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Griffiths R, Alarcon L, Bonello V, Scott V, Szollosi Z. Mucocele-like lesions of the breast - A radiological and clinicopathological analysis. Curr Probl Cancer 2021; 45:100762. [PMID: 34158182 DOI: 10.1016/j.currproblcancer.2021.100762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Mucocele-like lesions (MLL) of the breast are rare entities which are considered to harbor uncertain malignant potential. Current UK guidelines recommend vacuum assisted excision (VAE) of all such lesions regardless of whether they display epithelial atypia. This study sought to review the key histological and radiological features of MLLs and compare their differing outcomes based on the presence of epithelial atypia. METHODS Pathology records of a single breast cancer screening center were retrospectively searched for all biopsy diagnosed MLLs over an 11-year period. Upgrade rates to malignancy (positive predictive values) were calculated by reviewing histology from the initial core biopsy and comparing with the corresponding excision specimen. Radiological images were simultaneously reviewed to provide radiological-pathological correlation. RESULTS Three of 11 patients (27.3%) with atypical MLLs on biopsy had malignant outcomes at excision, compared with only 1 of 36 patients (2.8%) with non-atypical MLLs. The majority of MLLs (93%) were identified as microcalcifications on mammographic imaging. No specific radiological features were predictive of malignancy. CONCLUSIONS Our data suggest that MLLs without atypia are potentially overtreated with current protocols and could be managed conservatively with radiological follow up. Radiological-pathological correlation is essential.
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Affiliation(s)
- Richard Griffiths
- Department of Cellular Pathology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT.
| | - Lida Alarcon
- Department of Cellular Pathology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT
| | - Victoria Bonello
- Department of Cellular Pathology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT
| | - Victoria Scott
- Department of Cellular Pathology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT
| | - Zoltan Szollosi
- Department of Cellular Pathology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT
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Ginter PS, Tang X, Shin SJ. A review of mucinous lesions of the breast. Breast J 2020; 26:1168-1178. [PMID: 32419267 DOI: 10.1111/tbj.13878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
Mucinous lesions of the breast include a variety of benign and malignant epithelial processes that display intracytoplasmic or extracellular mucin, including mucocele-like lesions, mucinous carcinoma, solid papillary carcinoma, and other rare subtypes of mucin-producing carcinoma. The finding of free-floating or stromal mucin accumulations is a diagnostic challenge of which the significance depends on the clinical, radiologic, and pathologic context. This article emphasizes the differential diagnosis between benign and malignant mucin-producing lesions, with a brief consideration of potential mimics, such as biphasic and mesenchymal lesions with associated with mucinous, myxoid, or matrix material.
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Affiliation(s)
- Paula S Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Xiaoyu Tang
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
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Kim SJ, Kim JY. Unusual Changing Calcification Patterns on the Mammogram in a Pure Mucocele-Like Lesion of the Breast: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:926-932. [PMID: 31253756 PMCID: PMC6613490 DOI: 10.12659/ajcr.916335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 39 Final Diagnosis: Mucocele-like lesion Symptoms: None Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ji Yeon Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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Mucocelelike Lesions in the Breast: Radiologic and Clinicopathologic Correlations With Upgrade Rate. AJR Am J Roentgenol 2018; 210:1386-1394. [PMID: 29702014 DOI: 10.2214/ajr.17.18515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to investigate the radiologic and clinicopathologic findings of mucocelelike lesions (MLLs) and the rate of pathologic upgrade with factors predicting it. MATERIALS AND METHODS We reviewed our institution's database from January 2006 to December 2012 and enrolled 89 women with 89 MLLs. The pathologic findings from the initial biopsies identified 71 lesions without and 18 lesions with associated high-risk lesions. Images were reviewed according to the BI-RADS lexicon. Clinical and pathologic results were analyzed statistically, and upgrade rates were calculated. RESULTS Of the 89 lesions, 67 (75.3%) underwent surgical excision and 22 (24.7%) did not. After surgical excision (n = 67), one lesion was upgraded to mucinous carcinoma, three were upgraded to ductal carcinoma in situ, and 16 were upgraded to MLLs with associated high-risk lesions (29.9% total upgrade rate; 20/67). A statistically significant higher percentage of MLLs with associated high-risk lesions was observed in the surgical excision group (94.4% vs 70.4%; p = 0.036). The final pathologic diagnosis revealed larger lesions (16.4 ± 9.1 vs 12.6 ± 6.8 mm; p = 0.024) and younger patients in the high-risk group (46.9 ± 7.7 vs 50.6 ± 9.1 years; p = 0.049). Although no significant differences were observed in the imaging findings, including the BI-RADS category, upgraded lesions were seen as a mass with calcification as a predominant feature. CONCLUSION This study revealed no significant differences in imaging findings or BI-RADS category between high-risk and non-high-risk breast MLLs. However, we confirmed that high-risk lesions typically are seen as larger masses with calcifications.
