1
|
Pilewskie M, Eroglu I, Sevilimedu V, Le T, Mangino D, Morrow M. Participation in a High-Risk Program Is Associated with a Diagnosis of Earlier-Stage Disease Among Women at Increased Risk for Breast Cancer Development. Ann Surg Oncol 2024:10.1245/s10434-024-15633-x. [PMID: 38949720 DOI: 10.1245/s10434-024-15633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 06/05/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND High-risk programs provide recommendations for surveillance/risk reduction for women at elevated risk for breast cancer development. This study evaluated the impact of high-risk surveillance program participation on clinicopathologic breast cancer features at the time of diagnosis. METHODS Women followed in the authors' high-risk program (high-risk cohort [HRC]) with a diagnosis of breast cancer from January 2015 to June 2021 were identified and compared with the general population of women undergoing breast cancer surgery at Memorial Sloan Kettering Cancer Center (MSK; general cohort [GC]) during the same period. Patient and tumor factors were collected. Clinicopathologic features were compared between the two cohorts and in a subset of women with a family history of known BRCA mutation. RESULTS The study compared 255 women in the HRC with 9342 women in the GC. The HRC patients were slightly older and more likely to be white and have family history than the GC patients. The HRC patients also were more likely to present with DCIS (41 % vs 23 %; p < 0.001), to have smaller invasive tumors (pT1: 100 % vs 77 %; p < 0.001), and to be pN0 (95 % vs 81 %; p < 0.001). The HRC patients had more invasive triple-negative tumors (p = 0.01) and underwent less axillary surgery (p < 0.001), systemic therapy (p < 0.001), and radiotherapy (p = 0.002). Among those with a known BRCA mutation, significantly more women in the HRC underwent screening mammography (75 % vs 40 %; p < 0.001) or magnetic resonance imaging (MRI: 82 % vs 9.9 %; p < 0.001) in the 12 months before diagnosis. CONCLUSIONS Women followed in a high-risk screening program have disease diagnosed at an earlier stage and therefore require less-intensive breast cancer treatment than women presenting to a cancer center at the time of diagnosis. Identification of high-risk women and implementation of increased surveillance protocols are vital to improving outcomes.
Collapse
Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Idil Eroglu
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tiana Le
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra Mangino
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
2
|
Urban LABD, Chala LF, Paula IBD, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, Oliveira TMGD, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for the Screening of Breast Cancer of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Society of Mastology and Brazilian Federation of Gynecology and Obstetrics Association. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e480-e488. [PMID: 37683660 PMCID: PMC10491472 DOI: 10.1055/s-0043-1772498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. METHODS Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. RECOMMENDATIONS Annual mammography screening is recommended for women at usual risk aged 40-74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.
Collapse
Affiliation(s)
| | - Luciano Fernandes Chala
- National Mammography Commission, Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Carlos Shimizu
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | | | - Flávia Engel Aduan
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Henrique Lima Couto
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - Gustavo Machado Badan
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - José Luis Esteves Francisco
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | - Thaís Paiva Moraes
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | | | - João Emílio Peixoto
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Miceli R, Mercado CL, Hernandez O, Chhor C. Active Surveillance for Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ. JOURNAL OF BREAST IMAGING 2023; 5:396-415. [PMID: 38416903 DOI: 10.1093/jbi/wbad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 03/01/2024]
Abstract
Atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) are relatively common breast lesions on the same spectrum of disease. Atypical ductal hyperblasia is a nonmalignant, high-risk lesion, and DCIS is a noninvasive malignancy. While a benefit of screening mammography is early cancer detection, it also leads to increased biopsy diagnosis of noninvasive lesions. Previously, treatment guidelines for both entities included surgical excision because of the risk of upgrade to invasive cancer after surgery and risk of progression to invasive cancer for DCIS. However, this universal management approach is not optimal for all patients because most lesions are not upgraded after surgery. Furthermore, some DCIS lesions do not progress to clinically significant invasive cancer. Overtreatment of high-risk lesions and DCIS is considered a burden on patients and clinicians and is a strain on the health care system. Extensive research has identified many potential histologic, clinical, and imaging factors that may predict ADH and DCIS upgrade and thereby help clinicians select which patients should undergo surgery and which may be appropriate for active surveillance (AS) with imaging. Additionally, multiple clinical trials are currently underway to evaluate whether AS for DCIS is feasible for a select group of patients. Recent advances in MRI, artificial intelligence, and molecular markers may also have an important role to play in stratifying patients and delineating best management guidelines. This review article discusses the available evidence regarding the feasibility and limitations of AS for ADH and DCIS, as well as recent advances in patient risk stratification.
Collapse
Affiliation(s)
- Rachel Miceli
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | | | | | - Chloe Chhor
- NYU Langone Health, Department of Radiology, New York, NY, USA
| |
Collapse
|
4
|
Urban LABD, Chala LF, de Paula IB, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, de Oliveira TMG, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations. Radiol Bras 2023; 56:207-214. [PMID: 37829583 PMCID: PMC10567087 DOI: 10.1590/0100-3984.2023.0064-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 10/14/2023] Open
Abstract
Objective To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities.Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.
Collapse
Affiliation(s)
- Linei Augusta Brolini Delle Urban
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Luciano Fernandes Chala
- Coordinator of the National Mammography Commission of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Marcela Brisighelli Schaefer
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ana Lúcia Kefalás Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Carlos Shimizu
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Tatiane Mendes Gonçalves de Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Paula de Camargo Moraes
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Beatriz Medicis Maranhão Miranda
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Flávia Engel Aduan
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Salete de Jesus Fonseca Rego
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ellyete de Oliveira Canella
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Henrique Lima Couto
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - Gustavo Machado Badan
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - José Luis Esteves Francisco
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Thaís Paiva Moraes
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Rosangela Requi Jakubiak
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - João Emílio Peixoto
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| |
Collapse
|
5
|
Su A, Zhang J, Liu J, Yang Y, He Z, Bao H, Deng H, Wu J. Impact of Atypical Hyperplasia at Surgical Margins on breast cancer outcomes in patients treated with neoadjuvant chemotherapy. Front Oncol 2023; 13:1202689. [PMID: 37274293 PMCID: PMC10235679 DOI: 10.3389/fonc.2023.1202689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background Women with atypical hyperplasia (AH) is associated with a higher risk of future breast cancer. However, whether AH found at margins in patients with breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) needs re-excision is not well-defined. The aim of the present study was to evaluate the impact of AH at the surgical margins on the local recurrence and survival outcomes in breast cancer patients treated with NAC and BCS. Methods A retrospective analysis comparing patients who treated with NAC and BCS with AH at the margins to those without AH was performed. Results 598 patients were included in this study. The 5-year rates of ipsilateral breast tumor recurrence (IBTR) were 4.6% and 6.2% in patients with and without AH, respectively. No significant differences were observed among the two groups in terms of IBTR, DMFS, or OS. HER2 overexpressing breast cancer patients with severe AH at margins have a significantly higher risk of IBTR compared to those without severe AH. Conclusion Our study suggests that the presence of AH at the surgical margins of BCS in patients who received NAC does not appear to increase the risk of ipsilateral breast cancer. Therefore, there is no need for surgeons to routinely perform additional re-excision of AH found at the margins of BCS in these patients. However, selective re-excision should be considered in certain cases, particularly in patients with HER2 overexpression.
