1
|
Harbhajanka A, Gilmore HL, Calhoun BC. High-risk and selected benign breast lesions diagnosed on core needle biopsy: Evidence for and against immediate surgical excision. Mod Pathol 2022; 35:1500-1508. [PMID: 35654997 DOI: 10.1038/s41379-022-01092-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022]
Abstract
The vast majority of image-detected breast abnormalities are diagnosed by percutaneous core needle biopsy (CNB) in contemporary practice. For frankly malignant lesions diagnosed by CNB, the standard practice of excision and multimodality therapy have been well-defined. However, for high-risk and selected benign lesions diagnosed by CNB, there is less consensus on optimal patient management and the need for immediate surgical excision. Here we outline the arguments for and against the practice of routine surgical excision of commonly encountered high-risk and selected benign breast lesions diagnosed by CNB. The entities reviewed include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, intraductal papillomas, and radial scars. The data in the peer-reviewed literature confirm the benefits of a patient-centered, multidisciplinary approach that moves away from the reflexive "yes" or "no" for routine excision for a given pathologic diagnosis.
Collapse
Affiliation(s)
- Aparna Harbhajanka
- Department of Pathology, Case Western University School of Medicine, Cleveland, OH, 44106, USA
| | - Hannah L Gilmore
- Department of Pathology, Case Western University School of Medicine, Cleveland, OH, 44106, USA
| | - Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
2
|
Ni Y, Tse GM. Papillary lesions of the breast - review and practical issues. Semin Diagn Pathol 2022; 39:344-354. [PMID: 35718581 DOI: 10.1053/j.semdp.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/09/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Abstract
Papillary lesions of the breast represent a heterogeneous group of neoplasm featuring fibrovascular cores covered by epithelial cells with or without intervening myoepithelial cells. According to the World Health Organization classification of breast tumors, papillary lesions of the breast are further classified into intraductal papilloma (including intraductal papilloma with atypical ductal hyperplasia /ductal carcinoma in situ), papillary ductal carcinoma in situ, encapsulated papillary carcinoma, solid papillary carcinoma (in situ and invasive) and invasive papillary carcinoma. The overlapping morphological features and immunohistochemical profiles make accurate diagnosis of breast papillary lesion a challenge for pathologists. In this review, the morphological and relevant immunohistochemical features of papillary lesions are discussed, with further emphasis on some commonly encountered practical diagnostic issues. A simple diagnostic algorithm will be established. The relevant molecular characteristics will be discussed as well.
Collapse
Affiliation(s)
- Yunbi Ni
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, China.
| |
Collapse
|
3
|
Park J, Lee NR, Oh HK, Park SH, Kim JK, Jeong YJ. Factors associated with upgrade, malignant upgrade, and subsequent breast cancer occurrence of papillary breast lesions diagnosed on core needle biopsy. Asia Pac J Clin Oncol 2022; 19:e96-e105. [PMID: 35634788 DOI: 10.1111/ajco.13798] [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: 12/17/2021] [Revised: 04/26/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Abstract
AIM In this study, we analyzed the upgrade rate and associated factors for upgrade, malignant upgrade, and subsequent breast cancer occurrence of papillary breast lesions diagnosed on core needle biopsy (CNB). METHODS One hundred sixty-nine patients who underwent surgery for the treatment of papillary breast lesions diagnosed on CNB were included in this study. Medical records including radiological and pathological reports were retrospectively reviewed. RESULTS The overall upgrade rate was 29.6%, and upgrade rate to malignancy was 16.6%. Age over 45 years, preoperative tumor size ≥0.7 cm on breast ultrasound, pathologic tumor size ≥0.4 cm, breast imaging reporting and data system (BIRADS) category 4b or 4c, and personal history of breast cancer were associated with upgrade. In addition, age over 45 years, preoperative tumor size ≥0.9 cm, pathologic tumor size ≥0.6 cm, atypia in CNB, and BIRADS category 4b or 4c were associated with malignancy. The risk of subsequent breast cancer occurrence was increased in preoperative tumor size ≥0.8 cm, pathologic tumor size ≥0.5 cm, multiple and recurrent lesions. CONCLUSION Our study showed high upgrade rate of papillary breast lesions diagnosed on CNB. Our findings suggest that surgical excision is recommended for papillary breast lesions diagnosed on CNB in selected patients.
Collapse
Affiliation(s)
- Junyoung Park
- Department of Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Na-Rang Lee
- Department of Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Hoon Kyu Oh
- Department of Pathology, Daegu Catholic University, School of Medicine, Daegu, Republic of Korea
| | - Sung Hwan Park
- Department of Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea.,Department of Surgery, Daegu Catholic University, School of Medicine, Daegu, Republic of Korea
| | | | - Young Ju Jeong
- Department of Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea.,Department of Surgery, Daegu Catholic University, School of Medicine, Daegu, Republic of Korea
| |
Collapse
|
4
|
Miller TI, Flanagan MR, Lowry KP, Kilgore MR. Error Reduction and Diagnostic Concordance in Breast Pathology. Surg Pathol Clin 2022; 15:1-13. [PMID: 35236626 DOI: 10.1016/j.path.2021.11.001] [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: 06/14/2023]
Abstract
Errors in anatomic pathology can result in patients receiving inappropriate treatment and poor patient outcomes. Policies and procedures are necessary to decrease error and improve diagnostic concordance. Breast pathology may be more prone to diagnostic errors than other surgical pathology subspecialties due to inherit borderline diagnostic categories such as atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Mandatory secondary review of internal and outside referral cases before treatment is effective in reducing diagnostic errors and improving concordance. Assessment of error through amendment/addendum tracking, implementing an incident reporting system, and multidisciplinary tumor boards can establish procedures to prevent future error.
Collapse
Affiliation(s)
- Timothy Isaac Miller
- Department of Laboratory Medicine and Pathology, University of Washington, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357100, Seattle, WA 98195, USA.
| | - Meghan R Flanagan
- Department of Surgery, University of Washington, 1100 Fairview Avenue, M4-B874, Seattle, WA 98109, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG-215, Seattle, WA 98109, USA
| | - Mark R Kilgore
- Department of Laboratory Medicine and Pathology, University of Washington, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357100, Seattle, WA 98195, USA
| |
Collapse
|
5
|
Alberty‐Oller JJ, Reyes S, Moshier E, Ru M, Weltz S, Santos A, Pisapati K, Port E, Jaffer S. Does previous history of cancer or atypia predict histologic upgrade for pure intraductal papillomas diagnosed via core biopsy? A study of 490 cases at a single institution. Cancer Rep (Hoboken) 2021; 5:e1481. [PMID: 34729946 PMCID: PMC8955065 DOI: 10.1002/cnr2.1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature. AIM We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population. METHODS AND RESULTS A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16-85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia (p < .01), as well as age over ≥55 years (p < .01) and a prior history of cancer (p < .01). No other clinical, radiologic and histologic factors were found to be significant predictors of upgrade. 40/439 (9.1%) patients in the total cohort had prior history of cancer, and of these, 2/40 (5%) were found to have a new cancer after excision. CONCLUSIONS In patients with pure IDP on CNB, the upgrade rate to malignancy was 1.1%, while 12.3% were upgraded to atypia. The clinical significance of identifying atypia in a papilloma is unknown, especially in a patient with a prior history of atypia or cancer. However, the majority of patients who were upgraded to either atypia or cancer had no prior history of high-risk or malignant breast disease and are therefore considered true clinical upgrades. As such excision for IDP should be considered.
