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Grabenstetter A, Brennan SB, Jochelson MS, Brogi E, Morrow M, Tan LK, D’Alfonso TM. Radial sclerosing lesions found on core needle biopsy: excision can be safely avoided. Histopathology 2024; 85:397-404. [PMID: 38845392 PMCID: PMC11305922 DOI: 10.1111/his.15233] [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: 01/12/2024] [Revised: 03/29/2024] [Accepted: 05/25/2024] [Indexed: 08/09/2024]
Abstract
AIMS Radial sclerosing lesions (RSLs) are benign breast lesions composed of glandular and epithelial proliferations with stellate architecture and fibro-elastotic stroma, which can mimic invasive carcinoma on imaging. Surgical management following a core biopsy diagnosis of RSLs remains controversial. METHODS AND RESULTS We retrospectively identified core biopsies with RSLs without atypia who underwent subsequent surgical excision between 2015 and 2021. All core biopsy slides were reviewed to confirm the diagnosis. Imaging was reviewed to determine radiological-pathological concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ (DCIS) in the excision. The final cohort consisted of 130 core biopsies from 124 women (median age = 52 years, range = 27-76). The imaging modality was mammogram in 52 (40%) cases, MRI in 52 (40%) and ultrasound in 26 (20%). One hundred and seven (82%) core biopsies were vacuum-assisted and 23 (18%) were ultrasound-guided without vacuum assistance. The median lesion size on imaging was 9 mm (range = 2-41). Overall, two (1%) cases were upgraded at excision, including one microinvasive lobular carcinoma and one 2 mm focus of invasive mammary carcinoma with associated DCIS. In both cases, the upgraded foci of carcinoma were not closely associated with the biopsy site and were considered incidental upgrades. CONCLUSIONS This study adds to the body of literature supporting observation, rather than routine excision of radial sclerosing lesions without atypia.
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Affiliation(s)
- Anne Grabenstetter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sandra B Brennan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maxine S. Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edi Brogi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lee K Tan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Timothy M D’Alfonso
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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2
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Athanasiou A, Appelman L, Pijnappel RM, Gilbert FJ, Pediconi F, Mann R. ESR Essentials: diagnostic work-up in patients with symptomatic breast disease-practice recommendations by the European Society of Breast Imaging. Eur Radiol 2024:10.1007/s00330-024-10980-5. [PMID: 39085641 DOI: 10.1007/s00330-024-10980-5] [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: 01/25/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 08/02/2024]
Abstract
Breast complaints are frequent reasons for consultations in primary care or breast clinics. Breast pain, breast lumps, and nipple discharge are the most common complaints. Less common symptoms such as skin changes and axillary abnormalities also require specific diagnostic approaches. Imaging the symptomatic breast should be performed by appropriately trained breast radiologists following the best practice guidelines and quality standards. Full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and breast ultrasound (US) are the main modalities used in this primary setting. The choice depends on the patient's age and symptoms. Women younger than 30-years-old are first imaged by US, whereas women over 40-years-old usually require both FFDM or DBT and US. For women between 30-years-old and 40-years-old, the US is the modality of choice, whereas FFDM or DBT might also be performed if needed. Pregnant or lactating women with palpable lesions or nipple discharge are imaged with US as the first method; FFDM or DBT can also be performed depending on the degree of suspicion as the dose to the fetus is minimal, and shielding may even further reduce the dose. More advanced techniques such as breast magnetic resonance imaging or contrast-enhanced mammography are not indicated in this first diagnostic setting and are reserved for cases of established malignancy (local staging) or rare cases of equivocal findings not otherwise resolved or inflammatory breast cancer. Last, but not least, male breast symptoms should also be addressed with US and/or FFDM. CLINICAL RELEVANCE STATEMENT: It is equally important to correctly diagnose an underlying malignancy and to avoid false positives that would lead to unnecessary biopsies, increased costs, and anxiety for the patient. Proper use of imaging modalities ensures optimal diagnostic approach and minimizes false negatives. KEY POINTS: Ultrasound, full-field digital mammography, or digital breast tomosynthesis are the main imaging modalities in the diagnostic setting, while MRI or contrast-enhanced mammography should be reserved to selected cases. Initial imaging modality includes ultrasound combined with mammography or digital breast tomosynthesis depending on women's age and the presence (or not) of inconclusive findings. A negative imaging evaluation should not deter biopsy when a highly suspicious finding is found on physical examination.
