalating protocol. All other women had normal biopsies. Women with abnormal biopsies had significantly thinner endometrium (< or = 6 mm) but similar endometrial patterns compared with women with normal biopsies. In women having US in preparatory and transfer cycles, there were no differences in endometrial thickness or pattern between examinations. CONCLUSIONS: Endometrial thickness > or = 7 mm in hormone replacement cycles predicts in phase endometrial histology and can replace the endometrial biopsy.     

The diagnostic problem associated with blunt traumatic azygous vein injury: delayed appearance of right haemothorax after blunt chest trauma

BACKGROUND: The histologic diagnosis of atypical ductal hyperplasia (ADH) has been reported as having a high rate of malignancy, either ductal carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC). We reviewed our surgical group's experience with stereotactic core-needle biopsies (SCNB), specifically looking at the follow-up of ADH. METHODS: From November 1994 through July 1997 our group performed 539 SCNB. Twenty-one patients (4%) were diagnosed as ADH. Eighteen patients had subsequent wire-localized excisional biopsies. Three patients were followed up mammographically. One patient refused follow-up. RESULTS: Of the 18 patients who underwent excisional biopsies, 2 patients were found to have DCIS and 1 patient had lobular carcinoma in-situ. There were no cases of IDC. CONCLUSION: Our results show a much lower incidence of malignancy in cases of ADH found on SCNB than has been previously reported. While the standard of care is still to follow up ADH found on SCNB with excisional biopsy, more data may justify following up certain subsets of patients.