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Flat epithelial atypia on core needle biopsy, must we surgically excise? Am J Surg 2016; 212:1211-1213. [DOI: 10.1016/j.amjsurg.2016.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022]
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Dion L, Racin A, Brousse S, Beltjens F, Cauchois A, Levêque J, Coutant C, Lavoué V. Atypical epithelial hyperplasia of the breast: state of the art. Expert Rev Anticancer Ther 2016; 16:943-53. [PMID: 27367571 DOI: 10.1080/14737140.2016.1204916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atypical epithelial hyperplasia (AEH) of the breast is considered benign histological lesions with breast cancer risk. This review focuses on clinical signification and management of AEH that remains controversial. AREAS COVERED A review of published studies was performed using medline database. In this review, we fully describe the current evidence available. In particular, we describe 1) data from immunohistochemistry and molecular studies that suggest AEH is a precursor of breast cancer; 2) epidemiological studies demonstrate low rate of breast cancer in women with AEH; 3) surgical excision is necessary after diagnosis of AEH, such as lobular carcinoma in situ or atypical ductal hyperplasia, on core needle biopsy; 4) although current recommendations are evolving to fewer (if not no) excisions for flat epithelial with atypia and classic lobular neoplasia found on percutaneous biopsy (without radiologic indications for excision). Expert commentary: HEA management steel need prospective evidences, but recent retrospective data give some clue for less invasive management for some of HEA.
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Affiliation(s)
- Ludivine Dion
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Adelaïde Racin
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Susie Brousse
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Françoise Beltjens
- b Department of Tumour Pathology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France.,c University of Burgundy-Franche Comté , Dijon , France.,d Department of Surgical Oncology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France
| | - Aurélie Cauchois
- e Department of Tumour Pathology , Rennes University Hospital, University of Rennes 1 , Rennes , France
| | - Jean Levêque
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France.,f Regional University Centre of Mastology, CRLCC Eugène Marquis , Rennes , Cedex , France.,g ER440, Oncogenesis, Stress and Signaling , INSERM , Rennes , France
| | - Charles Coutant
- b Department of Tumour Pathology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France.,c University of Burgundy-Franche Comté , Dijon , France.,d Department of Surgical Oncology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France
| | - Vincent Lavoué
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France.,f Regional University Centre of Mastology, CRLCC Eugène Marquis , Rennes , Cedex , France.,g ER440, Oncogenesis, Stress and Signaling , INSERM , Rennes , France
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Stearns V, Fackler MJ, Hafeez S, Bujanda ZL, Chatterton RT, Jacobs LK, Khouri NF, Ivancic D, Kenney K, Shehata C, Jeter SC, Wolfman JA, Zalles CM, Huang P, Khan SA, Sukumar S. Gene Methylation and Cytological Atypia in Random Fine-Needle Aspirates for Assessment of Breast Cancer Risk. Cancer Prev Res (Phila) 2016; 9:673-682. [PMID: 27261491 DOI: 10.1158/1940-6207.capr-15-0377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/23/2016] [Indexed: 11/16/2022]
Abstract
Methods to determine individualized breast cancer risk lack sufficient sensitivity to select women most likely to benefit from preventive strategies. Alterations in DNA methylation occur early in breast cancer. We hypothesized that cancer-specific methylation markers could enhance breast cancer risk assessment. We evaluated 380 women without a history of breast cancer. We determined their menopausal status or menstrual cycle phase, risk of developing breast cancer (Gail model), and breast density and obtained random fine-needle aspiration (rFNA) samples for assessment of cytopathology and cumulative methylation index (CMI). Eight methylated gene markers were identified through whole-genome methylation analysis and included novel and previously established breast cancer detection genes. We performed correlative and multivariate linear regression analyses to evaluate DNA methylation of a gene panel as a function of clinical factors associated with breast cancer risk. CMI and individual gene methylation were independent of age, menopausal status or menstrual phase, lifetime Gail risk score, and breast density. CMI and individual gene methylation for the eight genes increased significantly (P < 0.001) with increasing cytological atypia. The findings were verified with multivariate analyses correcting for age, log (Gail), log (percent density), rFNA cell number, and body mass index. Our results demonstrate a significant association between cytological atypia and high CMI, which does not vary with menstrual phase or menopause and is independent of Gail risk and mammographic density. Thus, CMI is an excellent candidate breast cancer risk biomarker, warranting larger prospective studies to establish its utility for cancer risk assessment. Cancer Prev Res; 9(8); 673-82. ©2016 AACR.