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Affiliation(s)
| | - Linda Appelman
- Breast Imaging Department, Alexander Monro Hospital, Bilthoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fiona J Gilbert
- Department of Radiology, Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Ritse Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, Antoni van Leeuwenhoek Hospital and Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Matias MA, Sharma N. Nonsurgical Management of High-Risk Lesions. Radiol Clin North Am 2024; 62:679-686. [PMID: 38777542 DOI: 10.1016/j.rcl.2023.12.005] [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: 05/25/2024]
Abstract
This article highlights the recent publications and changing trends in practice regarding management of high-risk lesions of the breast. Traditional management has always been a surgical operation but this is recognized as overtreatment. It is recognized that overdiagnosis is inevitable but what we can control is overtreatment. Vacuum-assisted excision is now established as an alternative technique to surgery for further sampling of these high-risk lesions in the United Kingdom. Guidelines from the United Kingdom and Europe now recognize this alternative pathway, and data are available showing that vacuum-assisted excision is a safe alternative to surgery.
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Affiliation(s)
- Mariana Afonso Matias
- Breast Unit, Leeds Teaching Hospital NHS Trust, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds LS9 7TF
| | - Nisha Sharma
- Breast Unit, Leeds Teaching Hospital NHS Trust, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds LS9 7TF.
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4
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Bernini M, Spolveri F, Tofani L, De Benedetto D, Bicchierai G, Bellini C, Morrone D, Nori Cucchiari J, Bianchi S, Livi L, Orzalesi L, Meattini I. B3 Breast Lesions: Positive Predictive Value and Follow-Up on a Large Single-Institution Series. J Surg Res 2024; 299:366-373. [PMID: 38815523 DOI: 10.1016/j.jss.2024.04.057] [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: 05/09/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Lesions of uncertain malignant potential (B3) represent 10% of core needle biopsies (CNBs) or vacuum-assisted breast biopsies (VABBs). Traditionally, B3 lesions are operated on. This study investigated the association between B3 subtypes and malignancy to determine the best management. METHODS Pre- and postoperative histological reports from 226 patients, who had undergone excisional surgery for B3 lesions, following CNB or VABB, were retrospectively analyzed. The correlation between the CNB/VABB diagnosis and the final pathology was investigated, along with the correlation between malignancy upgrade and the type of mammographic lesion. The positive predictive value (PPV) of malignancy of B3 lesions was calculated by simple logistic regression. Patients without cancer diagnosis underwent a 7-y follow-up. RESULTS Pathology showed 171 (75.6%) benign and 55 (24.3%) malignant lesions. The PPV was 24.3% (P = 0.043), including 31 (13.7%) ductal carcinomas in situ and 24 (10.6%) invasive carcinomas. The most frequently upgraded lesions were atypical ductal hyperplasia, 34.2% (P = 0.004), followed by lobular intraepithelial neoplasia, 27.5% (P = 0.025). The median diameter of mammographic lesions was 1.5 [0.9-2.5] cm, while for surgical specimens, it was 5 [4-7] cm (P < 0.0001). Mammographic findings and histology showed a significant correlation (P = 0.038). After a 7-y follow-up, 15 (8.9%) patients developed carcinoma, and 7 patients (4%) developed a new B3 lesion. CONCLUSIONS We can conclude that atypical ductal hyperplasia and lobular intraepithelial neoplasia still require surgery for a significant PPV. Other types that lacked significance or confidence intervals were too wide to draw any conclusion.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Middle Aged
- Retrospective Studies
- Adult
- Aged
- Follow-Up Studies
- Biopsy, Large-Core Needle
- Predictive Value of Tests
- Mammography
- Breast/pathology
- Breast/diagnostic imaging
- Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Aged, 80 and over
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Affiliation(s)
- Marco Bernini
- Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Federico Spolveri
- Breast Surgery Division, Breast Unit, San Jacopo Hospital, Pistoia, Italy.