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Abstract
Mucinous lesions of the breast include a variety of benign and malignant epithelial processes that display intracytoplasmic or extracellular mucin, including mucocelelike lesions, mucinous carcinoma, solid papillary carcinoma, and other rare subtypes of mucin-producing carcinoma. The most important diagnostic challenge is the finding of free-floating or stromal mucin accumulations for which the significance depends on the clinical, radiologic, and pathologic context. This article emphasizes the differential diagnosis between mucocelelike lesions and mucinous carcinoma, with a brief consideration of potential mimics, such as biphasic and mesenchymal lesions with myxoid stroma ("stromal mucin") and foreign material.
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Affiliation(s)
- Beth T Harrison
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Amory 3, Boston, MA 02115, USA.
| | - Deborah A Dillon
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Amory 3, Boston, MA 02115, USA
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Gibreel WO, Boughey JC. Mucocele-Like Lesions of the Breast: Rate of Upstaging and Cancer Development. Ann Surg Oncol 2016; 23:3838-3842. [PMID: 27364498 DOI: 10.1245/s10434-016-5352-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast mucocele-like lesions (MLLs) are rare breast lesions. There is a paucity of literature on the rate of pathologic upstaging of MLL to in situ or invasive breast cancer. We sought to review our experience with MLL at a tertiary care center and review published literature. METHODS A retrospective review was undertaken of all patients with breast MLL at the Mayo Clinic, Rochester, from 1998 to 2016. Descriptive statistics were performed. RESULTS Overall, 30 patients were diagnosed with MLL, with a mean age of 54.6 years (range 51-58). Calcifications on screening mammogram were the most common method of MLL detection (n = 26, 86.7 %), with core needle biopsy (CNB) being performed in 29/30 patients. MLL with atypia was identified in 14 patients (48 %), and surgical excision was performed in 26 patients. Disease was upstaged to invasive disease in one patient (3.8 %) who presented with a palpable mass. With a median duration of follow up of 3.5 years [interquartile range 1-7.1], two patients developed contralateral invasive breast cancer (both patients had a remote history of invasive breast cancer on that side), and one patient developed contralateral in situ disease. Review of the literature demonstrates a 2.9 % upgrade rate of MLL without atypia on excisional biopsy. CONCLUSIONS The upstage rate of MLL identified on CNB to invasive disease at surgical excision in this series was 3.8 %. In cases with MLL presenting as calcifications, no cases were upstaged in this series. Across the literature, upstage rates of MLL without atypia on CNB are low, indicating excisional biopsy may be avoided in these cases.
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Diorio C, Provencher L, Morin J, Desbiens C, Poirier B, Poirier É, Hogue J, Jacob S, Côté G. Is there an Upgrading to Malignancy at Surgery of Mucocele‐Like Lesions Diagnosed on Percutaneous Breast Biopsy? Breast J 2015; 22:173-9. [DOI: 10.1111/tbj.12548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caroline Diorio
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Department of Social and Preventive Medicine Cancer Research Center Université Laval Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
| | - Louise Provencher
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
- Department of Surgery Cancer Research Center Université Laval Québec Quebec Canada
| | - Josée Morin
- Department of Radiology Cancer Research Center Université Laval Québec Quebec Canada
| | - Christine Desbiens
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
- Department of Surgery Cancer Research Center Université Laval Québec Quebec Canada
| | - Brigitte Poirier
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
- Department of Surgery Cancer Research Center Université Laval Québec Quebec Canada
| | - Éric Poirier
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
- Department of Surgery Cancer Research Center Université Laval Québec Quebec Canada
| | - Jean‐Charles Hogue
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
| | - Simon Jacob
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
- Department of Pathology Cancer Research Center Université Laval Québec Quebec Canada
- Service of Pathology and Molecular Biology Hôpital Saint‐Sacrement CHU de Québec‐ Université Laval Québec Quebec Canada
| | - Gary Côté
- Centre des maladies du sein Deschênes‐Fabia Hôpital Saint‐Sacrement Québec Quebec Canada
- Oncology Research Unit Centre de Recherche du CHU de Québec‐Université Laval Québec Quebec Canada
- Department of Radiology Cancer Research Center Université Laval Québec Quebec Canada
- Service of Radiology Hôpital Saint‐Sacrement CHU de Québec‐ Université Laval Québec Quebec Canada
