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Guirguis MS, Yang WT. Overview of incidental breast lesions. Br J Radiol 2023; 96:20211326. [PMID: 35451861 PMCID: PMC9975524 DOI: 10.1259/bjr.20211326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/17/2022] [Accepted: 04/02/2022] [Indexed: 01/27/2023] Open
Abstract
Screening mammography identifies early-stage breast cancers and is associated with reduced breast cancer mortality. An unintended consequence of breast screening is the detection and diagnosis of multiple incidental benign and malignant breast lesions, including the heterogenous group of incidental benign (B3) lesions with uncertain biological outcomes and malignant potential, for which management remains controversial. Recent shifts toward more conservative management approaches, including the identification of patients who can undergo observation after vacuum-assisted excision, has gained interest. This commentary provides an overview of incidental B3 lesions and summarizes the current management paradigms for them.
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Affiliation(s)
- Mary S Guirguis
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center Holcombe Blvd, Unit 1350, Houston, United States
| | - Wei T Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center Holcombe Blvd, Unit 1350, Houston, United States
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Indeterminate (B3) Breast Lesions and the Ongoing Role of Diagnostic Open Biopsy. Int J Breast Cancer 2022; 2021:5555458. [PMID: 34987869 PMCID: PMC8723853 DOI: 10.1155/2021/5555458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Due to their uncertain malignant potential, indeterminate breast lesions on core needle biopsy (CNB) require diagnostic open biopsy (DOB). This study evaluated DOB results given largely benign pathology. Lesions included are atypical papilloma, atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and radial scar/complex sclerosing lesions (RS/CSL). Methodology. A retrospective audit from 2010 to 2017 analysed patients with a screen-detected suspicious lesion and indeterminate (B3) CNB diagnosis. Primary outcome was the malignancy upgrade rate, with secondary evaluation of patient factors predictive of malignancy including age, symptoms, mammogram characteristics, lesion size, biopsy method, and past and family history. Results 152 patients (median age 57 years) were included, with atypical papillomas being the largest subgroup (44.7%). On DOB histology, 99.34% were benign, resulting in a 0.66% malignancy upgrade rate. Patient characteristic analysis identified 86.84% of B3 lesions were in patients greater than 50 years old. 90.13% were asymptomatic, whilst 98.68% and 72.37% had a negative past and family history. Majority 46.71% of lesions had the mammogram characteristic of being a mass. However, with 57.89% of the lesion imaging size less than 4 mm, a corresponding 60.5% of core needle biopsies were performed stereotactically. The small malignant subgroup limited predictive factor evaluation. Conclusion Albeit a low 0.66% malignancy upgrade rate in B3 lesions, no statistically significant patient predictive factors were identified. Until predictive factors and further assessment of vacuum-assisted excision (VAE) techniques evolve, DOB remains the standard of care.
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Björnström M, Niinikoski L, Meretoja TJ, Leidenius MHK, Hukkinen K. Comparison of vacuum-assisted excision (VAE) and breast lesion excision system (BLES) in the treatment of intraductal papillomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:67-72. [PMID: 34728140 DOI: 10.1016/j.ejso.2021.10.020] [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: 06/23/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aims to compare the feasibility of VAE and BLES in the treatment of intraductal papillomas. MATERIAL AND METHODS Patients with a suspected intraductal papilloma who underwent a BLES or a VAE procedure were included in this retrospective study. The BLES procedures were performed between November 2011 and June 2016 and the VAE procedures between May 2018 and September 2020 at the Department of Radiology of Helsinki University Hospital (HUH). The procedures were performed with an intent of complete removal of the lesions. RESULTS In total, 72 patients underwent 78 BLES procedures and 95 patients underwent 99 VAE procedures. Altogether 52 (60%) papillomas with or without atypia were completely removed with VAE, whereas 24 (46%) were completely removed with BLES, p = 0.115. The median radiological size of the high-risk lesions completely removed with BLES was 6 mm (4-12 mm), whereas with VAE it was 8 mm (3-22 mm), p = 0.016. Surgery was omitted in 90 (94.7%) non-malignant breast lesions treated with VAE and in 66 (90.4%) treated with BLES, p = 0.368. CONCLUSION Both VAE and BLES were feasible in the treatment of intraductal papillomas. In most non-malignant lesions surgery was avoided, but VAE was feasible in larger lesions than BLES. However, follow-up ultrasound was needed more often after VAE. The histopathologic assessment is more reliable after BLES, as the lesion is removed as a single sample.