| | - Lorenzo Tofani
- Department of Statistic, Computer Science, Applications, University of Florence, Florence, Italy
| | | | - Giulia Bicchierai
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Chiara Bellini
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Doralba Morrone
- Diagnostic Senology Unit, Villa Donatello Clinic, Florence, Italy
| | | | - Simonetta Bianchi
- Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
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5
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Delaloge S, Khan SA, Wesseling J, Whelan T. Ductal carcinoma in situ of the breast: finding the balance between overtreatment and undertreatment. Lancet 2024; 403:2734-2746. [PMID: 38735296 DOI: 10.1016/s0140-6736(24)00425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/10/2024] [Accepted: 02/29/2024] [Indexed: 05/14/2024]
Abstract
Ductal carcinoma in situ (DCIS) accounts for 15-25% of all breast cancer diagnoses. Its prognosis is excellent overall, the main risk being the occurrence of local breast events, as most cases of DCIS do not progress to invasive cancer. Systematic screening has greatly increased the incidence of this non-obligate precursor of invasion, lending urgency to the need to identify DCIS that is prone to invasive progression and distinguish it from non-invasion-prone DCIS, as the latter can be overdiagnosed and therefore overtreated. Treatment strategies, including surgery, radiotherapy, and optional endocrine therapy, decrease the risk of local events, but have no effect on survival outcomes. Active surveillance is being evaluated as a possible new option for low-risk DCIS. Considerable efforts to decipher the biology of DCIS have led to a better understanding of the factors that determine its variable natural history. Given this variability, shared decision making regarding optimal, personalised treatment strategies is the most appropriate course of action. Well designed, risk-based de-escalation studies remain a major need in this field.
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Affiliation(s)
- Suzette Delaloge
- Department of Cancer Medicine, Interception Programme, Gustave Roussy, Villejuif, France.
| | - Seema Ahsan Khan
- Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Jelle Wesseling
- Divisions of Molecular Pathology & Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Timothy Whelan
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Crowley C, Bahl M. Radial Scars on Screening Digital Breast Tomosynthesis: Upstaging Rates and Management Strategies. AJR Am J Roentgenol 2024; 222:e2430845. [PMID: 38477526 DOI: 10.2214/ajr.24.30845] [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: 03/14/2024]
Abstract
BACKGROUND. Radial scars are more commonly identified on digital breast tomosynthesis (DBT) than on digital mammography (DM). Nonetheless, universal guidelines for radial scar management in the current era of DBT are lacking. OBJECTIVE. The purpose of this study was to determine the upstaging rates of screening DBT-detected radial scars with and without atypia and to identify features related to upstaging risk. METHODS. This retrospective study included patients who underwent core needle biopsy (CNB) showing a radial scar after screening DBT and DM from January 1, 2013, to December 31, 2020. Patients without surgical excision or at least 2 years of imaging follow-up after CNB were excluded. Rates of upstaging to breast cancer (ductal carcinoma in situ [DCIS] or invasive disease) were compared between radial scars with and without atypia at CNB. Associations of upstaging with patient, imaging, and pathologic variables were explored using standard statistical tests. RESULTS. Of 165 women with 171 radial scars, the final study sample included 153 women (mean age, 56 years; range, 33-83 years) with 159 radial scars that underwent surgical excision (80.5%, 128/159) or at least 2 years of imaging follow-up (19.5%, 31/159). Seven radial scars were upstaged to DCIS and one to invasive disease. Therefore, the up-staging rate of radial scars to cancer was 5.0% (8/159). The upstaging rate of radial scars without atypia at CNB was 1.6% (2/129) and that of radial scars with atypia was 20.0% (6/30) (p < .001). On multivariable analysis, features associated with higher upstaging risk included a prior breast cancer diagnosis (62.5% vs 4.8%; p = .01) and the presence of atypia at CNB (75.0% vs 15.9%; p = .02). The upstaging rate according to mammographic finding type was 7.1% (1/14) for asymmetries, 12.5% (2/16) for masses, 5.3% (5/95) for architectural distortion, and 0.0% (0/34) for calcifications. CONCLUSION. Screening-detected radial scars without atypia at CNB have a low upstaging rate to breast cancer of 1.6%. CLINICAL IMPACT. Imaging surveillance rather than surgery is a reasonable approach for radial scars without atypia, particularly for those presenting as calcifications.