Collapse
Affiliation(s)
- An Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jing Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Anesthesiology Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jieqiong Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhou He
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haoshi Bao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Heran Deng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiannan Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
6
|
Khadka VS, Nasu M, Deng Y, Jijiwa M. Circulating microRNA Biomarker for Detecting Breast Cancer in High-Risk Benign Breast Tumors. Int J Mol Sci 2023; 24:7553. [PMID: 37108716 PMCID: PMC10142546 DOI: 10.3390/ijms24087553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
High-risk benign breast tumors are known to develop breast cancer at high rates. However, it is still controversial whether they should be removed during diagnosis or followed up until cancer development becomes evident. Therefore, this study sought to identify circulating microRNAs (miRNAs) that could serve as detection markers of cancers arising from high-risk benign tumors. Small RNA-seq was performed using plasma samples collected from patients with early-stage breast cancer (CA) and high-risk (HB), moderate-risk (MB), and no-risk (Be) benign breast tumors. Proteomic profiling of CA and HB plasma was performed to investigate the underlying functions of the identified miRNAs. Our findings revealed that four miRNAs, hsa-mir-128-3p, hsa-mir-421, hsa-mir-130b-5p, and hsa-mir-28-5p, were differentially expressed in CA vs. HB and had diagnostic power to discriminate CA from HB with AUC scores greater than 0.7. Enriched pathways based on the target genes of these miRNAs indicated their association with IGF-1. Furthermore, the Ingenuity Pathway Analysis performed on the proteomic data revealed that the IGF-1 signaling pathway was significantly enriched in CA vs. HB. In conclusion, these findings suggest that these miRNAs could potentially serve as biomarkers for detecting early-stage breast cancer from high-risk benign tumors by monitoring IGF signaling-induced malignant transformation.
Collapse
Affiliation(s)
| | | | - Youping Deng
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA; (V.S.K.); (M.N.)
| | - Mayumi Jijiwa
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA; (V.S.K.); (M.N.)
| |
Collapse
|
7
|
Aguiar F, Rhana P, Bloise E, Nunes C, Rodrigues A, Ferreira E. T-type Ca2+ channels and their relationship with pre-neoplastic and neoplastic lesions in the human breast. Braz J Med Biol Res 2023; 56:e11879. [PMID: 36790286 PMCID: PMC9925191 DOI: 10.1590/1414-431x2023e11879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023] Open
Abstract
The expression of T-type voltage-dependent Ca2+ channels (Cav3) has been previously observed in breast cancer, but their expression and subcellular localization were not evaluated in pre-neoplastic lesions. Therefore, this work aimed to evaluate protein expression and subcellular localization of T-type channel isoforms in human breast tissue samples. Protein expressions of CaV3.1, CaV3.2, and CaV3.3 were evaluated by immunohistochemistry in breast without alteration, in proliferative non-neoplastic lesions, and in neoplastic ductal epithelial lesions of the human breast. CaV3.1, CaV3.2, and CaV3.3 nuclear expressions were decreased in advanced stages of neoplastic transformation, whereas CaV3.1 and CaV3.2 cytoplasmic expression increased. Also, the decrease in nuclear expression was correlated with an increase in cytoplasmic expression for CaV3.1 isoform. The change in CaV3 protein expression and subcellular localization are consistent with the neoplastic transformation stages of mammary epithelial cells, evident in early neoplastic lesions, such as ductal carcinomas in situ. These results suggest a possible involvement of CaV3 in the carcinogenic processes and could be considered as a potential pharmacological target in new therapies for breast cancer treatment.
Collapse
Affiliation(s)
- F. Aguiar
- Departamento de Patologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil,Programa de Imunologia e Biologia Tumoral, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
| | - P. Rhana
- Department of Physiology and Membrane Biology, University of California Davis, Davis, CA, USA
| | - E. Bloise
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - C.B. Nunes
- Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - A.L. Rodrigues
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - E. Ferreira
- Departamento de Patologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| |
Collapse
|
8
|
Aguiar F, Rhana P, Bloise E, Rodrigues ALP, Ferreira E. L-type voltage-dependent Ca2+ channels expression involved in pre-neoplastic transformation of breast cancer. SURGICAL AND EXPERIMENTAL PATHOLOGY 2022. [DOI: 10.1186/s42047-022-00117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intracellular Ca2+ levels can modulate several cellular functions, including proliferation and other processes found altered in neoplastic cells. Helping to maintain Ca2+ homeostasis, L-type voltage-dependent Ca2+ channels had its expression identified in neoplasias, including breast cancer. Invasive breast carcinoma of no special type, the most common classification of breast cancer, has ductal hyperplasia and ductal carcinoma in situ as its possible non-obligate precursors. This channel’s role in breast cancer development from these precursors has not been investigated. Evaluate protein expression and subcellular localization of CaV1.1, CaV1.2, and CaV1.3 in mammary epithelium without alteration and neoplastic and non-neoplastic ductal proliferative lesions through immunohistochemistry was the aim of this investigation.
Methods
In the present study, CaV1.1, CaV1.2, and CaV1.3 protein expression was evaluated by immunohistochemistry in breast without alteration and in proliferative non-neoplastic and neoplastic ductal epithelial lesions of the human breast.
Results
It was observed that CaV1.3 presented a reduction in nuclear expression at neoplastic lesions, in addition to an increase in cytoplasmic CaV1.1 expression. The analyses of membrane immunostaining showed that CaV1.2 and CaV1.3 had an increase of expression as the lesions progressed in the stages leading to invasive carcinomas.
Conclusions
Changes in protein expression and subcellular localization of these channels during the progression stages indicate that they may be involved in neoplastic transformation.
Collapse
|
9
|
Atypical Hyperplasia Found Incidentally during Routine Breast Reduction Mammoplasty: Incidence and Management. Plast Reconstr Surg Glob Open 2022; 10:e4141. [PMID: 35223346 PMCID: PMC8865503 DOI: 10.1097/gox.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
UNLABELLED Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) of the breast are premalignant lesions. Although the literature on ADH and ALH as a whole is well-developed, research on ADH and ALH incidentally discovered during breast reduction is less robust. METHODS In this study, 355 patients undergoing bilateral reduction mammoplasty at West Virginia University were retrospectively reviewed. A variety of demographic and clinicopathologic variables were collected for each patient, and the incidence of atypical hyperplasia was calculated. Four patients (1.13%) were found to have atypical hyperplasia, three ALH, and one ADH, which is within the range reported in the literature. For patients incidentally found to have atypical hyperplasia, an in-depth analysis of postoperative management was performed. RESULTS Of the four patients with atypical hyperplasia, three were referred to a cancer center, and one patient followed only with plastic surgery. The three patients who were referred to a cancer center saw a breast surgeon, whereas the patient followed only by plastic surgery did not. None of the four patients received anti-estrogen therapy, but each patient who followed with a cancer center was offered treatment and declined. CONCLUSIONS As a relatively uncommon finding with complex management guidelines, atypical hyperplasia discovered on breast reduction should be referred to a cancer center for long-term follow-up and management when possible. Further research is needed to assess if the management of atypical hyperplasia discovered incidentally after routine reduction should mimic treatment of atypical hyperplasia found after biopsy for suspicion of malignancy.
Collapse
|
10
|
Nguyen DL, Oluyemi E, Myers KS, Panigrahi B, Mullen LA, Ambinder EB. Disparities Associated With Patient Adherence of Post-Breast-Conserving Surgery Surveillance Imaging Protocols. J Am Coll Radiol 2021; 18:1540-1546. [PMID: 34364841 DOI: 10.1016/j.jacr.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Currently, national and international breast imaging practices utilize variable postsurgical surveillance protocols without uniform recommendations. Due to the innate differences between screening versus diagnostic mammography from scheduling flexibility to out-of-pocket costs, this creates the opportunity for lapses in patient adherence, which has the potential to impact clinical outcomes. The purpose of this study is to evaluate the relationship between sociodemographic factors and postsurgical surveillance imaging protocols on patient adherence rates. METHODS This retrospective study reviewed 3 years of surveillance imaging for all patients having breast-conserving surgery at our institution from January 2011 to December 2016. Follow-up adherence was defined as returning for all of the first 3 years of annual follow-up after breast-conserving surgery (institutional surveillance protocol). Associations between adherence to surveillance imaging and patient sociodemographic characteristics were evaluated using univariate and multivariate logistic regression. RESULTS The study included 1,082 patients after breast surgery, 715 of whom adhered completely to the first 3 years of annual follow-up (66.1%). Black women were 1.36 times less likely to follow up annually compared with White women (95% confidence interval 1.02-1.80). Similarly, patients with Medicare were 1.84 times less likely to follow up annually compared with patients with private insurance (95% confidence interval 1.34-2.51). Women with benign breast disease after breast-conserving surgery were significantly less likely to adhere to annual surveillance than women with breast cancer. CONCLUSION Sociodemographic disparities exist as barriers for annual mammography surveillance in patients after breast-conserving surgery.