Collapse
Affiliation(s)
- J. Jaime Alberty‐Oller
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sylvia Reyes
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Erin Moshier
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Meng Ru
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sarah Weltz
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Antonio Santos
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kereeti Pisapati
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elisa Port
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Shabnam Jaffer
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| |
Collapse
|
6
|
Kang HJ, Kwon SY, Kim A, Kim WG, Kim EK, Kim AR, Kim C, Min SK, Park SY, Sung SH, Yoon HK, Lee A, Lee JS, Lee HI, Lee HC, Lim SC, Jun SY, Jung MJ, Jung CW, Cho SY, Cho EY, Choi HJ, Park SY, Kim JY, Park IA, Kwon Y. A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification. J Pathol Transl Med 2021. [PMID: 34614346 DOI: 10.4132/jptm.2021.07.29.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. METHODS Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). RESULTS On WHO classification, H&E staining exhibited 'fair agreement' (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. CONCLUSIONS Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.
Collapse
Affiliation(s)
- Hye Ju Kang
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Sun Young Kwon
- Department of Pathology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Ahrong Kim
- Department of Pathology, Pusan National University Hospital, Busan, Korea
| | - Woo Gyeong Kim
- Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji University Hospital, Seoul, Korea
| | - Ae Ree Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Chungyeul Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Soo Kee Min
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - So Young Park
- Department of Pathology, MizMedi Hospital, Seoul, Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
| | - Ahwon Lee
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyang Im Lee
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Ho Chang Lee
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Chul Lim
- Department of Pathology, Chosun University Hospital, Gwangju, Korea
| | - Sun Young Jun
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Min Jung Jung
- Department of Pathology, Kosin University Gospel Hospital, Busan, Korea
| | - Chang Won Jung
- Department of Pathology, Green Cross Laboratories, Yongin, Korea
| | - Soo Youn Cho
- Department of Pathology, Sungkyunkwan University Samsung Medical Center, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Sungkyunkwan University Samsung Medical Center, Seoul, Korea
| | - Hye Jeong Choi
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Yeon Kim
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Youngmee Kwon
- Department of Pathology, National Cancer Center, Goyang, Korea
| |
Collapse
|
7
|
Pang JMB, Castles B, Byrne DJ, Button P, Hendry S, Lakhani SR, Sivasubramaniam V, Cooper WA, Armes J, Millar EK, Raymond W, Roberts-Thomson S, Kumar B, Burr M, Selinger C, Harvey K, Chan C, Beith J, Clouston D, O’Toole SA, Fox SB. SP142 PD-L1 Scoring Shows High Interobserver and Intraobserver Agreement in Triple-negative Breast Carcinoma But Overall Low Percentage Agreement With Other PD-L1 Clones SP263 and 22C3. Am J Surg Pathol 2021; 45:1108-1117. [PMID: 34232604 PMCID: PMC8277187 DOI: 10.1097/pas.0000000000001701] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SP142 programmed cell death ligand 1 (PD-L1) status predicts response to atezolizumab in triple-negative breast carcinoma (TNBC). Prevalence of VENTANA PD-L1 (SP142) Assay positivity, concordance with the VENTANA PD-L1 (SP263) Assay and Dako PD-L1 IHC 22C3 pharmDx assay, and association with clinicopathologic features were assessed in 447 TNBCs. SP142 PD-L1 intraobserver and interobserver agreement was investigated in a subset of 60 TNBCs, with scores enriched around the 1% cutoff. The effect of a 1-hour training video on pretraining and posttraining scores was ascertained. At a 1% cutoff, 34.2% of tumors were SP142 PD-L1 positive. SP142 PD-L1 positivity was significantly associated with tumor-infiltrating lymphocytes (P <0.01), and node negativity (P=0.02), but not with tumor grade (P=0.35), tumor size (P=0.58), or BRCA mutation (P=0.53). Overall percentage agreement (OPA) for intraobserver and interobserver agreement was 95.0% and 93.7%, respectively, among 5 pathologists trained in TNBC SP142 PD-L1 scoring. In 5 TNBC SP142 PD-L1-naive pathologists, significantly higher OPA to the reference score was achieved after video training (posttraining OPA 85.7%, pretraining OPA 81.5%, P<0.05). PD-L1 status at a 1% cutoff was assessed by SP142 and SP263 in 420 cases, and by SP142 and 22C3 in 423 cases, with OPA of 88.1% and 85.8%, respectively. The VENTANA PD-L1 (SP142) Assay is reproducible for classifying TNBC PD-L1 status by trained observers; however, it is not analytically equivalent to the VENTANA PD-L1 (SP263) Assay and Dako PD-L1 IHC 22C3 pharmDx assay.
Collapse
Affiliation(s)
| | | | | | | | | | - Sunil R. Lakhani
- University of Queensland Centre for Clinical Research
- Pathology Queensland, Brisbane
| | | | - Wendy A. Cooper
- Sydney Medical School, The University of Sydney
- Department of Tissue Pathology, Royal Prince Alfred Hospital, NSW Health Pathology
- Western Sydney University, Campbelltown
| | - Jane Armes
- Pathology Queensland, Sunshine Coast, QLD
| | - Ewan K.A. Millar
- NSW Health Pathology, St George Hospital
- St. George and Sutherland Clinical School, University of New South Wales, Kogarah
| | - Wendy Raymond
- Flinders Medical Centre, Flinders University of South Australia
- Clinpath Laboratories, Adelaide, SA, Australia
| | | | | | - Marian Burr
- Royal Melbourne Hospital
- Sir Peter MacCallum Department of Oncology, University of Melbourne
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, UK
| | | | - Kate Harvey
- The Garvan Institute of Medical Research, Darlinghurst
| | - Charles Chan
- Concord Clinical School, The University of Sydney, Sydney
- Concord Repatriation General Hospital, Concord, NSW
| | - Jane Beith
- Sydney Medical School, The University of Sydney
- Chris O’Brien Lifehouse, Camperdown
| | | | - Sandra A. O’Toole
- Sydney Medical School, The University of Sydney
- The Garvan Institute of Medical Research, Darlinghurst
- Department of Tissue Pathology, Royal Prince Alfred Hospital, NSW Health Pathology
- Western Sydney University, Campbelltown
| | - Stephen B. Fox
- Peter MacCallum Cancer Centre
- Sir Peter MacCallum Department of Oncology, University of Melbourne
| |
Collapse
|
8
|
Macon WR. A radiology survey and sub-sub-specialization in hematopathology. J Hematop 2021. [DOI: 10.1007/s12308-021-00444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
9
|
Lin LH, Ozerdem U, Cotzia P, Lee J, Chun J, Schnabel F, Darvishian F. Upgrade rate of intraductal papilloma diagnosed on core needle biopsy in a single institution. Hum Pathol 2020; 110:43-49. [PMID: 33159966 DOI: 10.1016/j.humpath.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
The management of intraductal papilloma (IDP) diagnosed on core needle biopsy (CNB) is controversial due to the variable upgrade rates to breast carcinoma (BC) on subsequent surgical excision reported in the literature. The purpose of our study was to investigate the upgrade rate of IDP diagnosed on CNB to BC in subsequent surgical excision and the impact of clinical, pathologic, and radiologic variables. This is a retrospective cohort of all women who had a diagnosis of IDP on a CNB between 2005 and 2018 in a tertiary academic center with subsequent surgical excision. Upgrade was defined as ductal carcinoma in situ (DCIS) and invasive carcinoma on surgical excision. Statistical analyses included Pearson's chi-square, Wilcoxon rank-sum, and logistic regression. A total of 216 women with IDP in a CNB were included. Nineteen patients (8.8%) upgraded to BC in the overall cohort, including 14 DCIS and 5 invasive carcinomas. An upgrade rate of 27% was found in atypical IDP (14 of 51 cases), while only 3% of pure IDP upgraded to BC (5 of 165 cases). Older age (>53 years) at the time of biopsy (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.01-1.09, p = 0.027) and concomitant atypical ductal hyperplasia (ADH) (OR = 9.69, 95% CI = 3.37-27.81, p < 0.0001) were significantly associated with upgrade. Our results support surgical excision of IDP on CNB when associated with ADH or diagnosed in women aged older than 53 years. The low surgical upgrade rate of 3% for pure IDP on CNB in younger women should be part of the management discussion.