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Affiliation(s)
- Michaela Björnström
- Radiology, HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 140, 00029, HUS, Finland.
| | - Laura Niinikoski
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Tuomo J Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Marjut H K Leidenius
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 281, 00029, HUS, Finland.
| | - Katja Hukkinen
- Radiology, HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 140, 00029, HUS, Finland.
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McMahon MA, Haigh I, Chen Y, Millican-Slater RA, Sharma N. Role of vacuum assisted excision in minimising overtreatment of ductal atypias. Eur J Radiol 2020; 131:109258. [PMID: 32919262 DOI: 10.1016/j.ejrad.2020.109258] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE B3 lesions are indeterminate lesions of uncertain malignant potential. They include lesions with and without epithelial atypia. Those with atypia include atypical intraductal epithelial proliferation (AIDEP)/atypical ductal hyperplasia (ADH) and flat epithelial atypia (FEA). They are traditionally managed with surgery. Vacuum assisted excision (VAE) allows larger samples to be obtained using a vacuum assisted biopsy (VAB) device, which equates to a surgical biopsy. We propose that VAE and mammographic surveillance is a safe alternative to surgery in managing the ductal atypias; (AIDEP/ADH and FEA). METHOD Retrospective analysis of prospectively collected data on B3 lesions (April 2009 - March 2016) from consecutive breast screening patients diagnosed with AIDEP/ADH or FEA on initial diagnostic core biopsy. Mammographic abnormality, breast density, size, management pathway and upgrade to cancer and types of cancer were also collected during the treatment pathway and 5 year surveillance period (April 2009 - April 2019). RESULTS 273 cases of ductal atypia were identified. 187/273 (68.5 %) cases were managed with VAE only as no upgrade to malignancy and then 5 year mammographic surveillance. 34/273 (12.5 %) cases had a VAE diagnosing malignancy. 24/273 (8.8 %) cases had a VAE and then a surgical biopsy due to radiological or pathological concern, 8/24 upgraded to malignancy. 22/273 (8%) cases had a surgical diagnostic biopsy, 9/22 (41 %) cases were upgraded to malignancy. In total 51/273 (19 %) cases were diagnosed with cancer on the new pathway (13 invasive (all ER positive and Her2 negative) and 38 non-invasive, (34 ductal carcinoma in situ (DCIS) and 4 cases of lobular carcinoma in situ (LCIS)). While 17/273 (6.2 %) cases developed malignancy (12 invasive (all HER2 negative) and 4 DCIS and 1 LCIS) during the 5 year surveillance period. CONCLUSIONS VAE is a safe alternative to surgery in managing ductal atypias. 187/273 (68.5 %) women avoided surgery. While 34/51 cancers (66.7 %) were diagnosed preoperatively using VAE, allowing the women to have a single therapeutic procedure.
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Affiliation(s)
- M A McMahon
- Department of Breast Radiology, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - I Haigh
- Department of Breast Radiology, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Y Chen
- Division of Cancer and Stem Cell, School of Medicine at University of Nottingham, United Kingdom
| | | | - N Sharma
- Department of Breast Radiology, Leeds Teaching Hospitals NHS Trust, United Kingdom.