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Affiliation(s)
- Claire Crowley
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
| | - Manisha Bahl
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
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7
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Chou R, Tran D, Descallar J, Jalaludin B, Soon PS. Outcomes of atypical (B3) core biopsy lesions diagnosed across BreastScreen NSW, Australia. Breast 2024; 75:103720. [PMID: 38564975 PMCID: PMC10993176 DOI: 10.1016/j.breast.2024.103720] [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: 11/05/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Atypical or B3 lesions comprise a heterogeneous group of uncertain malignant potential. B3 lesions diagnosed on core biopsy are usually recommended for diagnostic open biopsy. Identifying factors which could allow conservative management of B3 lesions would be helpful in avoiding unnecessary surgery. The aim of this study was to identify the upgrade rate to malignancy for B3 core biopsy lesions and to compare characteristics of lesions which were malignant and benign at excision. METHOD This retrospective study used data from BreastScreen New South Wales (NSW), Australia, of women who were diagnosed with B3 lesions on needle biopsy from 2011 to 2019. RESULTS During the study period, 1927 B3 lesions were included. The upgrade rate to malignancy was 26.4%. Of the malignant lesions on excision, 29.6% were invasive and 69.2% were in situ. The rates of upgrade to invasive cancer and DCIS varied substantially with the core biopsy lesion type. Lesions with atypia on core biopsy had significantly higher upgrade rates to malignancy at 34.7% compared to 13.6% for lesions without atypia (p < 0.0001). Lesions with malignant pathology were significantly larger than those with benign pathology (difference = 5.1 mm (95% CI 2.7-7.5 mm), p < 0.001). CONCLUSIONS The overall upgrade rate of B3 lesions to malignancy was 26.4%. The majority of the lesions were upgraded to DCIS instead of invasive cancer. Upgrade rates varied by lesion type. Lesions with atypia had significantly higher upgrade rates to cancer compared to lesions without atypia. Malignant lesions were significantly larger than benign lesions.
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Affiliation(s)
- Richard Chou
- Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Diana Tran
- BreastScreen South Western Sydney Local Health District, Liverpool, NSW, Australia; Department of Radiology, Bankstown Hospital, Bankstown, NSW, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; School of Population Health, University of New South Wales, NSW, Australia
| | - Patsy S Soon
- Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia; BreastScreen South Western Sydney Local Health District, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
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8
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Gil MLBV, Coelho BA, Couto HL, Silva HMS, Pessoa EC, Sharma N, Mann R, McIntosh SA, Diniz PHC, Cantidio FS, Gil GOB, Salvador AD, de Almeida Júnior WJ, Avelar JTC, Laranjeira CLS, Silva Filho AL. Vacuum-assisted excision: a safe minimally invasive option for benign phyllodes tumor diagnosis and treatment-a systematic review and meta-analysis. Front Oncol 2024; 14:1394116. [PMID: 38807769 PMCID: PMC11130386 DOI: 10.3389/fonc.2024.1394116] [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: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024] Open
Abstract
Synopsis This is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint. Objective To determine the frequency of local recurrence (LR) of benign phyllodes tumor (PT) after ultrasound-guided vacuum-assisted excision (US-VAE) compared to the frequency of LR after surgical excision. Method A systematic review and meta-analysis [following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard] was conducted by comparing LR in women older than 18 years treated for benign PT by US-VAE compared with local surgical excision with at least 12 months of follow-up. Studies were retrieved from PubMed, Scopus, Web of Science, and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence. Results Five comparative prospective or retrospective observational studies published between January 1, 1992, and January 10, 2022, comparing surgical excision with percutaneous US-VAE for LR of benign PT met the selection criteria. Four were retrospective observational cohorts, and one was a prospective observational cohort. A total of 778 women were followed up. Of them, 439 (56.4%) underwent local surgical excision, and 339 (43.6%) patients had US-VAE. The median age of patients in the five studies ranged from 33.7 to 39 years; the median size ranged from 1.5 cm to 3.0 cm, and the median follow-up ranged from 12 months to 46.6 months. The needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 versus 34 of 439; OR 1.3; p = 0.29). Conclusion This meta-analysis suggests that using US-VAE for the removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022309782.