Collapse
Affiliation(s)
- Lawrence Hsu Lin
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States
| | - Ugur Ozerdem
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States
| | - Paolo Cotzia
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States
| | - Jiyon Lee
- New York University Langone Health, Department of Radiology, NYU Perlmutter Cancer Center, New York, NY, 10016, United States
| | - Jennifer Chun
- New York University Langone Health, Department of Surgery, Division of Breast Surgical Oncology, NYU Perlmutter Cancer Center, New York, NY, 10016, United States
| | - Freya Schnabel
- New York University Langone Health, Department of Surgery, Division of Breast Surgical Oncology, NYU Perlmutter Cancer Center, New York, NY, 10016, United States
| | - Farbod Darvishian
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States.
| |
Collapse
|
10
|
Li X, Gao H, Xu M, Wu Y, Gao D. Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision. BMC Surg 2020; 20:204. [PMID: 32933518 PMCID: PMC7493139 DOI: 10.1186/s12893-020-00869-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.
Collapse
Affiliation(s)
- Xiaohui Li
- Nosocomial Infection Department, The Second Hospital, Shandong University Cheeloo College of Medicine, Jinan, 250033, China
| | - Hua Gao
- Department of Thoracic and General Surgery, Shandong Provincial Chest Hospital, Jinan, 250101, China
| | - Minling Xu
- Maternity and Child Care Center of DeZhou, DeZhou, 253015, China
| | - Yang Wu
- Department of Breast Surgery, The Second Hospital, Shandong University Cheeloo College of Medicine, No. 247, Beiyuandajie Street, Jinan, 250033, China
| | - Dezong Gao
- Department of Breast Surgery, The Second Hospital, Shandong University Cheeloo College of Medicine, No. 247, Beiyuandajie Street, Jinan, 250033, China.
| |
Collapse
|
11
|
Li X, Wang H, Sun Z, Fan C, Jin F, Mao X. A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real-world experience. Cancer Med 2020; 9:7751-7762. [PMID: 32822113 PMCID: PMC7571817 DOI: 10.1002/cam4.3308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Breast intraductal papilloma is a heterogeneous group. The aim of the study is to investigate the intraductal breast papilloma and its coexisting lesions retrospectively in real‐world practice. Methods We retrospectively identified 4450 intraductal breast papilloma and its coexisting lesions. Results About 18.36% of intraductal papilloma coexisted with malignant lesions of the breast, 37.33% coexisted with atypia hyperplasia (AH), 25.24% coexisted with benign lesions, and only 19.10% coexisted without concomitant lesions. In addition, 36.80% of intraductal breast papilloma had nipple discharge, 51.46% had a palpable breast mass, and 16.45% had both nipple discharge and a palpable breast mass. About 28.18% experienced discomfort or were asymptomatic. Furthermore, 98.99% had ultrasound abnormalities, and 53.06% had intraductal hypoechogenicity upon ultrasound. 31.89% had mammographic distortion, and 14.45% had microcalcification upon mammography. Intraductal breast papilloma with malignancy had significant correlations with clinical manifestations. Conclusion Coexisting malignancy was also related to ultrasound abnormality (BIRADS 4C and 5), mammographic distortion, and microcalcification upon mammography but was not related to the intraductal hypoechoic upon ultrasound. Coexisting atypical hyperplasia correlated with nipple discharge but not palpable mass, mammographic distortion, or intraductal hypoechoic upon ultrasound. The coexisting AH was also related to abnormality upon ultrasound or microcalcification compared with the benign lesions. The intraductal papilloma coexists with malignancy or AH accounted for more than 50%, and the clinical information on papilloma and its coexisting lesions is nonspecific. We recommended surgical treatment for benign intraductal papillary lesions.
Collapse
Affiliation(s)
- Xiaona Li
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University & School of Fundamental Science, China Medical University, Shenyang, People's Republic of China
| | - Huan Wang
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhe Sun
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Chuifeng Fan
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences of China Medical University, Shenyang, People's Republic of China
| | - Feng Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaoyun Mao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| |
Collapse
|
12
|
Genco IS, Tugertimur B, Manolas PA, Hasanovic A, Hajiyeva S. Upgrade rate of intraductal papilloma without atypia on breast core needle biopsy: A clinical, radiological and pathological correlation study. Am J Surg 2020; 220:677-681. [PMID: 32007236 DOI: 10.1016/j.amjsurg.2020.01.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of the study was to determine the upgrade rate on excision of intraductal papilloma (IDP) without atypia diagnosed on breast core needle biopsy (CNB). METHODS We searched our pathology department database for breast CNB with a diagnosis of IDP from 2013 to 2018. The exclusion criteria included radiologic-pathologic discordance, atypia on the same CNB, absence of histologic slides to review or absence of excision information. Upgrade was defined as ductal carcinoma in situ (DCIS) or invasive cancer identified on excision. RESULTS 126 IDP without atypia cases from 94 patients were identified. The upgrade rate was 1.58% (2/126). Both upgrade cases showed DCIS with low and intermediate nuclear grade. Histologic size of IDP ≥1 cm was the only statistically significant predictor factor for an upgrade on excision. CONCLUSION The results suggest that non-surgical management of patients with radiologic-pathologic concordant IDP without atypia diagnosed on CNB may be appropriate in routine practice.