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Forester ND, Lowes S, Mitchell E, Twiddy M. High risk (B3) breast lesions: What is the incidence of malignancy for individual lesion subtypes? A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 45:519-527. [PMID: 30579653 DOI: 10.1016/j.ejso.2018.12.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Provide evidence to support evolving management strategies for high-risk (B3) breast lesions by assessing risk of carcinoma in subgroups of B3 lesions using systematic review and meta-analysis. METHODS Databases identified observational studies between 1980 and 2015 that reported on underestimation of malignancy following B3 lesion diagnosis at core needle biopsy. Critical appraisal, quality assessment, data extraction and meta-analysis was undertaken to calculate rate of malignancy of the whole B3 group and individual lesions. Study heterogeneity and association between variables and underestimation rate was investigated using random effects logistic modelling. RESULTS Meta-analysis, using data from 129 studies, assessed 11 423 lesions of which 2160 were upgraded to malignancy after surgical excision biopsy (17% malignancy rate, 95% CI 15-19%). Malignancy rates varied from 6% in radial scars with no atypia (95% CI 2-13%, I2 72.8%), to 32% in papillomas with atypia (95% CI 23-41%, I2 57.4%). Differences in upgrade rates between atypical and non-atypical lesions were statistically significant (p < 0.05). Study heterogeneity could not be explained by differences in core biopsy size or year of publication. CONCLUSIONS This comprehensive, inclusive assessment of all published literature, provides an accurate estimate of malignancy risk in subgroups of B3 lesions, to guide tailored management strategies. Some lesions have a high risk of malignancy, while others have a much lower risk, and could be safely managed with surveillance strategies rather than surgery.
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Affiliation(s)
- Nerys Dawn Forester
- Breast Screening and Assessment Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP, UK.
| | - Simon Lowes
- Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK
| | - Elizabeth Mitchell
- Hull York Medical School, Institute of Clinical and Applied Health Research, The Allam Medical Building, University of Hull, Hull, HU6 7RX, UK
| | - Maureen Twiddy
- Hull York Medical School, Institute of Clinical and Applied Health Research, The Allam Medical Building, University of Hull, Hull, HU6 7RX, UK
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Pinder S, Shaaban A, Deb R, Desai A, Gandhi A, Lee A, Pain S, Wilkinson L, Sharma N. NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol 2018; 73:682-692. [DOI: 10.1016/j.crad.2018.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 10/28/2022]
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Use of Breast Magnetic Resonance Imaging in Women Diagnosed With Atypical Ductal Hyperplasia at Core Needle Biopsy Helps Select Women for Surgical Excision. Can Assoc Radiol J 2018; 69:240-247. [PMID: 29958833 DOI: 10.1016/j.carj.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/22/2017] [Accepted: 03/10/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The study sought to investigate the role of breast magnetic resonance imaging (MRI) in patients diagnosed with atypical ductal hyperplasia (ADH) at core needle biopsy (CNB). METHODS The breast MRI database at our centre was queried for studies performed between January 2010 and December 2016 for the clinical indication of ADH diagnosed at CNB. Medical files were reviewed for demographic data, clinical information, and radiology and pathology reports. Pathological results of the surgical specimens were considered the gold standard for comparison with breast MRI findings. In women not undergoing excision, at least 2 years of follow-up was used to ascertain the benign nature of the finding. RESULTS Fifty patients were included in the study. Thirty-one (62%) patients had surgical excision of the ADH lesion, and 7 (23%) were upgraded to malignancy. Breast MRI accurately identified 6 of the 7 cases. Six of the 12 women (50%) with positive MRI findings at the biopsy site were upgraded to malignancy on surgical pathology, compared with only 1 of 19 (5%) with negative MRI findings. Forty-nine percent of the women with a negative MRI did not undergo surgical excision of the ADH lesion, compared with 8% of the women with a positive MRI (P = .009), with no cancer diagnosed during follow-up. The sensitivity, specificity, negative predictive value, and positive predictive value of breast MRI for predicting upgrade to malignancy were 86%, 83%, 97%, and 46%, respectively. CONCLUSIONS MRI may have a role in the management of women diagnosed with ADH on CNB, to minimize diagnostic excisional biopsies.