Collapse
|
11
|
Dunne EC, Quinn EM, Stokes M, Barry JM, Kell M, Flanagan F, Kennedy MM, Walsh SM. Upgrade rates and outcomes of screen-detected atypical intraductal epithelial proliferation (AIDEP) diagnosed on core needle biopsy. Breast Dis 2021; 40:155-160. [PMID: 33749633 DOI: 10.3233/bd-201031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Atypical intraductal epithelial proliferation (AIDEP) is a breast lesion categorised as "indeterminate" if identified on core needle biopsy (CNB). The rate at which these lesions are upgraded following diagnostic excision varies in the literature. Women diagnosed with AIDEP are thought to be at increased risk of breast cancer. Our aim was to identify the rate of upgrade to invasive or in situ carcinoma in a group of patients diagnosed with AIDEP on screening mammography and to quantify their risk of subsequent breast cancer. METHODS We conducted a retrospective review of a prospectively maintained database containing all patients diagnosed with AIDEP on CNB between 2005 and 2012 in an Irish breast screening centre. Basic demographic data was collected along with details of the original CNB result, rate of upgrade to carcinoma and details of any subsequent cancer diagnoses. RESULTS In total 113 patients were diagnosed with AIDEP on CNB during the study period. The upgrade rate on diagnostic excision was 28.3% (n = 32). 6.2% (n = 7) were upgraded to invasive cancer and 22.1% (n = 25) to DCIS. 81 patients were not upgraded on diagnostic excision and were offered 5 years of annual mammographic surveillance. 9.88% (8/81) of these patients went on to receive a subsequent diagnosis of malignancy. The mean time to diagnosis of these subsequent cancers was 65.41 months (range 20.18-145.21). CONCLUSION Our data showing an upgrade rate of 28% to carcinoma reflects recently published data and we believe it supports the continued practice of excising AIDEP to exclude co-existing carcinoma.
Collapse
Affiliation(s)
- Emma C Dunne
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edel M Quinn
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John M Barry
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm Kell
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fidelma Flanagan
- Department of Breast Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Margaret M Kennedy
- Department of Cellular Pathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
12
|
Nicosia L, Latronico A, Addante F, De Santis R, Bozzini AC, Montesano M, Frassoni S, Bagnardi V, Mazzarol G, Pala O, Lazzeroni M, Lissidini G, Mastropasqua MG, Cassano E. Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate? Diagnostics (Basel) 2021; 11:diagnostics11061120. [PMID: 34205428 PMCID: PMC8259513 DOI: 10.3390/diagnostics11061120] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients’ characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.
Collapse
Affiliation(s)
- Luca Nicosia
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Antuono Latronico
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Francesca Addante
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70124 Bari, Italy;
| | - Rossella De Santis
- Postgraduate School in Radiology, University of Milan, 20122 Milan, Italy;
| | - Anna Carla Bozzini
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Marta Montesano
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Giovanni Mazzarol
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.M.); (O.P.)
| | - Oriana Pala
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.M.); (O.P.)
| | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Germana Lissidini
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Mauro Giuseppe Mastropasqua
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-0805594414
| | - Enrico Cassano
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| |
Collapse
|
13
|
Su M, Huynh V, Bronsert M, Su E, Goode J, Lock A, Banden S, Ahrendt G, Afghahi A, Arruda J, Tevis S. Longitudinal Risk Management for Patients with Increased Risk for Breast Cancer. J Surg Res 2021; 266:421-429. [PMID: 34102512 DOI: 10.1016/j.jss.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aims to characterize longitudinal care management and evaluate the relationship between various patient factors and the likelihood of choosing risk-reducing behaviors in women with increased risk of developing breast cancer. METHODS A retrospective study was conducted to evaluate all adult female patients who had at least one clinic visit with a surgical provider for discussion of breast cancer risk assessment between January, 2017 to July, 2020 at an academic center. Patients with prior history of breast cancer were excluded. Patient details and strategies pursued at clinic visits were recorded. A time-to-event analysis was performed, and hazard ratios were determined to characterize associations between patient characteristics and time to pursuing risk-reducing care management. RESULTS There were 283 participants with at least one follow-up visit and 48 (17.0%) ultimately changed their initial strategy to either chemoprevention or prophylactic mastectomy. Patients with gene mutations were 6 times more likely to engage in risk-reducing management compared to those without (hazard ratio (HR) 5.99, P < 0.001). Those with histories of high-risk proliferative changes (HR 7.62, P < 0.001) and hysterectomy (HR 2.99, P = 0.019) were also more likely to engage in risk-reducing management. Age, race, and increased predicted risk of developing breast cancer (estimated by various calculators) were not associated with increased likelihood of engaging in risk-reducing strategies. CONCLUSION Known gene mutations, history of high-risk proliferative changes, and prior hysterectomy were factors associated with women who were more likely to engage in risk-reducing strategies. These findings, when paired with patient reported outcome measures, may help guide shared decision-making.
Collapse
Affiliation(s)
- Malcolm Su
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael Bronsert
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) and Surgical Outcomes and Applied Research (SOAR) Program, Aurora, CO, USA
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Jennifer Goode
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Lock
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Serenity Banden
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anosheh Afghahi
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jaime Arruda
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| |
Collapse
|
14
|
Samreen N, Mercado C, Heacock L, Chacko C, Partridge SC, Chhor C. Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques. JOURNAL OF BREAST IMAGING 2021; 3:387-398. [PMID: 38424773 DOI: 10.1093/jbi/wbaa116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 03/02/2024]
Abstract
Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients. Abbreviated breast MRI (Ab-MRI) reduces scan time by decreasing the number of sequences obtained, but as multiple delayed contrast enhanced sequences are not obtained, no kinetic information is available. Ultrafast techniques rapidly acquire multiple sequences during the first minute of gadolinium contrast injection and provide information about both lesion morphology and vascular kinetics. Diffusion-weighted imaging is a noncontrast MRI technique with the potential to detect mammographically occult cancers. This review article aims to discuss the current indications of breast MRI as a screening tool, examine the standard breast DCE-MRI technique, and explore alternate screening MRI protocols, including Ab-MRI, ultrafast MRI, and noncontrast diffusion-weighted MRI, which can decrease scan time and interpretation time.