Collapse
Affiliation(s)
- Iskender Sinan Genco
- Northwell Health Lenox Hill Hospital, Department of Pathology and Laboratory Medicine, 100 E 77th street, New York, NY, 10075, USA.
| | - Bugra Tugertimur
- Northwell Health Lenox Hill Hospital, Department of Surgery, 100 E 77th street, New York, NY, 10075, USA
| | - Panagiotis A Manolas
- Northwell Health Lenox Hill Hospital, Department of Surgery, 100 E 77th street, New York, NY, 10075, USA
| | - Adnan Hasanovic
- Northwell Health Lenox Hill Hospital, Department of Pathology and Laboratory Medicine, 100 E 77th street, New York, NY, 10075, USA
| | - Sabina Hajiyeva
- Northwell Health Lenox Hill Hospital, Department of Pathology and Laboratory Medicine, 100 E 77th street, New York, NY, 10075, USA
| |
Collapse
|
13
|
Feig SA. Management of papillary lesions of the breast diagnosed by core biopsy: Need for an evidence‐based standard of care. Breast J 2019; 25:804-806. [DOI: 10.1111/tbj.13351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Stephen A. Feig
- UCI Medical Center, Department of Radiology University of California Irvine School of Medicine Orange California
| |
Collapse
|
14
|
Qiu L, Mais DD, Nicolas M, Nanyes J, Kist K, Nazarullah A. Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability. Int J Surg Pathol 2019; 27:736-743. [PMID: 31187678 DOI: 10.1177/1066896919854543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the "substantial" agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). "Substantial" and "fair" κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into "excellent" range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.
Collapse
Affiliation(s)
- Lianqun Qiu
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Daniel D Mais
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Jennifer Nanyes
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kenneth Kist
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alia Nazarullah
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| |
Collapse
|
15
|
Fuentes JAP, Martínez CEM, Casadiego AKR, Freites VFA, Marín VAA, Castellano ACR. Papillary breast lesions diagnosed by percutaneous needle biopsy: management approach. Ecancermedicalscience 2019; 13:902. [PMID: 30915160 PMCID: PMC6390833 DOI: 10.3332/ecancer.2019.902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 11/29/2022] Open
Abstract
Papillary breast lesions are a heterogeneous group of neoplasms of diverse imagenological, clinical and morphological presentation that display different behaviour, prognosis and, therefore, controversial diagnosis and management. The aim of this study is to propose an algorithm for the management of mammary lesions.
Collapse
|
16
|
Chen YA, Mack JA, Karamchandani DM, Zaleski MP, Xu L, Dodge DG, Chetlen AL. Excision recommended in high-risk patients: Revisiting the diagnosis of papilloma on core biopsy in the context of patient risk. Breast J 2019; 25:232-236. [PMID: 30697873 DOI: 10.1111/tbj.13200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
Abstract
We investigate the clinical history, past medical history, and risk status in women with benign intraductal papillomas(IDP). We observed an upgrade rate of 3.9% to ductal carcinoma in situ (DCIS) and upgrade rate of 10.7% to a high-risk lesion. Prior or concurrent atypia or cancer and high-risk status had a significant increase risk of upgrade. Surgical excision of papillomas is recommended especially in high-risk patients and women with concurrent or history of atypia or malignancy.
Collapse
Affiliation(s)
- Yun An Chen
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Julie A Mack
- Department of Radiology, Division of Breast Imaging, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Dipti M Karamchandani
- Department of Pathology, Division of Anatomic Pathology, Penn State Health, Milton S. Hershey Medical Center / Penn State College of Medicine, Hershey, Pennsylvania
| | - Michael P Zaleski
- Department of Pathology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Liyan Xu
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Daleela G Dodge
- Division of Surgery Specialties and Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Alison L Chetlen
- Division of Breast Imaging, Department of Radiology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
17
|
Kupsik M, Perez C, Bargaje A. Upstaging papillary lesions to carcinoma on surgical excision is not impacted by patient race. Breast Dis 2019; 38:67-72. [PMID: 30988233 DOI: 10.3233/bd-180379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The management of papillary lesions is controversial with studies showing different rates of upstaging to malignancy. There is a paucity of research into race as an independent risk factor. The aim of this study is to identify if race is correlated with upstaging to malignancy with a secondary focus of analyzing for other personal and tumor specific risk factors for upstaging. METHODS We performed a retrospective review of 123 papillary lesions with univariate analysis to identify risk factors for upstaging. RESULTS The incidence of papillary lesions found on core needle biopsy was 6%. Atypical papillary lesions were most likely to be upstaged to malignancy at a rate of 27.7%. Papillary lesions and papillary lesions with hyperplasia were also upstaged to cancer at a lower rate of 8.3% and 12.5%, respectively. A univariate analysis of all papillary lesions and a separate analysis of atypical lesions demonstrated a higher likelihood of upstage based on BIRADS classification. Race, age, size of tumor and other radiographic features were not associated with an increased risk for upstaging to malignancy. CONCLUSIONS Atypia remains the most significant contributor to the risk of upstaging papillary lesions to malignancy. Our research supports the practice of excising all atypical papillary lesions with selected excision of those without atypia. In our cohort, there was no association between race and risk of upstaging to malignacy.
Collapse
Affiliation(s)
- M Kupsik
- Division of Breast Surgical Oncology, Mercy Hospital and Medical Center, 2525 Michigan Avenue, Chicago, IL, USA
- University of Illinois, Metropolitan Group Hospitals, 836 W Wellington Ave, Chicago, IL, USA
| | - C Perez
- Division of Breast Surgical Oncology, Mercy Hospital and Medical Center, 2525 Michigan Avenue, Chicago, IL, USA
| | - A Bargaje
- Division of Surgical Pathology, Mercy Hospital and Medical Center, 2525 Michigan Avenue, Chicago, IL, USA
| |
Collapse
|
18
|
Yu Y, Salisbury E, Gordon-Thomson D, Yang JL, Crowe PJ. Management of papillary lesions without atypia of the breast diagnosed on needle biopsy. ANZ J Surg 2018; 89:524-528. [PMID: 30414221 DOI: 10.1111/ans.14827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current surgical practice often leads to excision of all papillary lesions of the breast diagnosed on percutaneous biopsy. This study aims to identify a subset of patients with papillary lesions who may be able to avoid surgery. METHODS Between January 2000 and December 2015, 157 cases of papillary lesions with complete surgical excision pathology results were reviewed retrospectively to compare the clinical, imaging and pathology features. Of these, 50 patients with benign papillary lesions without atypia and 19 patients with benign papillary lesions with atypia on needle biopsy were analysed to determine the rate of upgrade to malignancy after surgery. RESULTS Of the 50 patients with benign papillary lesions without atypia on biopsy, two (4%) were upgraded to low grade ductal carcinoma in situ after surgical excision. Both these patients had suspicious features on imaging. Of the 19 patients with papillary lesions with atypia diagnosed on needle biopsy, eight (42%) were upgraded to malignancy after surgery. The differences between benign, atypical and malignant papillary lesions were further compared. Malignant lesions were more suspicious radiologically (P = 0.001), more likely to have architectural distortion (P = 0.001), more peripherally located (P = 0.001) and were larger in size (P = 0.01). Patients diagnosed with malignant lesions were also older (P = 0.001). CONCLUSION Younger patients diagnosed with small central benign papillary lesions without atypia on needle biopsy, and without suspicious imaging, may be managed conservatively with surveillance.