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Affiliation(s)
| | - Bertha Andrade Coelho
- Breast Imaging Department, Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obtetrics and Gynecology, UNIFIMOC University Center, Montes Claros, Minas Gerais, Brazil
| | - Henrique Lima Couto
- Breast Imaging Department, Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Breast Imaging Department, Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Redimama-Redimasto, Belo Horizonte, Minas Gerais, Brazil
| | | | - Eduardo Carvalho Pessoa
- Breast Imaging Department, Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil
| | - Nisha Sharma
- Breast Screening Unit, Seacroft Hospital, Leeds Teaching Hospital National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Ritse Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Stuart A. McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - Paulo Henrique Costa Diniz
- Oncology Department, Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brazil
- Internal Medicine Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Anna Dias Salvador
- Mastology Department, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
| | - Waldeir José de Almeida Júnior
- Mastology Department, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Cláudia Lourdes Soares Laranjeira
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Obstetrics and Gynecology Department, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
| | - Agnaldo Lopes Silva Filho
- Breast Imaging Department, Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Redimama-Redimasto, Belo Horizonte, Minas Gerais, Brazil
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Rescinito G, Brunetti N, Garlaschi A, Tosto S, Gristina L, Conti B, Pieroni D, Calabrese M, Tagliafico AS. Long-term outcome of 9G MRI-guided vacuum-assisted breast biopsy: results of 293 single-center procedures and underestimation rate of high-risk lesions over 12 years. LA RADIOLOGIA MEDICA 2024; 129:767-775. [PMID: 38512628 PMCID: PMC11088538 DOI: 10.1007/s11547-024-01808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Breast magnetic resonance imaging (MRI) can detect some malignant lesions that are not visible on mammography (MX) or ultrasound (US). If a targeted, second-look fails, MRI-guided breast biopsy is the only available tool to obtain a tissue sample and pathological proof of these "MRI-only lesions". The aim of this study is to report the performance and underestimation rate of 9G MRI-guided vacuum-assisted breast biopsy (VABB) over 12 years at a single center. MATERIAL AND METHODS All 9G MRI-VABB procedures performed from January 2010 to December 2021 were retrospectively reviewed. Two MRI scanners (1.5 T and 3 T) were used with the same image resolution and contrast media. All suspicious lesions detected only by breast MRI underwent biopsy. Reference standard was histological diagnosis or at least 1-year negative follow-up. All malignant and atypical lesions underwent surgery, which was used as the reference standard. RESULTS A total of 293 biopsies were retrospectively reviewed. Histopathological VABB results revealed 142/293 (48.4%) benign lesions, 77/293 (26.2%) high-risk lesions, and 74/293 (25.2%) malignant lesions. No significant complications were observed. Surgical pathology results allowed for the reclassification of n = 7/48 B3b lesions: n = 4 were ductal carcinoma in situ, while n = 3 presented invasive features at surgical histology (2 IDC; 1 ILC). B3b underestimation occurred overall in 14.6% of B3 cases. Breast follow-up was achieved for all benign VABB results, and only one false-negative case was observed. CONCLUSION Our results confirm that 1.5 T and 3 T MRI-guided VABB is an accurate and safe procedure for histopathologic final diagnosis of MRI-only lesions. Critical issues remain the potential high-risk underestimation rate of B3b VABB results and management of follow-up of benign lesions.
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Affiliation(s)
- Giuseppe Rescinito
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Nicole Brunetti
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
- Department of Experimental Medicine (DIMES), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy.
| | - Alessandro Garlaschi
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Simona Tosto
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Licia Gristina
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Benedetta Conti
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
| | - Diletta Pieroni
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
| | - Massimo Calabrese
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
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10
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Nicosia L, Mariano L, Pellegrino G, Ferrari F, Pesapane F, Bozzini AC, Frassoni S, Bagnardi V, Pupo D, Mazzarol G, De Camilli E, Sangalli C, Venturini M, Pizzamiglio M, Cassano E. Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention. Cancers (Basel) 2024; 16:837. [PMID: 38398228 PMCID: PMC10886664 DOI: 10.3390/cancers16040837] [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: 12/29/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively, p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Luciano Mariano
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy;
| | - Federica Ferrari
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (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.)
| | - Davide Pupo
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Giovanni Mazzarol
- Division of Pathology, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (E.D.C.)
| | - Elisa De Camilli
- Division of Pathology, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (E.D.C.)