Collapse
Affiliation(s)
- Naziya Samreen
- New York University, Department of Radiology, Garden City, NY, USA
| | - Cecilia Mercado
- NYU School of Medicine, Department of Radiology, New York, NY, USA
| | - Laura Heacock
- NYU School of Medicine, Department of Radiology, New York, NY, USA
| | - Celin Chacko
- New York University, Department of Radiology, Garden City, NY, USA
| | | | - Chloe Chhor
- NYU School of Medicine, Department of Radiology, New York, NY, USA
| |
Collapse
|
15
|
Figueroa JD, Gierach GL, Duggan MA, Fan S, Pfeiffer RM, Wang Y, Falk RT, Loudig O, Abubakar M, Ginsberg M, Kimes TM, Richert-Boe K, Glass AG, Rohan TE. Risk factors for breast cancer development by tumor characteristics among women with benign breast disease. Breast Cancer Res 2021; 23:34. [PMID: 33736682 PMCID: PMC7977564 DOI: 10.1186/s13058-021-01410-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Among women diagnosed with invasive breast cancer, 30% have a prior diagnosis of benign breast disease (BBD). Thus, it is important to identify factors among BBD patients that elevate invasive cancer risk. In the general population, risk factors differ in their associations by clinical pathologic features; however, whether women with BBD show etiologic heterogeneity in the types of breast cancers they develop remains unknown. Methods Using a nested case-control study of BBD and breast cancer risk conducted in a community healthcare plan (Kaiser Permanente Northwest), we assessed relationships of histologic features in BBD biopsies and patient characteristics with subsequent breast cancer risk and tested for heterogeneity of associations by estrogen receptor (ER) status, tumor grade, and size. The study included 514 invasive breast cancer cases (median follow-up of 9 years post-BBD diagnosis) and 514 matched controls, diagnosed with proliferative or non-proliferative BBD between 1971 and 2006, with follow-up through mid-2015. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using multivariable polytomous logistic regression models. Results Breast cancers were predominantly ER-positive (86%), well or moderately differentiated (73%), small (74% < 20 mm), and stage I/II (91%). Compared to patients with non-proliferative BBD, proliferative BBD with atypia conferred increased risk for ER-positive cancer (OR = 5.48, 95% CI = 2.14–14.01) with only one ER-negative case, P-heterogeneity = 0.45. The presence of columnar cell lesions (CCLs) at BBD diagnosis was associated with a 1.5-fold increase in the risk of both ER-positive and ER-negative tumors, with a 2-fold increase (95% CI = 1.21–3.58) observed among postmenopausal women (56%), independent of proliferative BBD status with and without atypia. We did not identify statistically significant differences in risk factor associations by tumor grade or size. Conclusion Most tumors that developed after a BBD diagnosis in this cohort were highly treatable low-stage ER-positive tumors. CCL in BBD biopsies may be associated with moderately increased risk, independent of BBD histology, and irrespective of ER status. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01410-1.
Collapse
Affiliation(s)
- Jonine D Figueroa
- National Cancer Institute, National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA. .,The Usher Institute, Old Medical School, The University of Edinburgh, Teviot Place, Edinburgh, UK. .,CRUK Edinburgh Centre, The University of Edinburgh, Edinburgh, UK.
| | - Gretchen L Gierach
- National Cancer Institute, National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Máire A Duggan
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Shaoqi Fan
- National Cancer Institute, National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Ruth M Pfeiffer
- National Cancer Institute, National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Yihong Wang
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Roni T Falk
- National Cancer Institute, National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Olivier Loudig
- Center for Discovery and Innovation (CDI), Hackensack Meridian Health, Nutley, NJ, USA
| | - Mustapha Abubakar
- National Cancer Institute, National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Mindy Ginsberg
- Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Belfer Building, Room 1301, Bronx, NY, 10461, USA
| | - Teresa M Kimes
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Andrew G Glass
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Thomas E Rohan
- Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Belfer Building, Room 1301, Bronx, NY, 10461, USA.
| |
Collapse
|
16
|
Beca F, Oh H, Collins LC, Tamimi RM, Schnitt SJ. The impact of mammographic screening on the subsequent breast cancer risk associated with biopsy-proven benign breast disease. NPJ Breast Cancer 2021; 7:23. [PMID: 33674619 PMCID: PMC7935945 DOI: 10.1038/s41523-021-00225-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023] Open
Abstract
Data on the risk of breast cancer following a benign breast disease (BBD) diagnosis were derived predominantly from populations of women biopsied before the widespread use of mammographic screening and in whom these lesions were mostly incidental findings. Whether or not similar risk associations are seen when these lesions are detected in mammographically screened populations is unknown. To address this, we examined the variation in BBD and breast cancer risk associations by the calendar time of BBD diagnosis (pre- vs. post-mammography era [before vs. 1985 and after]) in a nested case–control study within the Nurses’ Health Study (NHS) and NHSII BBD subcohort (488 cases; 1908 controls). We performed logistic regression analysis, adjusting for matching factors and potential confounders, to estimate odds ratio (ORs) and 95% confidence interval (CI) for the association between BBD subtype (non-proliferative, proliferative without atypia, proliferative with atypical hyperplasia (AH)) and subsequent breast cancer risk. When compared with non-proliferative lesions, both proliferative lesions without atypia (PWA) and AHs were associated with similar levels of risk in the pre-mammographic (pre) and post-mammographic (post) time periods (PWA: OR [95% CI] = 1.73 [1.27, 2.36] pre vs. 1.12 [0.73, 1.74] post; AH: 4.41 [2.90, 6.70] pre vs. 3.69 [2.21, 6.15] post). The interaction by mammography era was not statistically significant (p-interaction = 0.47). These results suggest that the risk associations reported for BBD subtypes in the pre-mammography era remain valid for BBD detected after the widespread implementation of mammographic screening.
Collapse
Affiliation(s)
- Francisco Beca
- Department of Pathology, Stanford University Medical School, Stanford, CA, USA
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, College of Health Sciences, Korea University, Seoul, South Korea
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Dana-Farber Cancer Institute, Boston, MA, USA.
| |
Collapse
|
17
|
Vellal AD, Sirinukunwattan K, Kensler KH, Baker GM, Stancu AL, Pyle ME, Collins LC, Schnitt SJ, Connolly JL, Veta M, Eliassen AH, Tamimi RM, Heng YJ. Deep Learning Image Analysis of Benign Breast Disease to Identify Subsequent Risk of Breast Cancer. JNCI Cancer Spectr 2021; 5:pkaa119. [PMID: 33644680 PMCID: PMC7898083 DOI: 10.1093/jncics/pkaa119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/04/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background New biomarkers of risk may improve breast cancer (BC) risk prediction. We developed a computational pathology method to segment benign breast disease (BBD) whole slide images into epithelium, fibrous stroma, and fat. We applied our method to the BBD BC nested case-control study within the Nurses' Health Studies to assess whether computer-derived tissue composition or a morphometric signature was associated with subsequent risk of BC. Methods Tissue segmentation and nuclei detection deep-learning networks were established and applied to 3795 whole slide images from 293 cases who developed BC and 1132 controls who did not. Percentages of each tissue region were calculated, and 615 morphometric features were extracted. Elastic net regression was used to create a BC morphometric signature. Associations between BC risk factors and age-adjusted tissue composition among controls were assessed using analysis of covariance. Unconditional logistic regression, adjusting for the matching factors, BBD histological subtypes, parity, menopausal status, and body mass index evaluated the relationship between tissue composition and BC risk. All statistical tests were 2-sided. Results Among controls, direction of associations between BBD subtypes, parity, and number of births with breast composition varied by tissue region; select regions were associated with childhood body size, body mass index, age of menarche, and menopausal status (all P < .05). A higher proportion of epithelial tissue was associated with increased BC risk (odds ratio = 1.39, 95% confidence interval = 0.91 to 2.14, for highest vs lowest quartiles, P trend = .047). No morphometric signature was associated with BC. Conclusions The amount of epithelial tissue may be incorporated into risk assessment models to improve BC risk prediction.
Collapse
Affiliation(s)
- Adithya D Vellal
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Korsuk Sirinukunwattan
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Engineering Science, Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - Kevin H Kensler
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Gabrielle M Baker
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andreea L Stancu
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Pyle
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Laura C Collins
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stuart J Schnitt
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Dana-Farber Cancer Institute-Brigham and Women's Hospital, Boston, MA, USA
| | - James L Connolly
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mitko Veta
- Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yujing J Heng
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
18
|
Karwowski P, Lumley D, Stokes D, Pavlica M, Edsall B, Fu S, Francfort J, Cohen B, Capizzi A, Ma ZW, Green A, Kao J. Atypical ductal hyperplasia on core needle biopsy: Surgical outcomes of 200 consecutive cases from a high-volume breast program. Breast J 2021; 27:287-290. [PMID: 33506606 DOI: 10.1111/tbj.14170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
Atypical ductal hyperplasia (ADH) is an indication for excisional biopsy to rule out occult breast cancer. We analyzed pathological findings on excisional biopsy for ADH diagnosed in a high volume breast center equipped with digital tomosynthesis. Two hundred consecutive patients were diagnosed with ADH on core biopsy with radiographic concordance followed by excisional biopsy. On excisional biopsy, 33 patients (16.5%) were diagnosed with DCIS or invasive breast cancer. Patients with a concurrent diagnosis of papilloma had a higher risk of upstaging on both univariate and multivariate analysis (41.7% vs. 14.9%, p=0.015). No other statistically significant predictors of upgrading were identified (p>0.05).