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Shield PW, Ribu DL, Cominos D. The significance of extracellular mucin in breast fine needle aspiration specimens. Cytopathology 2015; 27:185-92. [PMID: 26104545 DOI: 10.1111/cyt.12257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine if all breast fine needle aspiration (FNA) specimens with abundant extracellular mucin require excisional biopsy. METHODS Fifty cases of breast FNA containing extracellular mucin, reported with a recommendation for biopsy and with histological follow-up were reviewed. Cellular features were noted, and the cases reclassified ignoring the presence of mucin and then correlated with histological outcome. RESULTS Subsequent histology showed benign changes in 20% (10/50), two cases (4%) of atypical ductal hyperplasia (ADH) and 76% (38/50) to be malignant lesions, including three cases of ductal carcinoma in situ (DCIS). When the FNA cases were reviewed disregarding the presence of mucin, 11 cases were reclassified as benign and one case that contained mucin-like material but no epithelial cells reviewed as non-diagnostic. All cases of invasive mixed and mucinous carcinoma (MC) would have been reported with a recommendation for histological examination. In addition, the three cases each of fibroadenoma (FA) and a benign mucocoele-like lesion (MLL) were correctly identified as benign. However, two cases each of DCIS and ADH would have been reported benign with no recommendation for further histology. CONCLUSIONS Breast FNA specimens with mucinous material may arise from sampling of a range of benign and malignant processes; however, a biopsy should be recommended, even in cases of low cellularity, owing to sampling problems and the frequent co-occurrence of significant lesions. FNA is highly accurate at predicting carcinoma with mucinous differentiation although it is not possible to reliably predict if the lesion represents pure MC or a mixed carcinoma.
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Affiliation(s)
- P W Shield
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia.,Cytology Department, Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - D L Ribu
- Cytology Department, Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - D Cominos
- Cytology Department, Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
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Which patients require or can skip biopsy for breast clustered microcysts? Predictive findings of breast cancer and mucocele-like tumor. Breast Cancer 2015; 23:590-6. [DOI: 10.1007/s12282-015-0607-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
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Mucocele-Like Lesions in the Breast Diagnosed With Percutaneous Biopsy: Is Surgical Excision Necessary? AJR Am J Roentgenol 2015; 204:204-10. [DOI: 10.2214/ajr.13.11988] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Park YJ, Kim EK. A pure mucocele-like lesion of the breast diagnosed on ultrasonography-guided core-needle biopsy: is imaging follow-up sufficient? Ultrasonography 2014; 34:133-8. [PMID: 25623052 PMCID: PMC4372707 DOI: 10.14366/usg.14036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/12/2014] [Accepted: 12/27/2014] [Indexed: 12/21/2022] Open
Abstract
Purpose: To evaluate the upgrade rate of ultrasonography (US)-guided core-needle biopsy (CNB) of the breast for a pure mucocele-like lesion (MLL), to evaluate the clinical and radiologic features, and to correlate the image-pathologic features further on to guide the management of MLL. Methods: Between January 2003 and February 2013, 14-gauge US-guided CNB was performed in 18,111 cases. Thirty-two cases associated with MLL were identified, and five cases of MLLs associated with breast carcinoma or with other high-risk breast lesions (i.e., atypical ductal hyperplasia [ADH], papillary lesions, lobular carcinoma in situ, and radial scar complex) were excluded. Among these 27 pure MLLs, 21 cases with surgical or vacuum-assisted excision (VAE) pathology were included in our study. Medical records, mammograms, and ultrasonograms were reviewed for the clinical and radiologic features of the cases. Results: Among the 21 cases with pure MLLs at CNB, the final pathology showed a 0% proportion of cases upgraded to malignancy. All the 21 cases with either surgical or VAE pathology were benign MLLs including three cases of focal involvement of ADH (14.3%). The common features were mammographic features of microcalcifications that were round in shape and had a grouped distribution. The US features included oval shape, circumscribed margin, parallel orientation, complex solid and cystic echo pattern, no posterior feature, and complex solid and cystic echoic masses. The predominant Breast Imaging Reporting and Data System (BIRADS) category was 4A. All the lesions showed image-pathologic concordance. Conclusion: For pure MLL on US-guided CNB with image-pathologic concordance, close imaging follow-up might be considered instead of surgical excision.