| | - Claudia Sangalli
- Data Management, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy;
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
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11
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Li JK, Jin ZY, Xu YJ, Fu NQ, Jiang Y, Li SY, Niu RL, Liu G, Wang ZL. Contrast-enhanced ultrasound to predict malignant upgrading of atypical ductal hyperplasia. Breast Cancer Res 2024; 26:27. [PMID: 38347651 PMCID: PMC10863177 DOI: 10.1186/s13058-024-01772-2] [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: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND A malignancy might be found at surgery in cases of atypical ductal hyperplasia (ADH) diagnosed via US-guided core needle biopsy (CNB). The objective of this study was to investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in predicting ADH diagnosed by US-guided CNB that was upgraded to malignancy after surgery. METHODS In this retrospective study, 110 CNB-diagnosed ADH lesions in 109 consecutive women who underwent US, CEUS, and surgery between June 2018 and June 2023 were included. CEUS was incorporated into US BI-RADS and yielded a CEUS-adjusted BI-RADS. The diagnostic performance of US BI-RADS and CEUS-adjusted BI-RADS for ADH were analyzed and compared. RESULTS The mean age of the 109 women was 49.7 years ± 11.6 (SD). The upgrade rate of ADH at CNB was 48.2% (53 of 110). The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS for identification of malignant upgrading were 96.2%, 66.7%,72.9%, and 95.0%, respectively, based on BI-RADS category 4B threshold. The two false-negative cases were low-grade ductal carcinoma in situ. Compared with the US, CEUS-adjusted BI-RADS had better specificity for lesions smaller than 2 cm (76.7% vs. 96.7%, P = 0.031). After CEUS, 16 (10 malignant and 6 nonmalignant) of the 45 original US BI-RADS category 4A lesions were up-classified to BI-RADS 4B, and 3 (1 malignant and 2 nonmalignant) of the 41 original US BI-RADS category 4B lesions were down-classified to BI-RADS 4A. CONCLUSIONS CEUS is helpful in predicting malignant upgrading of ADH, especially for lesions smaller than 2 cm and those classified as BI-RADS 4A and 4B on ultrasound.
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Affiliation(s)
- Jun Kang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Department of Ultrasound, Chinese PLA 63820 Hospital, Mianyang, Sichuan, China
| | - Zhi Ying Jin
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yong Jie Xu
- Department of Ultrasound Diagnosis, Strategic Support Force Medical Center of Chinese PLA, Beijing, China
| | - Nai Qin Fu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ying Jiang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shi Yu Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Rui Lan Niu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Gang Liu
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Zhi Li Wang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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12
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Varga Z, Maccio U. Molecular pathology in breast disease: diagnostic, prognostic, and therapeutic tools. Virchows Arch 2024; 484:247-261. [PMID: 38015260 PMCID: PMC10948467 DOI: 10.1007/s00428-023-03709-0] [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: 07/31/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Molecular testing in breast cancer gained increasing attention and importance as specific molecular results can tailor not only oncological decisions on systemic adjuvant or neoadjuvant or in metastatic setting, but increasingly serve in diagnostic routine histopathological services to differentiate between morphologically overlapping or ambiguous histological pictures. Diagnostic tools involve in most cases a broad spectrum of immunohistochemical panels, followed by entity-specific in situ hybridization probes and in given cases NGS-based sequencing. Workflow of which methodology is applied and in which order depends on the specific entity resp. on the given differential diagnosis in question. Regarding prognostic/predictive molecular testing, the choice of assay and the workflow are based on clinical algorithms and on the evidence of targeted therapies following the molecular alterations. In this review paper, we aim to address the use of molecular technics in [1] the histological diagnostic setting (such as subtyping of invasive carcinomas/malignant spindle cell tumors and sarcomas and some B3 lesions) and [2] in the context of adjuvant or neoadjuvant or other clinical settings with special focus of targeted therapies.