Collapse
Affiliation(s)
- Yue Yu
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Salisbury
- South East Sydney Laboratory Services, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - David Gordon-Thomson
- Department of Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jia-Lin Yang
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Philip J Crowe
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| |
Collapse
|
19
|
Asirvatham JR, Jorns JM, Zhao L, Jeffries DO, Wu AJ. Outcomes of benign intraductal papillomas diagnosed on core biopsy: a review of 104 cases with subsequent excision from a single institution. Virchows Arch 2018; 473:679-686. [DOI: 10.1007/s00428-018-2449-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/26/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
|
20
|
Nasehi L, Sturgis CD, Sharma N, Turk P, Calhoun BC. Breast Cancer Risk Associated With Benign Intraductal Papillomas Initially Diagnosed on Core Needle Biopsy. Clin Breast Cancer 2018; 18:468-473. [PMID: 30017794 DOI: 10.1016/j.clbc.2018.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The long-term risk for patients with benign intraductal papillomas (IDPs) on core needle biopsy (CNB) who are not upgraded on excision is not well-defined. The goal of this study was to determine the cumulative breast cancer (BC) incidence for patients with benign IDP on CNB. MATERIALS AND METHODS There were 152 benign IDPs diagnosed on CNB between 2003 and 2008. Radiology and pathology data were reviewed by breast radiologists and pathologists. Clinical follow-up was obtained from the electronic medical record (Epic). RESULTS Excision results were: 96 (63%) not upgraded, 9 (6%) with BC on excision (6 ductal carcinoma in situ, 3 invasive carcinoma), and 5 (3%) lacked correlation with the CNB site. Excision reports were unavailable for 42 (28%). Excluding cases with Breast Imaging Reporting and Data System (BI-RADS) 5 or discordant imaging, there were 6 (4%) true upgrades (all ductal carcinoma in situ). After the exclusion of patients with other major risk factors, follow-up was available for 55 of 58 patients with benign IDPs, and 8 (14%) developed BC after a median of 112 months (range, 11-159 months). None of the benign IDP patients without an excision report developed BC after a median of 97 months (range, 5-164 months). CONCLUSIONS The upgrade rate for benign IDP diagnosed on CNB was 4%, similar to recent studies. The cumulative BC incidence for those who were not upgraded and who had no history of BC was 14% at a median of 9 years. When combined with patients without an excision pathology report, the overall BC incidence was 9%. The findings support continued breast cancer surveillance in this patient population.
Collapse
Affiliation(s)
- Leyla Nasehi
- Department of Breast Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Charles D Sturgis
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Nidhi Sharma
- Department of Breast Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Paulette Turk
- Department of Breast Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Benjamin C Calhoun
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
21
|
Han SH, Kim M, Chung YR, Yun BL, Jang M, Kim SM, Kang E, Kim EK, Park SY. Benign Intraductal Papilloma without Atypia on Core Needle Biopsy Has a Low Rate of Upgrading to Malignancy after Excision. J Breast Cancer 2018; 21:80-86. [PMID: 29628987 PMCID: PMC5880969 DOI: 10.4048/jbc.2018.21.1.80] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/05/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The management of benign intraductal papilloma (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial. This study was performed to evaluate the rate of upgrading to malignancy or high-risk lesions after excision and to identify factors associated with upgrading using a large series of benign IDP cases without atypia. METHODS We included patients who were diagnosed as having benign IDP without atypia on CNB and underwent surgical or vacuum-assisted excision between 2010 and 2015. We analyzed the clinical, radiologic, and histopathologic features of IDPs that were upgraded to malignancy or high-risk lesions after excision. RESULTS A total of 511 benign IDPs without atypia diagnosed via CNB were identified, of which 398 cases were treated with excision. After reviewing these cases, four cases of high-risk lesions in adjacent tissue on CNB, two cases which were revealed as papilloma with atypia, and nine cases of malignancy in the same breast were excluded. In the remaining 383 cases, the rate of upgrading to malignancy and high-risk lesions after excision was 0.8% and 4.4%, respectively. The presence of concurrent contralateral breast cancer, the presence of symptoms, and multifocality were factors significantly associated with upgrading to malignancy on subsequent excision. Surgical excision rather than vacuum-assisted excision was significantly associated with upgrading to high-risk lesions or malignancy. CONCLUSION The rate of upgrading to malignancy for benign IDP without atypia was very low, suggesting that close clinical and radiologic observation may be sufficient for patients with benign IDP without atypia on CNB under proper settings.
Collapse
Affiliation(s)
- Song-Hee Han
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Pathology, Konyang University Hospital, Daejeon, Korea
| | - Milim Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yul Ri Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
22
|
The Management Strategy of Benign Solitary Intraductal Papilloma on Breast Core Biopsy. Clin Breast Cancer 2017; 17:367-372. [PMID: 28438672 DOI: 10.1016/j.clbc.2017.03.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/14/2017] [Accepted: 03/23/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intraductal papilloma (IDP) is well-known as one of the common benign breast lesions requiring excision. However, treatment of IDP without atypia is controversial. The aim of our study was to determine the proper management of solitary IDP by core needle biopsy (CNB). PATIENTS AND METHODS We retrospectively reviewed patients with solitary IDP confirmed by CNB from March 2003 to March 2015. We collected data about final pathology after excision, as well as clinical, histologic, and radiologic findings at initial diagnosis. The final pathology was categorized as benign or malignant. We evaluated the rate of upgrade to malignancy and factors associated with malignancy. RESULTS We identified 405 patients who presented benign solitary IDP by CNB. The mean age was 46.1 years (range, 15-86 years). In total, 135 patients underwent surgical excision, and 211 underwent vacuum-assisted excision. Of 346 patients, malignant lesions were found in 8 patients (2.3%): 7 underwent surgical excision, and 1 underwent vacuum-assisted excision. Only the size of IDP was significantly associated with cancer upgrade (P = .003). CONCLUSIONS Our study shows that overall malignancy upgrade rate of benign solitary IDP after excision is very low (2.3%). Even when the size of IDP was less than 1 cm, the upgrade rate to cancer was only 0.9%. Therefore, for patients with small solitary IDP, we recommend close follow-up with ultrasound instead of excision.