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Affiliation(s)
- Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mary Jo Fackler
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sidra Hafeez
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Zoila Lopez Bujanda
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Robert T Chatterton
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Lisa K Jacobs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Nagi F Khouri
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - David Ivancic
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Kara Kenney
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Christina Shehata
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stacie C Jeter
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Judith A Wolfman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Peng Huang
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Seema A Khan
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Saraswati Sukumar
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
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Radisky DC, Visscher DW, Frank RD, Vierkant RA, Winham S, Stallings-Mann M, Hoskin TL, Nassar A, Vachon CM, Denison LA, Hartmann LC, Frost MH, Degnim AC. Natural history of age-related lobular involution and impact on breast cancer risk. Breast Cancer Res Treat 2016; 155:423-30. [PMID: 26846985 PMCID: PMC4764623 DOI: 10.1007/s10549-016-3691-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/22/2016] [Indexed: 11/26/2022]
Abstract
Age-related lobular involution (LI) is a physiological process in which the terminal duct lobular units of the breast regress as a woman ages. Analyses of breast biopsies from women with benign breast disease (BBD) have found that extent of LI is negatively associated with subsequent breast cancer development. Here we assess the natural course of LI within individual women, and the impact of progressive LI on breast cancer risk. The Mayo Clinic BBD cohort consists of 13,455 women with BBD from 1967 to 2001. The BBD cohort includes 1115 women who had multiple benign biopsies, 106 of whom had developed breast cancer. Within this multiple biopsy cohort, the progression of the LI process was examined by age at initial biopsy and time between biopsies. The relationship between LI progression and breast cancer risk was assessed using standardized incidence ratios and by Cox proportional hazards analysis. Women who had multiple biopsies were younger age and had a slightly higher family history of breast cancer as compared with the overall BBD cohort. Extent of LI at subsequent biopsy was greater with increasing time between biopsies and for women age 55 + at initial biopsy. Among women with multiple biopsies, there was a significant association of higher breast cancer risk among those with involution stasis (lack of progression, HR 1.63) as compared with those with involution progression, p = 0.036. The multiple biopsy BBD cohort allows for a longitudinal study of the natural progression of LI. The majority of women in the multiple biopsy cohort showed progression of LI status between benign biopsies, and extent of progression was highest for women who were in the perimenopausal age range at initial biopsy. Progression of LI status between initial and subsequent biopsy was associated with decreased breast cancer risk.
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Affiliation(s)
- Derek C Radisky
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | | | - Ryan D Frank
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Robert A Vierkant
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Stacey Winham
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Tanya L Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Lori A Denison
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Lynn C Hartmann
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Marlene H Frost
- Division of Oncology Research, Mayo Clinic, Rochester, MN, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Berry JS, Trappey AF, Vreeland TJ, Pattyn AR, Clifton GT, Berry EA, Schneble EJ, Kirkpatrick AD, Saenger JS, Peoples GE. Analysis of Clinical and Pathologic Factors of Pure, Flat Epithelial Atypia on Core Needle Biopsy to Aid in the Decision of Excision or Observation. J Cancer 2016; 7:1-6. [PMID: 26722353 PMCID: PMC4679374 DOI: 10.7150/jca.12781] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/30/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The optimal treatment of flat epithelial atypia (FEA) found on breast core needle biopsy (CNB) is controversial. We performed a retrospective review of our institutional experience with FEA to determine if excisional biopsy may be deferred. METHODS Surgical records from 2009 to 2012 were reviewed for FEA diagnosis. After exclusion for concomitant lesions, CNBs of pure FEA were classified using a previously agreed upon descriptor of "focal" versus "prominent". Data was analyzed with the Fisher's Exact and Student-t test as appropriate. RESULTS Of 71 CNBs evaluated, pure FEA was identified on 27 CNBs. Final excisional biopsy was benign in 24 of 27 cases (88%) with associated ductal carcinoma in-situ (DCIS) in 3 of 27 cases (11%). Eighteen of 27 (67%) CNBs were classified as focal while 9 (33%) were described as prominent. Zero of the 18 focal patients had a malignancy compared to 3 of the 9 in the prominent group (0% vs 33%, p=0.02). Of the 27 pure FEA CNBs, 6 patients had a personal history of breast carcinoma, five DCIS and one invasive ductal carcinoma. No malignancies were found in the 21 patients without a personal history of breast carcinoma versus three in the patients with a positive history (0/21 v 3/6, p=0.007). CONCLUSIONS Our data suggests those women who have adequate sampling and sectioning of CNBs, with focal, pure FEA on pathology, and are without a personal history of breast cancer may undergo a period of imaging surveillance. Conversely, patients with a history of breast cancer or pure, prominent FEA on CNB disease should proceed to excisional biopsy.
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Affiliation(s)
- John S Berry
- 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Alfred F Trappey
- 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Timothy J Vreeland
- 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Adam R Pattyn
- 2. Department of Surgery, Madigan Military Medical Center, Fort Lewis, WA
| | - Guy T Clifton
- 3. Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX
| | - Elizabeth A Berry
- 4. Qwest Care Associates, Intensive Care Unit, Metropolitan Methodist Hospital, San Antonio, TX
| | - Erika J Schneble
- 1. Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Aaron D Kirkpatrick
- 5. Department of Radiology, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Jeffrey S Saenger
- 6. Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - George E Peoples
- 7. Director, Cancer Vaccine Development Program, San Antonio, TX, USA
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Importance of anatomopathological-imaging correlations for the validation of a breast biopsy results. Diagn Interv Imaging 2015; 97:247-56. [PMID: 26385837 DOI: 10.1016/j.diii.2015.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
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Abstract
Breast pathology is filled with pitfalls, including underdiagnosis of bland-appearing lesions, both invasive and non-invasive, misdiagnosis of malignant lesions as belonging to the wrong subgroup, for example, calling LCIS as DCIS or missing the metaplastic component of an invasive lesion, and overdiagnosis of benign lesions as malignancy. While each is a sin of varying severity, the overdiagnosis of benign lesions can be the most scarring, especially in this age where Angelina Jolie׳s prophylactic mastectomy is the headline news and patients are pushing for aggressive preventive treatment. In this review, we will consider some of the more common benign lesions and the malignant counterpart that they mimic, with the goal of identifying characteristic features that will lead to the correct diagnosis. Much of the discussions will center around the assessment of core biopsies, as smaller tissue volume is most often contributory to overcalling benign lesions.
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Affiliation(s)
- Laura Spruill
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Ave, MSC 908, Charleston, South Carolina 29425-9080.
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