Collapse
Affiliation(s)
- Pawel Karwowski
- Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Dean Lumley
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, New York, USA
| | - Deidre Stokes
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, New York, USA
| | - Matthew Pavlica
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, New York, USA
| | - Bonnie Edsall
- Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, USA.,Good Samaritan Hospital Medical Center, Charles E. DeClerk Department of Imaging Services, West Islip, New York, USA
| | - Sophia Fu
- Department of Surgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - John Francfort
- Department of Surgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Bradley Cohen
- Department of Surgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Anthony Capizzi
- Department of Surgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Zhi-Wei Ma
- Department of Pathology, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| | - Anne Green
- Good Samaritan Hospital Medical Center, Charles E. DeClerk Department of Imaging Services, West Islip, New York, USA
| | - Johnny Kao
- Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, USA
| |
Collapse
|
19
|
Allweis TM, Hermann N, Berenstein-Molho R, Guindy M. Personalized Screening for Breast Cancer: Rationale, Present Practices, and Future Directions. Ann Surg Oncol 2021; 28:4306-4317. [PMID: 33398646 DOI: 10.1245/s10434-020-09426-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
Ever since screening for early breast cancer (BC) diagnosis was shown to decrease mortality from the disease, screening programs have been widely implemented throughout the world. Targeted age groups and schedules vary between countries but the majority use a population-based approach, regardless of personal BC risk. The purpose of this review was to describe current population-based screening practices, point out some of the shortcomings of these practices, describe BC risk factors and risk assessment models, and present ongoing clinical trials of personalized risk-adapted BC screening. Three ongoing, large-scale, randomized controlled clinical trials (WISDOM in the US, MyPEBS in Europe, and TBST in Italy) were identified through a search of the MEDLINE and US National Library of Medicine (ClinicalTrials.gov) databases. In these trials, women either undergo standard or personalized screening. The trials vary in methods of risk stratification and screening modalities, but all aim to examine whether personalized risk-adapted screening can safely replace the current population-based approach and lead to rates of advanced-stage BC at diagnosis comparable with those of current screening regimens. The results of these trials may change current population-based screening practices.
Collapse
Affiliation(s)
- Tanir M Allweis
- Department of Surgery and Breast Health Center, Kaplan Medical Center, Rehovot, Israel. .,Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - Naama Hermann
- Department of General Surgery B and Meirav Comprehensive Breast Health Center, Sheba Medical Center, Ramat Gan, Israel
| | - Rinat Berenstein-Molho
- Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Guindy
- Department of Imaging, Assuta Medical Center, Tel Aviv, Israel
| |
Collapse
|
20
|
Breast cancer screening for women at high risk: review of current guidelines from leading specialty societies. Breast Cancer 2020; 28:1195-1211. [PMID: 32959120 DOI: 10.1007/s12282-020-01157-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this article is to overview the existing breast cancer screening guidelines for women at high risk from world-leading specialty societies. Accumulation of evidence and development of accessible genetic testing strategies have changed the idea of breast cancer screening for high-risk women. Personalized tailor-made screening adjusted for risk factors has been conducted in accordance with guidelines. The use of imaging modalities other than mammography including contrast-enhanced MRI and other various strategies for improving screening are discussed. The present review also mentions the existing challenges in high-risk screening and the latest information based on two large-scale studies.
Collapse
|
21
|
Hermann N, Klil-Drori A, Angarita FA, Westergard S, Freitas V, Scaranelo A, McCready DR, Cil TD. Screening women at high risk for breast cancer: one program fits all? Breast Cancer Res Treat 2020; 184:763-770. [DOI: 10.1007/s10549-020-05895-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022]
|
22
|
Yoon JH, Koo JS, Lee HS, Kim EK, Kim MJ, Park VY, Moon HJ. Factors Predicting Breast Cancer Development in Women During Surveillance After Surgery for Atypical Ductal Hyperplasia of the Breast: Analysis of Clinical, Radiologic, and Histopathologic Features. Ann Surg Oncol 2020; 27:3614-3622. [PMID: 32314161 DOI: 10.1245/s10434-020-08476-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study aimed to evaluate the risk of breast cancer development for women under surveillance after surgery for atypical ductal hyperplasia (ADH), as well as the clinical and pathologic factors associated with breast cancer development. METHODS From November 2003 to December 2014, the study included 205 women (mean age, 47.1 ± 11.2 years; range 18-73 years) with a pathologic diagnosis of ADH at surgical excision who had preoperative mammography and ultrasonography (US) images and pathology slides available for review. The patients were classified into three groups according to the detection method as follows: negative group (with ADH occult on imaging), mammography group (with ADH detected on mammography), and US group (with ADH detected on US only). Clinical, radiologic, and histopathologic factors associated with breast cancer development after ADH surgery were evaluated. RESULTS Breast cancer developed in 15 patients (7.3%) during surveillance after ADH surgery (follow-up period, 63.9 ± 40.8 months). Palpable lesions had significantly higher rates of breast cancer development after ADH surgery (26.7% vs 6.8%; P = 0.045). Breast cancer development after ADH surgery did not differ according to the detection method (P = 0.654). Palpability was significantly associated with breast cancer development during surveillance after ADH surgery (hazard ratio, 3.579; 95% confidence interval 1.048-12.220; P = 0.042). CONCLUSION The breast cancer development rate for women under surveillance after ADH surgery was 7.3%. Palpability at the time of ADH diagnosis was significantly associated with breast cancer development.
Collapse
Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Seung Koo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
23
|
Baker GM, Pyle ME, Tobias AM, Bartlett RA, Phillips J, Fein-Zachary VJ, Wulf GM, Heng YJ. Establishing a Cohort of Transgender Men and Gender Nonconforming Individuals to Understand the Molecular Impact of Testosterone on Breast Physiology. Transgend Health 2019; 4:326-330. [PMID: 31750394 PMCID: PMC6863056 DOI: 10.1089/trgh.2019.0040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To characterize a cohort of transgender men and masculine-centered gender nonconforming individuals who underwent gender-affirming chest-contouring surgeries at our institution between 2013 and 2018. Methods: Demographics, medical history, and breast histopathological assessment for 340 patients were retrieved from medical records. Results: Most of our patients were white, non-Hispanic (75.0%), were taking testosterone (83.2%), and opted for chest-contouring surgery after 12–14 months of testosterone therapy. Ten patients were parous (2.9%). Seventy-nine (23.2%) and 27 (7.9%) patients had a family history of breast cancer or ovarian cancer, respectively. One transgender man was incidentally diagnosed with ductal carcinoma in situ at chest-contouring surgery. Conclusion: Future studies on this cohort will provide valuable insights about the impact of testosterone on breast physiology.