Collapse
|
23
|
Moon SM, Jung HK, Ko KH, Kim Y, Lee KS. Management of Clinically and Mammographically Occult Benign Papillary Lesions Diagnosed at Ultrasound-Guided 14-Gauge Breast Core Needle Biopsy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2325-2332. [PMID: 27629753 DOI: 10.7863/ultra.15.11049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine how to manage clinically and mammographically occult benign papillary lesions diagnosed at ultrasound (US)-guided 14-gauge breast core needle biopsy (CNB) by evaluating their upgrade rates. METHODS From our pathologic database of US-guided 14-gauge breast CNB, 69 benign papillomas and 9 atypical papillomas with available subsequent excisional findings (surgery or vacuum-assisted removal with additional US follow-up for ≥2 years) or US follow-up alone (≥2 years) were included in this study. We analyzed their upgrade rates by using excisional or US follow-up findings, with no change at 2 years as the reference standard. Patient age, lesion size, lesion distance from the nipple, multiplicity, imaging-histologic concordance, and histologic findings were compared between groups with and without upgrades by statistical analysis. RESULTS Surgical excision was performed in 53 (67.9%) of 78 benign papillary lesions and revealed 5 upgrades (11.4%) to atypical papillomas in 44 benign papillomas and 2 upgrades (22.2%) to ductal carcinomas in situ in 9 atypical papillomas. Among 12 benign papillomas (15.4%) with vacuum-assisted removal and US follow-up (≥2 years), 1 (8.3%) was upgraded to atypical papilloma. The remaining 13 benign papillomas (16.7%) were followed with US and were stable after a 2-year follow-up period. There were no significant differences in the variables between the groups. CONCLUSIONS Uniform surgical excision is not a reasonable management strategy for clinically and mammographically occult benign papillary lesions diagnosed at US-guided 14-gauge breast CNB. Clinically and mammographically occult benign papillary lesions may be subsequently managed by vacuum-assisted removal or imaging follow-up if atypia is not found.
Collapse
Affiliation(s)
- Sung Mo Moon
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Kyung Hee Ko
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Youdong Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Kyong Sik Lee
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| |
Collapse
|
24
|
Seely JM, Verma R, Kielar A, Smyth KR, Hack K, Taljaard M, Gravel D, Ellison E. Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision? Breast J 2016; 23:146-153. [DOI: 10.1111/tbj.12702] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jean M. Seely
- Department of Medical Imaging; The Ottawa Hospital; University of Ottawa; Ottawa Ontario Canada
| | - Raman Verma
- The Ottawa Hospital; Ottawa Ontario Canada
- University of Ottawa; Ottawa Ontario Canada
| | - Ania Kielar
- The Ottawa Hospital; Ottawa Ontario Canada
- University of Ottawa; Ottawa Ontario Canada
- Royal Victoria Hospital; Barrie Ontario Canada
| | - Karl R. Smyth
- The Ottawa Hospital; Ottawa Ontario Canada
- University of Ottawa; Ottawa Ontario Canada
| | | | - Monica Taljaard
- Clinical Epidemiology Program; Ottawa Hospital Research Institute; Ottawa Ontario Canada
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Denis Gravel
- Department of Pathology; The Ottawa Hospital; Ottawa Ontario Canada
| | | |
Collapse
|
25
|
Ni YB, Tse GM. Pathological criteria and practical issues in papillary lesions of the breast - a review. Histopathology 2016; 68:22-32. [PMID: 26768027 DOI: 10.1111/his.12866] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Papillary lesions of the breast include a broad spectrum of lesions, ranging from benign papilloma, papilloma with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) to papillary carcinoma. The accurate diagnosis of mammary papillary lesions is a challenge for pathologists, owing to the overlapping features among these lesions. In this review, some of the diagnostic criteria of papillary lesions are discussed, with special emphasis on some key morphological features, namely fibrovascular cores, epithelial proliferation in a solid pattern, intraductal papilloma complicated by ADH or DCIS, and invasion and its mimics. The roles of immunohistochemistry, and the interpretation of myoepithelial cell markers, hormone receptors, and high molecular weight cytokeratin, are addressed. Finally, novel biomarkers and genetic aberrations in papillary lesions are summarized.
Collapse
Affiliation(s)
- Yun-Bi Ni
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
26
|
Pareja F, Corben AD, Brennan SB, Murray MP, Bowser ZL, Jakate K, Sebastiano C, Morrow M, Morris EA, Brogi E. Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision. Cancer 2016; 122:2819-27. [PMID: 27315013 DOI: 10.1002/cncr.30118] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/21/2016] [Accepted: 05/02/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The surgical management of mammary intraductal papilloma without atypia (IDP) identified at core-needle biopsy (CNB) is controversial. This study assessed the rate of upgrade to carcinoma at surgical excision (EXC). METHODS This study identified women with a CNB diagnosis of intraductal papilloma without atypia or carcinoma at a cancer center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. The radiologic and clinicopathologic features of patients with a CNB diagnosis of IDP were correlated with an upgrade to carcinoma at EXC. RESULTS The study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent EXC. The upgrade rate was 2.3% (4 of 171). The upgraded lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥ 8 mm away. Twenty-four women (25 IDPs) did not undergo EXC and had stable imaging on follow-up (median, 23.5 months). CONCLUSIONS The upgrade rate at EXC for IDPs diagnosed at CNB with radiologic-pathologic concordance was 2.3%. These findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2819-2827. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adriana D Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra B Brennan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa P Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zenica L Bowser
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kiran Jakate
- Department of Pathology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
27
|
Langer JC, Gordon JS, Chen LE. Subspecialization within pediatric surgical groups in North America. J Pediatr Surg 2016; 51:143-8. [PMID: 26541313 DOI: 10.1016/j.jpedsurg.2015.10.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/09/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to assess the current status of subspecialization in North American pediatric surgical practices and to evaluate factors associated with subspecialization. METHODS A survey was sent to each pediatric surgical practice in the United States and Canada. For each of 44 operation types, ranging in complexity and volume, the respondents chose one of the following responses: 1. everyone does the operation; 2. group policy--only some surgeons do the operation; 3. group policy--anyone can do it but mentorship required; 4. only some do it due to referral patterns; 5. no one in the group does it. Association of various factors with degree of subspecialization was analyzed using nonparametric statistics with p<0.05 considered significant. RESULTS Response rate was 70%. There was significant variability in subspecialization among groups. Factors found to be significantly associated with increased subspecialization included free-standing children's hospitals, pediatric surgery training programs, higher number of surgeons, higher case volume, and greater volume of tertiary/quaternary cases. CONCLUSIONS There is wide variation in the degree of subspecialization among North American pediatric surgery practices. These data will help to inform ongoing debate around strategies that may be useful in optimizing pediatric surgical care and patient outcomes in the future.
Collapse
Affiliation(s)
- Jacob C Langer
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Jennifer S Gordon
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Li Ern Chen
- Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| |
Collapse
|
28
|
Abstract
Breast pathology is filled with pitfalls, including underdiagnosis of bland-appearing lesions, both invasive and non-invasive, misdiagnosis of malignant lesions as belonging to the wrong subgroup, for example, calling LCIS as DCIS or missing the metaplastic component of an invasive lesion, and overdiagnosis of benign lesions as malignancy. While each is a sin of varying severity, the overdiagnosis of benign lesions can be the most scarring, especially in this age where Angelina Jolie׳s prophylactic mastectomy is the headline news and patients are pushing for aggressive preventive treatment. In this review, we will consider some of the more common benign lesions and the malignant counterpart that they mimic, with the goal of identifying characteristic features that will lead to the correct diagnosis. Much of the discussions will center around the assessment of core biopsies, as smaller tissue volume is most often contributory to overcalling benign lesions.