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Absence of epithelial atypia in B3-lesions of the breast is associated with decreased risk for malignancy. Breast 2017; 31:144-149. [DOI: 10.1016/j.breast.2016.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022] Open
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Hoffmann O, Stamatis GA, Bittner AK, Arnold G, Schnabel R, Krüger K, Kimmig R, Heubner M. B3-lesions of the breast and cancer risk - an analysis of mammography screening patients. Mol Clin Oncol 2016; 4:705-708. [PMID: 27123266 DOI: 10.3892/mco.2016.790] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/20/2016] [Indexed: 11/05/2022] Open
Abstract
The use of mammography screening, followed by needle core biopsy (NCB), is associated with an increasing amount of invasive procedures. A considerable amount of specimens must be classified as lesions with uncertain malignant potential (B3-lesion). In these cases, an open biopsy is indicated for further diagnosis. We evaluated patients with B3-lesions to determine the risk of malignancy corresponding to the histopathological NCB results and the type of radiological lesion identified. A total of 95 patients participating in the German mammography screening program with a B3-lesion following NCB (104 B3-lesions in total) were included in our analysis. We analyzed the correlation between the initial histopathological findings from the NCB specimen and cancer risk. We further analyzed the correlations of malignant results with the type of mammographic lesion. In 23 cases (22%), histopathological examination following excision revealed a malignant lesion, including invasive and in situ carcinoma. The positive predictive value of the subgroups of B3-lesions ranged between 0.11 and 0.31; the B3-lesion associated with the highest cancer risk was the atypical ductal hyperplasia; however, no significant difference was observed between the B3-lesion subgroups (P=0.309) regarding the risk of malignancy. Comparing the different types of mammographic findings, such as radiological mass or microcalcifications, there was no significant difference in the risk for malignancy (P=0.379). The different types of B3-lesions did not exhibit differences in the risk for malignancy, and the morphological type of mammographic lesion does not appear to be correlated with cancer risk; therefore, our results underline the need for open biopsy in patients with B3-lesions following NCB.
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Affiliation(s)
- Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45122 Essen, Germany
| | - Gesina Athina Stamatis
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45122 Essen, Germany; Intensive Care Unit (Critical Care Complex), North Middlesex University Hospital, London N181QX, UK
| | - Ann-Kathrin Bittner
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45122 Essen, Germany
| | - Georg Arnold
- Center of Pathology Essen-Mitte, D-45276 Essen, Germany
| | - Rolf Schnabel
- Department of Pathology Essen-Steele, D-45276 Essen, Germany
| | | | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45122 Essen, Germany
| | - Martin Heubner
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45122 Essen, Germany
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Pieri A, Hemming D, Westgarth J, Lunt L. Vacuum-assisted biopsy is a viable alternative to surgical biopsy in the investigation of breast lesions of uncertain malignant potential. Surgeon 2015; 15:59-64. [PMID: 26530998 DOI: 10.1016/j.surge.2015.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/05/2015] [Accepted: 10/11/2015] [Indexed: 11/28/2022]
Abstract
AIMS In patients presenting with a breast lesion, when initial core biopsy histology falls into the category of "uncertain malignant potential" (i.e. a B3 lesion), the next line of investigation has traditionally been a surgical biopsy (SBx). Vacuum-assisted biopsy (VAB) may be a viable minimally invasive alternative to SBx for B3 lesions. The primary aims of this study were to establish whether VAB reduces the need for surgical biopsy and determine VAB sensitivity for carcinoma following initial B3 histology. MATERIALS AND METHODS B3 lesion data was collected from 2004 to 2013 retrospectively, from a single institution that utilises both VAB and SBx. RESULTS A total of 413 lesions were categorised B3 on initial biopsy. Mean age was 61 years (range: 24-91 years). Mean follow up was 52 months (range: 19-60 months). 156 patients (38%) underwent VAB. Only 20% of patients underwent VAB in 2004, with an increase to 95% by 2013. VAB histology revealed twelve carcinomas, all of which progressed to surgical excision. In six cases, a SBx was required following VAB in order to provide further diagnostic information. In one case, carcinoma was missed on VAB. CONCLUSION The increase in VAB use over time suggests that the procedure is well tolerated. The results demonstrate a VAB sensitivity of 92% for carcinoma diagnosis. In 96% of cases (150 of 156), VAB results were conclusive enough to avoid a subsequent SBx. This data suggests that VAB may be a preferable alternative to surgical biopsy for many B3 lesions.