Collapse
Affiliation(s)
- Gabrielle M Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael E Pyle
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam M Tobias
- Department of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Richard A Bartlett
- Department of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jordana Phillips
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Valerie J Fein-Zachary
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gerburg M Wulf
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
24
|
Farkas A, Vanderberg R, Merriam S, DiNardo D. Breast Cancer Chemoprevention: A Practical Guide for the Primary Care Provider. J Womens Health (Larchmt) 2019; 29:46-56. [PMID: 31560601 DOI: 10.1089/jwh.2018.7643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Several organizations, including the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the United States Preventive Services Task Force, recommend incorporation of breast cancer risk-based counseling and chemoprevention into routine well-woman care. However, primary care providers report both discomfort with and a lack of medical knowledge on this topic. In this review we present a practical, evidence-based guide for incorporating breast cancer risk assessment and chemoprevention into routine care. We advocate a stepwise approach consisting of: (1) risk assessment and communication, (2) selection of appropriate chemoprevention based on risk-benefit analysis, (3) shared decision-making regarding chemoprevention, and (4) management of chemoprevention side effects. We encourage providers to identify high-risk women and refer them to genetic counseling or a high-risk breast cancer clinic. For women who are not considered high risk, we suggest using the Gail model to estimate a woman's 5-year risk of invasive breast cancer. Usually, the benefits of chemoprevention outweigh the risks of chemoprevention once a woman's 5-year risk of invasive breast cancer reaches 3%. For these women there are several factors that need to be considered when selecting a chemoprevention agent, including patient preference, thrombotic history, menopausal status, absence or presence of a uterus, and bone mineral density. We advocate an evidence-based shared decision-making approach that reflects the woman's individual preferences when communicating risk and counseling about chemoprevention. After starting a chemoprevention agent, close follow-up is important as side effects of chemoprevention are common, including vasomotor symptoms and arthralgias. We also review evidence-based management of chemoprevention side effects.
Collapse
Affiliation(s)
- Amy Farkas
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Medicine, Clement Zablocki Milwaukee VA Medical Center, Milwaukee, Wisconsin
| | - Rachel Vanderberg
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah Merriam
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania
| | - Deborah DiNardo
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
25
|
Rosa M, Agosto-Arroyo E. Core needle biopsy of benign, borderline and in-situ problematic lesions of the breast: Diagnosis, differential diagnosis and immunohistochemistry. Ann Diagn Pathol 2019; 43:151407. [PMID: 31634810 DOI: 10.1016/j.anndiagpath.2019.151407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.
Collapse
Affiliation(s)
- Marilin Rosa
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
| | - Emmanuel Agosto-Arroyo
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
| |
Collapse
|
26
|
Chen LY, Hu J, Tsang JYS, Lee MA, Ni YB, Chan SK, Tse GMK. Diagnostic upgrade of atypical ductal hyperplasia of the breast based on evaluation of histopathological features and calcification on core needle biopsy. Histopathology 2019; 75:320-328. [PMID: 31013355 DOI: 10.1111/his.13881] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/27/2019] [Accepted: 04/19/2019] [Indexed: 02/06/2023]
Abstract
AIMS Atypical ductal hyperplasia (ADH) of breast is increasingly diagnosed in core needle biopsy (CNB). As higher-grade lesions were found in the excision in a substantial proportion of ADH on CNB, factors predicting risk of subsequent upgrade are clinically significant. This study aims to investigate relevant histopathological factors in CNB that could predict diagnostic upgrade at excision. METHODS AND RESULTS One hundred and forty-three cases of CNB with paired subsequent excision were evaluated for multiple clinicopathological parameters related to CNB sampling, ADH morphology, calcification and other co-existing histological features, and which of these parameters were associated with diagnostic upgrade at subsequent excisions were determined. Forty-eight cases (34.3%) were upgraded to malignancy, including 15 invasive cancers and 33 ductal carcinomas in situ (DCIS). An increased tissue area occupied by ADH (P = 0.026), a higher number of ADH foci (P = 0.004), the presence of solid pattern (P = 0.037) and older age (P = 0.012) were positively associated with upgrade, while negative associations were found with the presence of micropapillary pattern (P = 0.025), co-existing columnar cell lesions (CCL) (P = 0.001) and the presence of calcifications (P = 0.009). Multivariate logistic regression analysis showed that the number of ADH foci (HR = 2.810, P = 0.013) was an independent positive predictor, while co-existing CCL (HR = 0.391, P = 0.013) was an independent negative predictor for upgrade. CONCLUSIONS Patients with ADH in CNB showing the presence of co-existing CCL and a lower number of ADH foci have a lower risk of disease upgrade at excision, and are potential candidates for observation-only management.
Collapse
Affiliation(s)
- Lin-Ying Chen
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jintao Hu
- Department of Pathology, Shenzhen People's Hospital, Shenzhen, China
| | - Julia Y S Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Michelle A Lee
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yun-Bi Ni
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Siu-Ki Chan
- Department of Pathology, Kwong Wah Hospital, Hong Kong, China
| | - Gary M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| |
Collapse
|
27
|
|
28
|
Rageth CJ, O'Flynn EAM, Pinker K, Kubik-Huch RA, Mundinger A, Decker T, Tausch C, Dammann F, Baltzer PA, Fallenberg EM, Foschini MP, Dellas S, Knauer M, Malhaire C, Sonnenschein M, Boos A, Morris E, Varga Z. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat 2018; 174:279-296. [PMID: 30506111 PMCID: PMC6538569 DOI: 10.1007/s10549-018-05071-1] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/24/2022]
Abstract
Purpose The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations. Methods This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy. Results In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 (p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 (p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 (p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 (p = 0.07)]. Conclusions Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.
Collapse
Affiliation(s)
- Christoph J Rageth
- Département de Gynécologie et d'Obstétrique, Centre du sein, Hôpitaux Universitaires de Genève, Bd de la Cluse 30, 1211, Geneva 14, Switzerland. .,, Ringlikerstrasse 53, 8142, Uitikon Waldegg, Switzerland.
| | - Elizabeth A M O'Flynn
- The Rose Centre, St George's University Hospitals NHS Foundation Trust, Perimeter Road, London, SW17 0QT, UK
| | - Katja Pinker
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - Rahel A Kubik-Huch
- Department of Medical Services, Institute of Radiology, Kantonsspital Baden, im Ergel, 5404, Baden, Switzerland
| | - Alexander Mundinger
- Zentrum Radiologie der Niels-Stensen-Kliniken; Marienhospital Osnabrück, Bischofsstraße 1, 49074, Osnabrück, Germany
| | - Thomas Decker
- Institut für Pathologie am Dietrich-Bonhoeffer-Klinikum, Salvador-Allende-Straße 30, 17036, Neubrandenburg, Germany
| | - Christoph Tausch
- Brust-Zentrum Zürich, Seefeldstr. 214, 8008, Zurich, Switzerland
| | - Florian Dammann
- Interventional and Pediatric Radiology, Department of Diagnostic, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Eva Maria Fallenberg
- Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences, Unit of Anatomic Pathology at Bellaria Hospital, University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Sophie Dellas
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Knauer
- Breast Center St. Gallen, Cantonal Hospital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland
| | - Caroline Malhaire
- Imaging Department, Institut Curie, PSL Research University, Paris, France
| | - Martin Sonnenschein
- Division of Radiology, Breast Center Bern (Brustzentrum Bern), Klinik Engeried, Lindenhofgruppe AG, Riedweg 15, 3012, Bern, Switzerland
| | - Andreas Boos
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland
| | - Elisabeth Morris
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - Zsuzsanna Varga
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland Schmelzbergstrasse 12., 8091, Zurich, Switzerland
| |
Collapse
|
29
|
Abstract
Atypical ductal hyperplasia (ADH) is a proliferative, nonobligate precursor breast lesion and a marker of increased risk for breast carcinoma. Surgical excision remains the standard recommendation following a core needle biopsy result consistent with ADH. Recent research suggests that women with no mass lesion or discordance, removal of greater than or equal to 90% of calcifications at the time of core needle biopsy, involvement of less than or equal to 2 terminal duct lobular units, and absence of cytologic atypia or necrosis are likely to have a less than 5% chance of a missed cancer.