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Affiliation(s)
- Yun Joo Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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High Risk Lesions. Breast Cancer 2014. [DOI: 10.1007/978-1-4614-8063-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rakha EA, Shaaban AM, Haider SA, Jenkins J, Menon S, Johnson C, Yamaguchi R, Murphy A, Liston J, Cornford E, Hamilton L, James J, Ellis IO, Lee AHS. Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology 2013; 62:894-8. [DOI: 10.1111/his.12081] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Emad A Rakha
- Department of Histopathology; Nottingham University; Nottingham; UK
| | - Abeer M Shaaban
- Department of Histopathology and Molecular Pathology; St James's University Hospital; Leeds; UK
| | - Syeda Asma Haider
- Department of Histopathology; Leicester University Hospitals NHS Trust; Leicester; UK
| | - Jacquie Jenkins
- East Midlands Breast Screening Programme Quality Assurance Reference Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Sindhu Menon
- Department of Histopathology; Derby Hospitals NHS Foundation Trust; Derby; UK
| | - Christopher Johnson
- Department of Histopathology; Leicester University Hospitals NHS Trust; Leicester; UK
| | - Rin Yamaguchi
- Department of Pathology; Kurume University Medical Centre; Kurume; Japan
| | - Alison Murphy
- East Midlands Breast Screening Programme Quality Assurance Reference Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Joyce Liston
- Leeds/Wakefield Breast Screening Service; Leeds; UK
| | - Eleanor Cornford
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Lisa Hamilton
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Jonathan James
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Ian O Ellis
- Department of Histopathology; Nottingham University; Nottingham; UK
| | - Andrew H S Lee
- Department of Histopathology; Nottingham University; Nottingham; UK
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Edelweiss M, Corben AD, Liberman L, Kaplan J, Nehhozina T, Catalano JP, Brogi E. Focal extravasated mucin in breast core needle biopsies: is surgical excision always necessary? Breast J 2013; 19:302-9. [PMID: 23534893 DOI: 10.1111/tbj.12104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Focal extravasated mucin (EM) with benign or atypical epithelium is a rare finding at breast core needle biopsy (CNB) and usually prompts surgical excision to rule out mucin-producing carcinoma. In the largest detailed series to date, we assessed surgical outcomes in lesions yielding EM with atypical or nonatypical epithelium at CNB. With IRB approval, we retrospectively reviewed 28 consecutive atypical and nonatypical CNBs with EM that underwent surgical excision at our center over a 22-year period. CNB imaging and pathologic findings were concordant if pathology sufficiently explained the radiologic features of the lesions. Pathologic findings in CNB and excision specimens were correlated. Statistical analysis was performed. CNBs sampled mammographic calcifications in 25/28 (89%) women and a mass in 3/28 (11%). All cases had concordant pathologic and imaging findings. At CNB, the epithelium associated with EM was atypical in 18/28 (64%) lesions and nonatypical in 10 (36%). Cancer (one mucinous carcinoma; three ductal carcinoma in situ) was present in 4/28 excision specimens (14%; 95% confidence intervals [CI], 4%-33%). All carcinomas were in lesions with epithelial atypia at CNB (4/18; 22%; 95% CI, 6%-48%) versus none (0/10; 0%; 95% CI, 0%-31%) in nonatypical lesions at CNB; this difference was not statistically significant (p = 0.3). Surgery is warranted for lesions yielding EM with atypia at CNB due to the high (22%) prevalence of cancer. Our data suggest that surgical excision of lesions yielding EM without epithelial atypia at CNB may not be necessary provided that imaging and pathologic findings are concordant.
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Affiliation(s)
- Marcia Edelweiss
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA.
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Sutton B, Davion S, Feldman M, Siziopikou K, Mendelson E, Sullivan M. Mucocele-like lesions diagnosed on breast core biopsy: assessment of upgrade rate and need for surgical excision. Am J Clin Pathol 2012; 138:783-8. [PMID: 23161710 DOI: 10.1309/ajcp1d8ylcfftlow] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Mucocele-like lesion (MLL) is a rare mucinous lesion of the breast with highly variable upgrade rates to atypia or malignancy on excision. This spectrum of data has led to differing opinions on the need for surgical excision. We evaluated 50 core biopsy specimens diagnosed as having MLLs and correlated the findings with those of excision pathology. Thirty-eight patients underwent surgical excision and 29 were benign (76%), 4 had atypical ductal hyperplasia (11%), and 5 had ductal carcinoma in situ (13%), with an overall upgrade rate of 13%. However, the risk of upgrade was exclusively associated with the presence of atypia as seen on the needle core biopsy. All 22 MLLs without atypia had benign excisions, while 5 (31%) of the 16 patients with MLLs with atypia were upgraded to ductal carcinoma in situ on excision. No invasive carcinoma was identified. We believe it is reasonable that women with the core biopsy diagnosis of MLL without atypia and no associated mass be offered close clinical follow-up as an alternative to surgery.
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Multidisciplinary Considerations in the Management of High-Risk Breast Lesions. AJR Am J Roentgenol 2012; 198:W132-40. [DOI: 10.2214/ajr.11.7799] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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