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Affiliation(s)
- Andrew Pieri
- Queen Elizabeth Hospital, Gateshead, Tyne & Wear, NE9 6SX, UK.
| | - Diane Hemming
- Queen Elizabeth Hospital, Gateshead, Tyne & Wear, NE9 6SX, UK
| | | | - Linsley Lunt
- Queen Elizabeth Hospital, Gateshead, Tyne & Wear, NE9 6SX, UK
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Strachan C, Horgan K, Millican-Slater RA, Shaaban AM, Sharma N. Outcome of a new patient pathway for managing B3 breast lesions by vacuum-assisted biopsy: time to change current UK practice? J Clin Pathol 2015; 69:248-54. [DOI: 10.1136/jclinpath-2015-203018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/17/2015] [Indexed: 11/03/2022]
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Role of Breast Imaging in Predicting Outcome of Lesions of Uncertain Malignant Potential (B3) Diagnosed at Core Needle Biopsy. TUMORI JOURNAL 2015; 102:203-8. [DOI: 10.5301/tj.5000398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 11/20/2022]
Abstract
Aims To elucidate whether breast imaging can predict final histologic diagnosis of lesions of uncertain malignant potential diagnosed at ultrasound core needle biopsy (CNB). Methods The imaging characteristics (mammography, ultrasound, and magnetic resonance imaging [MRI]) of lesions of uncertain malignant potential in the breast that were obtained by ultrasound CNB were retrospectively analyzed in 87 women. Radiologic characteristics of lesions were compared to definitive histopathologic findings. Results Out of 87 breast lesions of uncertain malignant potential, 27 (31%) were diagnosed as papillary lesions, 24 (28%) atypical ductal hyperplasia, 19 (22%) lobular intraepithelial neoplasia, 9 (10%) phyllodes tumors, 3 (3%) radial sclerosing lesions, and 5 (6%) unspecified lesions of uncertain malignant potential. The underestimation rate of malignancy at CNB based on the total number of lesions on final follow-up was 22%. Using multivariate logistic regression, Breast Imaging-Reporting and Data System (BI-RADS) score (odds ratio [OR] = 12.29, p = 0.027) and Göttingen MRI scoring system (OR = 8.1, p = 0.008) were found to be independent predictors of malignancy. Receiver operating characteristic analysis showed that Göttingen MRI score >3 provides a plausibly good cutoff value with sensitivity of 100 (95% confidence interval [CI] 74%-100%) and specificity of 76% (95% CI 61%-88%). Conclusions Lesions of uncertain malignant potential classified as BI-RADS 5 and Göttingen score 4 or higher are at significantly higher risk of harboring malignancy and therefore should be recommended for surgical excision.
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Non-malignant breast papillary lesions - b3 diagnosed on ultrasound--guided 14-gauge needle core biopsy: analysis of 114 cases from a single institution and review of the literature. Pathol Oncol Res 2015; 21:535-46. [PMID: 25573591 DOI: 10.1007/s12253-014-9882-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
One-hundred-fourteen consecutive cases of breast ultrasound-guided 14-gauge needle core biopsy (14G NCB) performed from January 2001 to June 2013 and diagnosed as non-malignant papillary lesion (PL)-B3, were reviewed and compared with definitive histological diagnosis on surgical excision (SE) to evaluate the diagnostic accuracy of ultrasound-guided 14G NCB. PL with epithelial atypia on 14G NCB were associated to malignancy on definitive histological diagnosis on SE in 22 (7 DCIS and 15 invasive carcinomas) of 46 cases with an underestimation rate of 47.8 %, while 9 (4 DCIS and 5 invasive carcinomas) cases out of 68 cases of PL without epithelial atypia were upgraded to carcinoma with an underestimation rate of 13.2 %. In cases of PL with epithelial atypia on ultrasound-guided 14G NCB, SE appears mandatory due to the high risk of associated malignancy. The diagnosis of PL without epithelial atypia on ultrasound-guided 14G NCB does not exclude malignancy at subsequent SE, consequently further assessment (by surgical or vacuum-assisted excision) is recommended to avoid the risk of delaying a diagnosis of malignancy, although this tends to be lower (1 in 8 patients).