Collapse
Affiliation(s)
- Jennifer M Racz
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
30
|
Drouet Y, Le Gall J, Gervasoni J, Peix M, Faure C, Lasset C, Treilleux I. Prise en charge des hyperplasies canalaires atypiques sur macrobiopsies : une désescalade possible ? IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Hodorowicz-Zaniewska D, Brzuszkiewicz K, Szpor J, Kibil W, Matyja A, Dyląg-Trojanowska K, Richter P, Szczepanik AM. Clinical predictors of malignancy in patients diagnosed with atypical ductal hyperplasia on vacuum-assisted core needle biopsy. Wideochir Inne Tech Maloinwazyjne 2018; 13:184-191. [PMID: 30002750 PMCID: PMC6041585 DOI: 10.5114/wiitm.2018.73528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/13/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atypical ductal hyperplasia (ADH) is a benign lesion, which due to the risk of coexisting cancer is classified as a lesion of uncertain malignant potential. AIM To identify clinical predictors of cancer underestimation in patients with ADH diagnosed after vacuum-assisted breast biopsy (VABB). MATERIAL AND METHODS Between 2001 and 2016, a total of 3804 vacuum-assisted core needle biopsies were performed at the First Chair of General Surgery of the Jagiellonian University Medical College in Krakow, including 2907 ultrasound (US)-guided biopsies and 897 digital stereotactic procedures. Seventy-six women were diagnosed with ADH and 72 of them underwent subsequent surgical excision. Demographic factors, medical history, family history, clinical symptoms, type and size of lesion determined in imaging scans, size of biopsy needle, and presence of coexisting lesions in VABB specimens were analysed as potential predictors of malignancy underestimation. RESULTS Underestimation of breast carcinoma occurred in 21 (29.2%) patients. The upgrade rate was significantly higher only in patients with a lesion visible both in mammography (MMG) and US examinations and combined BIRADS-5. CONCLUSIONS Vacuum-assisted core needle biopsy is a minimally invasive technique used in diagnosing ADH. As the risk of breast malignancy underestimation is relatively high, open surgical biopsy remains the recommended procedure, especially in patients with lesions detected both in mammography and US examination. As we could not identify the factors that preclude cancer underestimation, all the women diagnosed with ADH should be informed about the risk of cancer underestimation.
Collapse
Affiliation(s)
- Diana Hodorowicz-Zaniewska
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Brzuszkiewicz
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Szpor
- Chair of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Kibil
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Matyja
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Piotr Richter
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Antoni M. Szczepanik
- First Chair of General Surgery, Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
32
|
Degnim AC, Winham SJ, Frank RD, Pankratz VS, Dupont WD, Vierkant RA, Frost MH, Hoskin TL, Vachon CM, Ghosh K, Hieken TJ, Carter JM, Denison LA, Broderick B, Hartmann LC, Visscher DW, Radisky DC. Model for Predicting Breast Cancer Risk in Women With Atypical Hyperplasia. J Clin Oncol 2018; 36:1840-1846. [PMID: 29676945 DOI: 10.1200/jco.2017.75.9480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Women with atypical hyperplasia (AH) on breast biopsy have an aggregate increased risk of breast cancer (BC), but existing risk prediction models do not provide accurate individualized estimates of risk in this subset of high-risk women. Here, we used the Mayo benign breast disease cohort to develop and validate a model of BC risk prediction that is specifically for women with AH, which we have designated as AH-BC. Patients and Methods Retrospective cohorts of women age 18 to 85 years with pathologically confirmed benign AH from Rochester, MN, and Nashville, TN, were used for model development and external validation, respectively. Clinical risk factors and histologic features of the tissue biopsy were selected using L1-penalized Cox proportional hazards regression. Identified features were included in a Fine and Gray regression model to estimate BC risk, with death as a competing risk. Model discrimination and calibration were assessed in the model-building set and an external validation set. Results The model-building set consisted of 699 women with AH, 142 of whom developed BC (median follow-up, 8.1 years), and the external validation set consisted of 461 women with 114 later BC events (median follow-up, 11.4 years). The final AH-BC model included three covariates: age at biopsy, age at biopsy squared, and number of foci of AH. At 10 years, the AH-BC model demonstrated good discrimination (0.63 [95% CI, 0.57 to 0.70]) and calibration (0.87 [95% CI, 0.66 to 1.24]). In the external validation set, the model showed acceptable discrimination (0.59 [95% CI, 0.51 to 0.67]) and calibration (0.91 [95% CI, 0.65 to 1.42]). Conclusion We have created a new model with which to refine BC risk prediction for women with AH. The AH-BC model demonstrates good discrimination and calibration, and it validates in an external data set.
Collapse
Affiliation(s)
- Amy C Degnim
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Stacey J Winham
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Ryan D Frank
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - V Shane Pankratz
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - William D Dupont
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Robert A Vierkant
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Marlene H Frost
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Tanya L Hoskin
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Celine M Vachon
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Karthik Ghosh
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Tina J Hieken
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Jodi M Carter
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Lori A Denison
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Brendan Broderick
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Lynn C Hartmann
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Daniel W Visscher
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| | - Derek C Radisky
- Amy C. Degnim, Stacey J. Winham, Ryan D. Frank, Robert A. Vierkant, Marlene H. Frost, Tanya L. Hoskin, Celine M. Vachon, Karthik Ghosh, Tina J. Hieken, Jodi M. Carter, Lori A. Denison, Brendan Broderick, Lynn C. Hartmann, and Daniel W. Visscher, Mayo Clinic, Rochester, MN; V. Shane Pankratz, University of New Mexico Health Sciences Center, Albuquerque, NM; William D. Dupont, Vanderbilt University, Nashville, TN; and Derek C. Radisky, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
33
|
Buist DSM, Abraham L, Lee CI, Lee JM, Lehman C, O'Meara ES, Stout NK, Henderson LM, Hill D, Wernli KJ, Haas JS, Tosteson ANA, Kerlikowske K, Onega T. Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer. JAMA Intern Med 2018; 178:458-468. [PMID: 29435556 PMCID: PMC5876894 DOI: 10.1001/jamainternmed.2017.8549] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE There is little evidence on population-based harms and benefits of screening breast magnetic resonance imaging (MRI) in women with and without a personal history of breast cancer (PHBC). OBJECTIVE To evaluate biopsy rates and yield in the 90 days following screening (mammography vs magnetic resonance imaging with or without mammography) among women with and without a PHBC. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 6 Breast Cancer Surveillance Consortium (BCSC) registries. Population-based sample of 812 164 women undergoing screening, 2003 through 2013. EXPOSURES A total of 2 048 994 digital mammography and/or breast MRI screening episodes (mammogram alone vs MRI with or without screening mammogram within 30 days). MAIN OUTCOMES AND MEASURES Biopsy intensity (surgical greater than core greater than fine-needle aspiration) and yield (invasive cancer greater than ductal carcinoma in situ greater than high-risk benign greater than benign) within 90 days of a screening episode. We computed age-adjusted rates of biopsy intensity (per 1000 screening episodes) and biopsy yield (per 1000 screening episodes with biopsies). Outcomes were stratified by PHBC and by BCSC 5-year breast cancer risk among women without PHBC. RESULTS We included 101 103 and 1 939 455 mammogram screening episodes in women with and without PHBC, respectively; MRI screening episodes included 3763 with PHBC and 4673 without PHBC. Age-adjusted core and surgical biopsy rates (per 1000 episodes) doubled (57.1; 95% CI, 50.3-65.1) following MRI compared with mammography (23.6; 95% CI, 22.4-24.8) in women with PHBC. Differences (per 1000 episodes) were even larger in women without PHBC: 84.7 (95% CI, 75.9-94.9) following MRI and 14.9 (95% CI, 14.7-15.0) following mammography episodes. Ductal carcinoma in situ and invasive biopsy yield (per 1000 episodes) was significantly higher following mammography compared with MRI episodes in women with PHBC (mammography, 404.6; 95% CI, 381.2-428.8; MRI, 267.6; 95% CI, 208.0-337.8) and nonsignificantly higher, but in the same direction, in women without PHBC (mammography, 279.3; 95% CI, 274.2-284.4; MRI, 214.6; 95% CI, 158.7-280.8). High-risk benign lesions were more commonly identified following MRI regardless of PHBC. Higher biopsy rates and lower cancer yield following MRI were not explained by increasing age or higher 5-year breast cancer risk. CONCLUSIONS AND RELEVANCE Women with and without PHBC who undergo screening MRI experience higher biopsy rates coupled with significantly lower cancer yield findings following biopsy compared with screening mammography alone. Further work is needed to identify women who will benefit from screening MRI to ensure an acceptable benefit-to-harm ratio.