Collapse
Affiliation(s)
- Laura Spruill
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Ave, MSC 908, Charleston, South Carolina 29425-9080.
| |
Collapse
|
29
|
Foley NM, Racz JM, Al-Hilli Z, Livingstone V, Cil T, Holloway CMB, Romics L, Matrai Z, Bennett MW, Duddy L, Nofech-Mozes S, Slodkowska E, Mallon EA, Dawson N, Roche T, Relihan N, Hill ADK, Redmond HP, Corrigan MA. An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions. Ann Surg Oncol 2015; 22 Suppl 3:S385-90. [PMID: 26240010 DOI: 10.1245/s10434-015-4773-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population in which surgical excision may be unnecessary. METHODS A multicenter international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions was performed between 2009 and 2013, following institutional ethical approval. Patient demographics, histopathological, and radiological findings were recorded. All data was tabulated, and statistical analysis performed using Stata. RESULTS A total of 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (p < 0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4 %; however, only 3.7 % had invasive cancer. CONCLUSIONS This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with older age and the presence of atypia on core needle biopsy. It may be possible to stratify higher-risk patients according to age and core needle biopsy findings, thereby avoiding surgery on low-risk patients.
Collapse
Affiliation(s)
- N M Foley
- Breast Research Centre, Cork University Hospital, Cork, Ireland.
| | - J M Racz
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - Z Al-Hilli
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - V Livingstone
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - T Cil
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - C M B Holloway
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | - L Romics
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - Z Matrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - M W Bennett
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - L Duddy
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - S Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - E Slodkowska
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - E A Mallon
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - N Dawson
- Departments of Breast Surgery, Radiology & Pathology, Victoria Infirmary, Glasgow, UK
| | - T Roche
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - N Relihan
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - A D K Hill
- Department of Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H P Redmond
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - M A Corrigan
- Breast Research Centre, Cork University Hospital, Cork, Ireland
| |
Collapse
|
30
|
Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Terasaki H, Hirai Y, Nonaka Y, Morita M, Yokoyama T, Kanomata N, Naito Y, Akiba J, Yano H. Management of breast papillary lesions diagnosed in ultrasound-guided vacuum-assisted and core needle biopsies. Histopathology 2015; 66:565-76. [PMID: 25040190 DOI: 10.1111/his.12477] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/11/2014] [Indexed: 11/28/2022]
Abstract
AIMS To assess the outcome of breast papillary lesions diagnosed by ultrasound-guided core needle biopsy (CB) or vacuum-assisted 'mammotome' biopsy (MT), the accuracy of these diagnoses, and whether it is justified not to undertake surgical excision of non-malignant papillary lesions so diagnosed. METHODS AND RESULTS Among 3219 (MT, 2195; CB, 1024) breast biopsies spanning 5 years, 185 (5.7%) papillary lesions [MT, 162 (88%); CB, 23 (12%)] were identified. Of these, 142 cases (77%; MT/CB, 125/17) were benign, 24 (13%, 23/1) were atypical, and 19 (10%; 14/5) were malignant. Of the 142 benign cases, 114 had imaging follow-up (FU) (FU period 2-81 months); 17 of 114 cases were excised, and four were malignant (3.5%) (FU period 4-57 months). Of the 24 atypical cases (23 had FU), 19 were excised: six were benign (32%) and 13 malignant (68%). The remaining four cases were considered to be non-malignant (FU period 7-54 months). CONCLUSIONS Benign papillary lesions diagnosed by MT or CB might not require immediate excision, but should receive imaging FU for at least 5 years. Excision should be performed in cases showing changes in imaging features, as the possibilities of carcinoma coexisting with papilloma or carcinoma developing from papilloma cannot be excluded, as illustrated by the 4% upgrade rate at excision in this study.
Collapse
Affiliation(s)
- Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume General Hospital, Kurume, Japan; Department of Pathology, Kurume General Hospital, Kurume, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Wang H, Tsang P, D'Cruz C, Clarke K. Follow-up of breast papillary lesion on core needle biopsy: experience in African-American population. Diagn Pathol 2014; 9:86. [PMID: 24762090 PMCID: PMC4039081 DOI: 10.1186/1746-1596-9-86] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/02/2014] [Indexed: 12/04/2022] Open
Abstract
Background The optimal course of clinical follow-up after a diagnosis of breast papillary lesion on a core needle biopsy (CNB) remains elusive. In particular, no reports in literature have addressed this question in African-American population. We describe our experience with breast papillary lesions in a primarily African-American population. Methods A search of our database for breast papillary lesions diagnosed on CNB between September 2002 and September 2012 was conducted. Cases were categorized into benign, atypical, and malignant. CK5/6 and CK903 stains were performed when necessary. Results A total of 64 breast papillary lesions were diagnosed on CNB, including 55 (86%) benign papillary lesions, 6 (9%) atypical lesions, and 3 (5%) intraductal papillary carcinomas. Of these 64 patients, 29 patients (25 African-Americans, 3 Hispanics, 1 Asian American) underwent lumpectomy within 6 months after CNB. Pathology of the lumpectomy showed: five of the 25 (20%) benign papillary lesions on needle biopsy were upgraded to intraductal or invasive papillary carcinoma; 2 of the 3 atypical papillary lesion cases on core biopsy were upgraded (67%), one into intraductal papillary carcinoma, the other invasive papillary carcinoma; the only case of malignant papillary lesion on CNB remained as intraductal papillary carcinoma on lumpectomy. The rate of upgrade in lumpectomy/mastectomy was 25%. CK5/6 and CK903 immunostains were performed on all seven core needle biopsies that were later upgraded. Conclusions In our predominantly African-American urban population, 25% of benign or atypical papillary lesions diagnosed on CNB was upgraded in the final excisional examination. Early excision of all papillary lesions diagnosed on CNB may be justified in this patient population. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7950117821177201
Collapse
Affiliation(s)
- He Wang
- Department of Pathology and Lab Medicine, Temple University School of Medicine, 3401 North Broad Street, Room 350, Philadelphia, PA 19140, USA.
| | | | | | | |
Collapse
|
32
|
Neal L, Sandhu NP, Hieken TJ, Glazebrook KN, Mac Bride MB, Dilaveri CA, Wahner-Roedler DL, Ghosh K, Visscher DW. Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc 2014; 89:536-47. [PMID: 24684875 DOI: 10.1016/j.mayocp.2014.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/05/2014] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Abstract
Imaging abnormalities detected by mammographic screening often lead to diagnostic evaluations, with suspicious abnormalities subjected to image-guided core needle biopsy (CNB) to exclude malignancy. Most CNBs reveal benign pathological alterations, termed benign breast disease (BBD). Adoption of CNB presents challenges with pathologic classification of breast abnormalities and management of patients with benign or atypical histological findings. Patient management and counseling after CNB diagnosis of BBD depends on postbiopsy determination of radiologic-pathologic concordancy. Communication between radiologists and pathologists is crucial in patient management. Management is dependent on the histological type of BBD. Patients with concordant pathologic imaging results can be reassured of benign biopsy findings and advised about the future risk of developing breast cancer. Surgical consultation is advised for patients with discordant findings, symptomatic patients, and high-risk lesions. This review highlights benign breast lesions that are encountered on CNB and summarizes management strategies. For this review, we conducted a search of PubMed, with no date limitations, and used the following search terms (or a combination of terms): atypical ductal hyperplasia, atypical hyperplasia, atypical lobular hyperplasia, benign breast disease, cellular fibroepithelial lesions, columnar cell lesions, complex sclerosing lesion, core needle biopsy, fibroadenomas, flat epithelial atypia, lobular carcinoma in situ, lobular neoplasia, mucocele-like lesions, phyllodes tumor, pseudoangiomatous stromal hyperplasia, radial scar, and vascular lesions. The selection of references included in this review was based on study relevance and quality. We used additional articles culled from the bibliographies of retrieved articles to examine the published evidence for risk factors of BBD.