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Affiliation(s)
- Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland.
| | - Umberto Maccio
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland
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13
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Bianchi S, Caini S, Vezzosi V, Orzalesi L, Piovesan L, Mantellini P, Ambrogetti D. Upgrade rate to malignancy of uncertain malignant potential breast lesions (B3 lesions) diagnosed on vacuum-assisted biopsy (VAB) in screen detected microcalcifications: Analysis of 366 cases from a single institution. Eur J Radiol 2024; 170:111258. [PMID: 38091661 DOI: 10.1016/j.ejrad.2023.111258] [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: 10/20/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE We retrospectively investigated clinical, radiological, and pathological features of B3 lesions associated with the risk of subsequent upgrade to malignancy. METHODS We included consecutive vacuum-assisted biopsies (VABs) performed during 2011-2020 on suspicious microcalcifications not associated with other radiological signs diagnosed as B3 lesions and followed by surgical excision (SE) with definitive histological examination. Multiple logistic regression models were fitted to identify independent predictors of malignancy. RESULTS Out of the 366 B3 lesions included, 56 (15.3 %, 95 % CI 11.8-19.4 %) had upgraded to malignancy at SE: of these, 42/366 (11.5 %, 95 % CI 8.4-15.2 %) and 14/366 (3.8 %, 95 % CI 2.1-6.3 %) were in situ and invasive carcinoma, respectively. At univariate analysis, variables positively associated with upgrade to malignancy were age ≥ 60 years (p = 0.008), mixed morphology (p = 0.018), scattered distribution (p = 0,001), extension of microcalcifications > 10 mm (p = 0.001), and mixed B3 lesion (p = 0.017). Among B3 subtypes, the highest rates of upgrade were observed for AIDEP, LCIS/LIN2, FEA + AIDEP, FEA + LCIS/LIN2, and FEA + AIDEP + LCIS/LIN2 (24.6 %, 21.4 %, 25.3 %, 20.0 % and 40.0 % respectively), while FEA and ALH/LIN1 had a lower rates of upgrade (7.5 % and 3.7 %, respectively). Multiple logistic regression analysis confirmed as risk factors older age (p = 0.029), larger extension (p = 0.001) and mixed morphology (p = 0.007) of microcalcifications, AIDEP (p = 0.011) among pure B3 lesions, and FEA + AIDEP (p = 0.001) and FEA + AIDEP + LCIS/LIN2 (p = 0.037) among mixed B3 lesions. CONCLUSIONS Based on our findings, vacuum-assisted excision is reasonable as definitive management for FEA and ALH/LIN1, while SE should remain the mainstay of treatment for AIDEP and LCIS/LIN2, whose upgrade rates are too high to safely recommend VAE.
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Affiliation(s)
- Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Vania Vezzosi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Division of Breast Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luisa Piovesan
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Paola Mantellini
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Daniela Ambrogetti
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
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14
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Rubio IT, Wyld L, Marotti L, Athanasiou A, Regitnig P, Catanuto G, Schoones JW, Zambon M, Camps J, Santini D, Dietz J, Sardanelli F, Varga Z, Smidt M, Sharma N, Shaaban AM, Gilbert F. European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107292. [PMID: 38061151 DOI: 10.1016/j.ejso.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence. METHODS These guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool. RESULTS Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion. CONCLUSIONS These guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.
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Affiliation(s)
- Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain; European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy; European Society of Surgical Oncology (ESSO), Brussels, Belgium.
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | | | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Giuseppe Catanuto
- Humanitas-Istituto Clinico Catanese Misterbianco, Italy; Fondazione G.Re.T.A., ETS, Napoli, Italy
| | - Jan W Schoones
- Research Policy & Graduate School Advisor, Leiden University Medical Center Leiden, the Netherlands
| | - Marzia Zambon
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Julia Camps
- Breast Health Units in Ribera Salud Hospitals.Valencia, Spain
| | - Donatella Santini
- Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Jill Dietz
- The American Society of Breast Surgeons, Columbia, MD, USA
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Marjolein Smidt
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street Leeds, West Yorkshire, LS9 7TF, UK
| | - Abeer M Shaaban
- Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, UK.