Collapse
Affiliation(s)
- Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
| | | | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Deirdre Hill
- Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jennifer S Haas
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anna N A Tosteson
- Dartmouth Institute for Health Policy and Clinical Practice, Department of Medicine, and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Tracy Onega
- Department of Biomedical Data Science, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | | |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW The aim of this review is to summarize recently published literature addressing atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia [ALH] and classic lobular carcinoma in situ [C-LCIS]), non-classic lobular carcinoma in situ (NC-LCIS), papillary lesions, and flat epithelial atypia (FEA). RECENT FINDINGS While ADH, ALN, and C-LCIS are well-established markers of an increased risk of future breast cancers, the risk implications are less clear for papillary lesions and FEA. NC-LCIS is the least well-characterized lesion, with scant published literature on its natural history and surgical management when encountered on needle biopsy. Recent data suggest that lobular neoplasia on core biopsy of a BI-RADS ≤ 4 concordant lesion does not require an excision, while ADH, atypical papillomas, and NC-LCIS should be excised. Evidence on FEA and papillomas without atypia suggests a low risk of upgrade on excision, and prospective studies on the upgrade of these lesions are ongoing.
Collapse
Affiliation(s)
- Faina Nakhlis
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. .,Surgical Oncology, Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, 450 Brookline Ave., Boston, MA, 02115, USA.
| |
Collapse
|
35
|
Abstract
Benign and atypical lesions associated with breast cancer risk are often encountered in core needle biopsies (CNBs) of the breast. For these lesions, the rate of "upgrade" to carcinoma in excision specimens varies widely in the literature. Many CNB studies are limited by a lack of radiological-pathological correlation, consistent criteria for excision, and clinical follow-up for patients who forego excision. This article highlights contemporary diagnostic criteria and outcome data that would support an evidence-based approach to the management of these nonmalignant lesions of the breast diagnosed on CNB.
Collapse
Affiliation(s)
- Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, University of North Carolina, Women's and Children's Hospitals, 3rd Floor, Room 30212, 101 Manning Drive, Chapel Hill, NC 27514, USA.
| |
Collapse
|
36
|
Nakhlis F, Harrison BT, King TA. Non-classic LCIS Versus Classic LCIS Versus Atypical Hyperplasia: Should Management be the Same? CURRENT SURGERY REPORTS 2018. [DOI: 10.1007/s40137-018-0201-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
37
|
Mucocoele-like lesions: is surgical excision still necessary? Clin Radiol 2017; 72:992.e1-992.e6. [DOI: 10.1016/j.crad.2017.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 11/22/2022]
|
38
|
Latronico A, Nicosia L, Faggian A, Abbate F, Penco S, Bozzini A, Cannataci C, Mazzarol G, Cassano E. Atypical ductal hyperplasia: Our experience in the management and long term clinical follow-up in 71 patients. Breast 2017; 37:1-5. [PMID: 29032282 DOI: 10.1016/j.breast.2017.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Atypical ductal hyperplasia (ADH) is a high-risk benign lesion found in approximately 1-10% of breast biopsies and associated with a variable incidence of carcinoma after surgical excision. The main goal of our study is to present our experience in the management and long-term follow-up of 71 patients with ADH diagnosed on breast biopsy. MATERIALS AND METHODS Results of 3808 breast biopsy specimens from 1 January 2000 to 31 December 2005 were analyzed to identify all biopsies which resulted in a diagnosis of ADH. The histopathological results of the 45 patients who underwent surgery were analyzed. Long-term follow-up for the remaining patients was carried out. RESULTS 45 of 71 (63.4%) patients with histological diagnosis of ADH on breast biopsy underwent surgery. Definitive histological results revealed invasive carcinoma in 7 cases (15.6%), high grade Ductal Carcinoma in situ (DCIS) in 10 (22.2%) patients, Lobular Carcinoma in situ (LCIS) in 4 cases (8.9%) and benign findings in 24 cases (53.3%). 12 of 71 (16.9%) patients underwent only long term follow-up; one (8,3%) of these developed invasive breast carcinoma after 6 years. CONCLUSION Atypical ductal hyperplasia diagnosed on breast biopsy is associated with a relatively high incidence of invasive carcinoma and high grade ductal carcinoma in situ at the time of surgical excision. Certain radiological and cytological criteria can be used to help determine which patients should forgo surgery and be followed up with good results. Long term follow-up is always crucial for patients who have not undergone surgery.
Collapse
MESH Headings
- Adult
- Aged
- Biopsy
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm Grading
- Time Factors
- Watchful Waiting
Collapse
Affiliation(s)
- Antuono Latronico
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Luca Nicosia
- Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Via Festa del Perdono 7, Milan, Italy.
| | - Angela Faggian
- Department of Radiology, Private Hospital "Villa dei Fiori", Acerra, Naples, Italy
| | - Francesca Abbate
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Silvia Penco
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Anna Bozzini
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Christine Cannataci
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, Msida, MSD 2090, Malta
| | - Giovanni Mazzarol
- European Institute of Oncology, Pathology Department, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Enrico Cassano
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| |
Collapse
|
39
|
Donaldson AR, McCarthy C, Goraya S, Pederson HJ, Sturgis CD, Grobmyer SR, Calhoun BC. Breast cancer risk associated with atypical hyperplasia and lobular carcinoma in situ initially diagnosed on core-needle biopsy. Cancer 2017; 124:459-465. [PMID: 29023647 DOI: 10.1002/cncr.31061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/14/2017] [Accepted: 09/11/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Breast cancer risk estimates for atypical lesions are based primarily on case-control studies of patients with open biopsies. The authors report the cumulative breast cancer incidence after a core biopsy diagnosis of atypical hyperplasia (ductal or lobular) or lobular carcinoma in situ. METHODS A cohort study with central pathology review was conducted on 393 patients who had core biopsy diagnoses of atypical hyperplasia and lobular carcinoma in situ from 1995 through 2010. Follow-up was available for 255 of 264 patients (97%) at a median of 87 months (range, 3-236 months). RESULTS There were 212 patients (54%) who were not upgraded on excision and had no personal history of breast cancer. Of these, 21 of 212 (9.9%) developed breast cancer, including 15 invasive carcinomas, 4 ductal carcinomas in situ, 1 pleomorphic lobular carcinoma in situ, and 1 unknown type. The prior core biopsy diagnoses were atypical ductal hyperplasia for 11 patients (52%) and atypical lobular hyperplasia/lobular carcinoma in situ in the remaining 10 patients (48%). The number of atypical foci in the core biopsy was not significantly associated with the subsequent development of breast cancer (P = .42). Of the 15 invasive carcinomas, 11 (73%) were ipsilateral, 11 (73%) were pathologic T1 tumors, 5 (33%) were pathologic N1 tumors, 13 (87%) were estrogen receptor-positive, and 1 (7%) was amplified for human epidermal growth factor receptor 2. CONCLUSIONS In patients who had an initial diagnosis of atypical hyperplasia or lobular carcinoma in situ on core biopsy, the 7-year cumulative breast cancer incidence was 9.9%. Most tumors were ipsilateral, stage I, estrogen receptor-positive, invasive carcinomas. The current data support close clinical and radiologic follow-up for more than 5 years in this patient population. Cancer 2018;124:459-65. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Alana R Donaldson
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Caitlin McCarthy
- Division of Breast Services-Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shazia Goraya
- Division of Breast Services-Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Holly J Pederson
- Division of Breast Services-Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen R Grobmyer
- Division of Breast Services-Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin C Calhoun
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
40
|
Racz JM, Carter JM, Degnim AC. Lobular Neoplasia and Atypical Ductal Hyperplasia on Core Biopsy: Current Surgical Management Recommendations. Ann Surg Oncol 2017; 24:2848-2854. [DOI: 10.1245/s10434-017-5978-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 12/21/2022]
|
41
|
|