Collapse
Affiliation(s)
- Lonzetta Neal
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Nicole P Sandhu
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Karthik Ghosh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
33
|
Abstract
Papillary lesions of the breast encompass a spectrum of both benign and malignant lesions despite sharing a similar basic architecture. A reliable distinction between the different entities is possible even in biopsies with precise knowledge of the diagnostic criteria and using immunohistochemistry as a diagnostic adjunct. These include papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma and solid papillary carcinoma. Architectural features, cellular composition and distribution of myoepithelial cells as highlighted by immunohistochemistry are the major diagnostic criteria. In this review the most useful morphological and immunohistochemical criteria for routine diagnostic practice are presented.
Collapse
Affiliation(s)
- F Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
| | | | | |
Collapse
|
34
|
Groppi DE, Alexis CE, Sugrue CF, Bevis CC, Bhuiya TA, Crawford JM. Consolidation of the North Shore-LIJ Health System anatomic pathology services: the challenge of subspecialization, operations, quality management, staffing, and education. Am J Clin Pathol 2013; 140:20-30. [PMID: 23765530 DOI: 10.1309/ajcpzheyk8xf4fck] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To describe our experience, both in meeting challenges and in reporting outcomes, of the consolidation of anatomic pathology services in the North Shore-LIJ Health System in February 2011. METHODS We addressed issues of governance, personnel, physical plant, quality programming, connectivity, and education. CONCLUSIONS The highly regulated nature of the laboratory industry and the fact that patient care necessarily never pauses require that such a consolidation take place without a break in service or degradation in turnaround time and quality while engaging personnel at all levels in the extra duties related to consolidation. Subspecialization has allowed us to better meet the needs of our in-system health care community while increasing our access to the competitive outreach marketplace.
Collapse
Affiliation(s)
- Diane E. Groppi
- Department of Pathology and Laboratory Medicine, Hofstra North Shore–LIJ School of Medicine and North Shore–LIJ Health System, Manhasset, NY
| | - Claudine E. Alexis
- Department of Pathology and Laboratory Medicine, Hofstra North Shore–LIJ School of Medicine and North Shore–LIJ Health System, Manhasset, NY
| | - Chiara F. Sugrue
- Department of Pathology and Laboratory Medicine, Hofstra North Shore–LIJ School of Medicine and North Shore–LIJ Health System, Manhasset, NY
| | - Cynthia C. Bevis
- Department of Pathology and Laboratory Medicine, Hofstra North Shore–LIJ School of Medicine and North Shore–LIJ Health System, Manhasset, NY
| | - Tawfiqul A. Bhuiya
- Department of Pathology and Laboratory Medicine, Hofstra North Shore–LIJ School of Medicine and North Shore–LIJ Health System, Manhasset, NY
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Hofstra North Shore–LIJ School of Medicine and North Shore–LIJ Health System, Manhasset, NY
| |
Collapse
|
35
|
Swapp RE, Glazebrook KN, Jones KN, Brandts HM, Reynolds C, Visscher DW, Hieken TJ. Management of Benign Intraductal Solitary Papilloma Diagnosed on Core Needle Biopsy. Ann Surg Oncol 2013; 20:1900-5. [DOI: 10.1245/s10434-012-2846-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Indexed: 11/18/2022]
|
36
|
Can additional immunohistochemistry staining replace the surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage core needle biopsy? Breast Cancer Res Treat 2013; 137:797-806. [DOI: 10.1007/s10549-012-2403-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/24/2012] [Indexed: 10/27/2022]
|
37
|
Li X, Weaver O, Desouki MM, Dabbs D, Shyum S, Carter G, Zhao C. Microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on core biopsy. Am J Clin Pathol 2012; 138:789-95. [PMID: 23161711 DOI: 10.1309/ajcptdqchiwh4ohm] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The follow-up excision (FUE) results were analyzed from 370 cases diagnosed as intraductal papilloma on breast core needle biopsy (CNB) with no history of malignancy or other risk factors. Of these cases, 98.6% were rendered a Breast Imaging Reporting and Data System score of 4 on mammography before the CNB. Fifty-one cases (13.8%) were found to have microcalcifications on microscopic examination of CNB. A total of 7 (1.9%) of 370 cases were upgraded to invasive carcinoma, ductal carcinoma in situ, or pleomorphic lobular carcinoma in situ on FUE. Six of 51 (11.8%) cases with microcalcifications found on imaging and CNB were upgraded to ductal carcinoma in situ or invasive carcinoma, whereas only 1 (0.3%) of 319 cases without microcalcifications was upgraded to pleomorphic lobular carcinoma in situ (P = .003). Results of a multivariate analysis adjusted for age confirmed that microcalcifications was a risk factor for upgrading to cancer, independent of age. Our results indicate that surgical excision is required for intraductal papilloma diagnosed on CNB if microcalcifications are present. However, excision may not be required for those who have no microcalcifications on CNB and no other known risk factors.
Collapse
|
38
|
Wen X, Cheng W. Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors. Ann Surg Oncol 2012; 20:94-101. [PMID: 22878621 DOI: 10.1245/s10434-012-2590-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical management of nonmalignant breast papillary lesions diagnosed at core-needle biopsy (CNB) is controversial. A meta-analysis was performed to evaluate pooled estimates of the underestimation of malignant papillary lesions (which were diagnosed as nonmalignant lesions at CNB) and to survey factors that affect that underestimation. METHODS We searched for studies that provided data on CNB underestimates of malignant breast papillary lesions indexed in PUBMED. The pooled estimate for underestimation was calculated. The association between each variable and underestimation was investigated using either random- or fixed-effects logistic modeling. RESULTS A total of 34 studies, which included 2,236 nonmalignant breast papillary lesions diagnosed at CNB and histologically examined after surgical excision, were included. Of these, 346 nonmalignant lesions at CNB were upgraded to malignant after surgical excision. The pooled estimate for the percentage of underestimation was 15.7% [95% confidence interval (CI): 12.8-18.5%]. The factors associated with higher underestimation included atypical papillary lesions (P<0.001), positive mammographic findings (P=0.022), and article publication year before 2005 (P<0.05). CONCLUSIONS It is recommended that atypical papillary lesions at CNB undergo surgical excision, and it is reasonable to follow patients with benign lesions with serial imaging. Lesion type, mammographic findings, and article publication year were significantly associated with underestimation.
Collapse
Affiliation(s)
- Xin Wen
- Department of Ultrasound, The Third Affiliated Hospital of Harbin Medical University, Nangang District, Harbin, Heilongjiang Province, China
| | | |
Collapse
|