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15
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Suciu V, El Chamieh C, Soufan R, Mathieu MC, Balleyguier C, Delaloge S, Balogh Z, Scoazec JY, Chevret S, Vielh P. Real-World Diagnostic Accuracy of the On-Site Cytopathology Advance Report (OSCAR) Procedure Performed in a Multidisciplinary One-Stop Breast Clinic. Cancers (Basel) 2023; 15:4967. [PMID: 37894334 PMCID: PMC10605571 DOI: 10.3390/cancers15204967] [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: 07/09/2023] [Revised: 08/19/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
Fine-needle aspiration (FNA) cytology has been widely used for the diagnosis of breast cancer lesions with the objective of differentiating benign from malignant masses. However, the occurrence of unsatisfactory samples and false-negative rates remains a matter of concern. Major improvements have been made thanks to the implementation of rapid on-site evaluation (ROSE) in multidisciplinary and integrated medical settings such as one-stop clinics (OSCs). In these settings, clinical and radiological examinations are combined with a morphological study performed by interventional pathologists. The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The clinicoradiological, cytomorphological, and histological characteristics of all consecutive patients were retrieved from the hospital computerized medical records prospectively registered in the central information system. Histopathological analysis and ultrasound (US) follow-up (FU) were the reference diagnostic tests of the study design. In brief, we carried out either a histopathological verification or an 18-month US evaluation when a benign cytology was concordant with the components of the triple test. Overall, histology was available for 1138 masses, whereas 491 masses were analyzed at the 18-month US-FU. FNA specimens were morphologically nondiagnostic in 3.1%, false negatives were observed in 1.5%, and there was only one false positive (0.06%). The breast cancer prevalence was 62%. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19-98.31); specificity (Sp) = 94.98% (92.94-96.56); positive predictive value (PPV) = 96.80% (95.48-97.81); negative predictive value (NPV) = 95.91% (94.02-97.33); positive likelihood ratio (LR+) = 19.39 (13.75-27.32); negative predictive ratio (LR-) = 0.03 (0.02-0.04), and; accuracy = 96.45% (95.42-97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76-3827); 2.69 (1.8-3.96); 0.03 (0.02-0.04); and 0.37 (0.2-0.66), respectively. In conclusion, our study demonstrates that the OSCAR procedure is a highly reliable diagnostic approach and a perfect test to select patients requiring core-needle biopsy (CNB) when performed by interventional cytopathologists in a multidisciplinary and integrated OSC setting. Besides drastically limiting the rate of nondiagnostic specimens and diagnostic turn-around time, OSCAR is an efficient and powerful first-line diagnostic approach for patient-centered care.
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Affiliation(s)
- Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Ranya Soufan
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | | | - Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Zsofia Balogh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | - Sylvie Chevret
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Medipath and American Hospital of Paris, 92200 Paris, France
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16
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Bellini C, Nori Cucchiari J, Di Naro F, De Benedetto D, Bicchierai G, Franconeri A, Renda I, Bianchi S, Susini T. Breast Lesions of Uncertain Malignant Potential (B3) and the Risk of Breast Cancer Development: A Long-Term Follow-Up Study. Cancers (Basel) 2023; 15:3521. [PMID: 37444630 DOI: 10.3390/cancers15133521] [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: 05/29/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Breast lesions of uncertain malignant potential (B3) are frequently diagnosed in the era of breast cancer (BC) screening and their management is controversial. They are generally removed surgically, but some international organizations and guidelines for breast research suggest follow-up care alone or, more recently, propose vacuum-assisted excision (VAE). The risk of upgrade to BC is known, but very little data exist on its role as risk factor for future BC development. We analyzed 966 B3 lesions diagnosed at our institution, 731 of which had long-term follow-up available. Surgical removal was performed in 91%, VAE in 3.8%, and follow-up in 5.2% of cases. The B3 lesions included flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), lobular intraepithelial neoplasia (LIN), atypical papillary lesions (PLs), radial scars (RSs), and others. Overall, immediate upgrade to BC (invasive or in situ) was 22.7%. After long-term follow-up, 9.2% of the patients were diagnosed with BC in the same or contralateral breast. The highest risk was associated with ADH diagnosis, with 39.8% of patients upgraded and 13.6% with a future BC diagnosis (p < 0.0001). These data support the idea that B3 lesions should be removed and provide evidence to suggest annual screening mammography for women after a B3 diagnosis because their BC risk is considerably increased.
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Affiliation(s)
- Chiara Bellini
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Jacopo Nori Cucchiari
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Andrea Franconeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Irene Renda
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Simonetta Bianchi
- Pathology Unit, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Tommaso Susini
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50121 Florence, Italy
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