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Sohn YM, Yoon JH, Kim EK, Moon HJ, Kim MJ. Percutaneous ultrasound-guided vacuum-assisted removal versus surgery for breast lesions showing imaging-histology discordance after ultrasound-guided core-needle biopsy. Korean J Radiol 2014; 15:697-703. [PMID: 25469080 PMCID: PMC4248624 DOI: 10.3348/kjr.2014.15.6.697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/10/2014] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the upgrade rate and delayed false-negative results of percutaneous vacuum-assisted removal (VAR) and surgical excision in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy (CNB) of the breast and to validate the role of VAR as a rebiopsy method for these discordant lesions. Materials and Methods Percutaneous US-guided 14-gauge CNB was performed on 7470 patients between August 2005 and December 2010. Our study population included 161 lesions in 152 patients who underwent subsequent rebiopsy due to imaging-histologic discordance. Rebiopsy was performed using VAR (n = 88) or surgical excision (n = 73). We investigated the upgrade rate immediately after rebiopsy and delayed false-negative results during at least 24 months of follow-up after rebiopsy. We also evaluated the clinicoradiological differences between VAR and surgical excision. Results Total upgrade to malignancy occurred in 13.7% (22/161) of lesions at rebiopsy including both VAR and surgical excision: 4.6% (4/88) of VAR cases (4/88) and 24.7% (18/73) of surgical excision cases (p < 0.001). Surgical excision was performed significantly more frequently in older patients and for larger-sized lesions than that of VAR, and a significant difference was detected between VAR and surgical excision in the Breast Imaging and Reporting and Data System category (p < 0.007). No delayed false-negative results were observed after VAR or surgical excision during the follow-up period. Conclusion Long-term follow-up data showed no delayed cancer diagnoses after US-guided VAR in imaging-histologic discordant lesions of the breast, suggesting that VAR might be a rebiopsy method for these lesions.
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Affiliation(s)
- Yu-Mee Sohn
- Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea. ; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul 130-872, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hee Jung Moon
- Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Min Jung Kim
- Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
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Tzias D, Bhaludin B, Wilkinson LS, George S, Gay H. PB.33: Vacuum-assisted biopsy for lesions of uncertain malignant potential: further evidence of its suitability as a safe alternative to surgery. Breast Cancer Res 2013. [PMCID: PMC3980236 DOI: 10.1186/bcr3533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gatta G, Di Grezia G, Ancona A, Capodieci M, Coppolino F, Rossi C, Feragalli B, Iacomino A, Cappabianca S, Grassi R. Underestimation of Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Stereotaxic 11-Gauge Vacuum-Assisted Breast Biopsy. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aims of this study are to determine the frequency of diagnosis of atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) at stereotaxic-guided 11-gauge vacuum-assisted breast biopsy (VABB) and to assess the rate of underestimation of these at subsequent surgical excision and follow-up. Moreover, we aimed to define clinical, radiological and histological features of nonpalpable lesions in core biopsies that predict the lesion upgrade. Retrospective review of 11-gauge VABB was performed to identify the underestimation rate of nonpalpable lesions diagnosed as ALH or LCIS at VABB. Thirteen cases of ALH and 36 cases of LCIS were sent to surgery, 29 cases of ALH and 14 cases of LCIS were sent to follow-up. The clinical, mammographic and histologic features were assessed. The correlation between mammographic BI-RADS score and histological B-classification for both ALH and LCIS lesions were performed by Pearson's test. Of 1,765 patients enrolled, lobular lesions (ALH and/or LCIS) occurred in 82 cases, and underestimation arose in 9 (10.9%). Two cases of underestimated ALH were upgraded to invasive lobular carcinoma and one to invasive ductal carcinoma. One case of underestimated LCIS was upgraded to ductal carcinoma in situ, two to invasive ductal carcinoma and three to invasive lobular carcinoma. The histology of the core and surgical specimens were compared. A significant difference was seen in the BI-RADS score (4–5 in 91% of underestimated lesions), and the size of the lesions (≥ 1.5 cm) for underestimated cases versus accurately diagnosed cases (p<0.001). Further significant parameters predictive for malignancy were the incomplete lesion removal by VABB and the presence of associated different breast lesions in the specimen. In conclusion, as far as ALH is concerned, we propose surgery as first choice when at least one of the following condition is respected: positive history for breast carcinoma, lesion >1.5cm, co-presence of high-risk lesions in the sample, signs of ductal involvement, high histological grading for atypia and follow-up in the other cases. Surgery is recommended in all cases of LCIS:
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Affiliation(s)
- G. Gatta
- Radiology Department, Second University of Naples, Naples, Italy
| | - G. Di Grezia
- Radiology Department, Second University of Naples, Naples, Italy
| | - A. Ancona
- Radiology Department, San Paolo Hospital, Bari, Italy
| | - M. Capodieci
- Radiology Department, San Paolo Hospital, Bari, Italy
| | - F. Coppolino
- Radiology Department, University of Palermo, Palermo, Italy
| | - C. Rossi
- Radiology Department, Second University of Naples, Naples, Italy
| | - B. Feragalli
- Radiology Department, University of Chieti, Chieti Italy
| | - A. Iacomino
- Radiology Department, University of Chieti, Chieti Italy
| | - S. Cappabianca
- Radiology Department, Second University of Naples, Naples, Italy
| | - R. Grassi
- Radiology Department, Second University of Naples, Naples, Italy
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17
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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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18
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Maxwell AJ, Mataka G, Pearson JM. Benign papilloma diagnosed on image-guided 14 G core biopsy of the breast: effect of lesion type on likelihood of malignancy at excision. Clin Radiol 2012. [PMID: 23206431 DOI: 10.1016/j.crad.2012.06.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To ascertain the negative predictive value (NPV) for atypia and malignancy of 14 G core biopsy of papillomas and to determine whether lesion type influences the likelihood of malignancy at lesion excision. MATERIALS AND METHODS Ninety-six lesions with a 14 G core biopsy diagnosis of benign papilloma without atypia in 95 women were included. The imaging features (mass or microcalcification), biopsy mode, and number of core samples taken were documented. All patients subsequently underwent lesion excision with either extensive vacuum-assisted biopsy (VAB; 72 lesions) or surgery (24 lesions). Mammographic follow-up of at least 2 years was available for 32 lesions that were benign at VAB. RESULTS Atypia or malignancy was found more commonly in association with microcalcification (six of 29 lesions: 21%; median number of nine 14 G cores) than a mass (five of 67 lesions: 7%; median number of three 14 G cores), although the difference does not reach statistical significance (p = 0.088). The NPV of a 14 G core biopsy diagnosis of papilloma for atypia or malignancy is 89% (85/96). Disease underestimation may be more common in microcalcification lesions despite the greater number of cores obtained. CONCLUSION Excision (using VAB or surgically) of all papillomas diagnosed as benign on 14 G needle core biopsy is recommended. Surgery may be more appropriate than VAB for some microcalcification lesions unless they are small and can be confidently removed in their entirety using VAB.
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Affiliation(s)
- A J Maxwell
- Breast Unit, Royal Bolton Hospital, Bolton, UK.
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