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Loubrie S, Zou J, Rodriguez-Soto AE, Lim J, Andreassen MMS, Cheng Y, Batasin SJ, Ebrahimi S, Fang LK, Conlin CC, Seibert TM, Hahn ME, Dialani V, Wei CJ, Karimi Z, Kuperman J, Dale AM, Ojeda-Fournier H, Pisano E, Rakow-Penner R. Discrimination Between Benign and Malignant Lesions With Restriction Spectrum Imaging MRI in an Enriched Breast Cancer Screening Cohort. J Magn Reson Imaging 2024. [PMID: 39291552 DOI: 10.1002/jmri.29599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Breast cancer screening with dynamic contrast-enhanced MRI (DCE-MRI) is recommended for high-risk women but has limitations, including variable specificity and difficulty in distinguishing cancerous (CL) and high-risk benign lesions (HRBL) from average-risk benign lesions (ARBL). Complementary non-invasive imaging techniques would be useful to improve specificity. PURPOSE To evaluate the performance of a previously-developed breast-specific diffusion-weighted MRI (DW-MRI) model (BS-RSI3C) to improve discrimination between CL, HRBL, and ARBL in an enriched screening population. STUDY TYPE Prospective. SUBJECTS Exactly 187 women, either with mammography screening recommending additional imaging (N = 49) or high-risk individuals undergoing routine breast MRI (N = 138), before the biopsy. FIELD STRENGTH/SEQUENCE Multishell DW-MRI echo planar imaging sequence with a reduced field of view at 3.0 T. ASSESSMENT A total of 72 women had at least one biopsied lesion, with 89 lesions categorized into ARBL, HRBL, CL, and combined CLs and HRBLs (CHRLs). DW-MRI data were processed to produce apparent diffusion coefficient (ADC) maps, and estimate signal contributions (C1, C2, and C3-restricted, hindered, and free diffusion, respectively) from the BS-RSI3C model. Lesion regions of interest (ROIs) were delineated on DW images based on suspicious DCE-MRI findings by two radiologists; control ROIs were drawn in the contralateral breast. STATISTICAL TESTS One-way ANOVA and two-sided t-tests were used to assess differences in signal contributions and ADC values among groups. P-values were adjusted using the Bonferroni method for multiple testing, P = 0.05 was used for the significance level. Receiver operating characteristics (ROC) curves and intra-class correlations (ICC) were also evaluated. RESULTS C1, √C1C2, andlog C 1 C 2 C 3 $$ \log \left(\frac{{\mathrm{C}}_1{\mathrm{C}}_2}{{\mathrm{C}}_3}\right) $$ were significantly different in HRBLs compared with ARBLs (P-values < 0.05). Thelog C 1 C 2 C 3 $$ \log \left(\frac{{\mathrm{C}}_1{\mathrm{C}}_2}{{\mathrm{C}}_3}\right) $$ had the highest AUC (0.821) in differentiating CHRLs from ARBLs, performing better than ADC (0.696), especially in non-mass enhancement (0.776 vs. 0.517). DATA CONCLUSION This study demonstrated the BS-RSI3C could differentiate HRBLs from ARBLs in a screening population, and separate CHRLs from ARBLs better than ADC. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE 2.
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Affiliation(s)
- Stephane Loubrie
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Ana E Rodriguez-Soto
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Jihe Lim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Maren M S Andreassen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research and Innovation, Vestre Viken, Drammen, Norway
| | - Yuwei Cheng
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Summer J Batasin
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Sheida Ebrahimi
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Lauren K Fang
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Christopher C Conlin
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Tyler M Seibert
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine, University of California San Diego, La Jolla, California, USA
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Michael E Hahn
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Vandana Dialani
- Department of Radiology, Beth Israel Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine J Wei
- Department of Radiology, Mass General Brigham - Salem Hospital, Salem, Massachusetts, USA
| | - Zahra Karimi
- Department of Radiology, Beth Israel Hospital, Boston, Massachusetts, USA
| | - Joshua Kuperman
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Anders M Dale
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Haydee Ojeda-Fournier
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Etta Pisano
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- American College of Radiology, Reston, Virginia, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
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Cullinane C, Byrne J, Kelly L, O Sullivan M, Antony Corrigan M, Paul Redmond H. The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review & meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1464-1474. [PMID: 35491362 DOI: 10.1016/j.ejso.2022.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High-risk or B3 breast lesions are considered lesions of uncertain malignant potential and comprise between 5 and 12% of initial biopsy results. We sought to perform a systematic review and meta-analysis of studies published within the last twenty years to determine the pooled Positive Predictive Value (PPV) of VAB in selected B3 lesions. METHODS The study report is based on the guidelines of PRISMA and Meta-Analysis of Observational Studies in Epidemiology. OUTCOMES The primary outcome of this study was to determine the PPV of VAB in determining final histological diagnosis in B3 breast lesions using pooled estimates. The secondary outcomes were to determine if needle gauge or the re-classification of Lobular Carcinoma in Situ(LCIS) introduced in 2012 influenced pooled estimates. RESULTS 78 studies incorporating 6,377 B3 lesions were included in this review, 1214 of which were upgraded to DCIS or invasive malignancy following surgical excision(19%). The pooled PPV of VAB in Atypical Ductal Hyperplasia(ADH) and Lobular Neoplasia(LN) were 0.79(CI 0.76-0.83) and 0.84(CI 0.8-0.88). VAB of Flat Epithelial Atypia(FEA), radial scar and papillary lesions with/without atypia all had a pooled PPV >90% (underestimation rates 7%, 1%, 5% and 3% respectively). Needle gauge size and the change in LCIS classification did not appear to influence underestimation rates on subgroup analysis. CONCLUSION Results from this meta-analysis suggests it is reasonable to perform VAB as definitive treatment for certain B3 lesions, specifically LN, FEA, radial scar, and papillary lesions when specific criteria are fulfilled. Surgical excision should continue as the mainstay of treatment for ADH.
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Bong TSH, Tan JKT, Ho JTS, Tan PH, Lau WS, Tan TM, Wong JSL, Tan VKM, Tan BKT, Madhukumar P, Yong WS, Lim SZ, Wong CY, Ong KW, Sim Y. Atypical Ductal Hyperplasia of the Breast on Core Needle Biopsy: Risk of Malignant Upgrade On Surgical Excision. J Breast Cancer 2022; 25:37-48. [PMID: 35199500 PMCID: PMC8876544 DOI: 10.4048/jbc.2022.25.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/06/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making. Methods This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010–2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination. Results Between 2010 and 2015, 238,122 women underwent mammographic screening under the National Breast Cancer Screening Program. Among 29,564 women recalled, 5,971 CNBs were performed. Of these, 2,876 underwent CNBs at NCCS, with 88 patients (90 lesions) diagnosed with ADH and 26 lesions upgraded to breast malignancy on excision biopsy. In univariate analysis, factors associated with malignant upgrade were the presence of a mass on ultrasound (p = 0.018) or mammography (p = 0.026), microcalcifications (p = 0.047), diffuse microcalcification distribution (p = 0.034), mammographic parenchymal density (p = 0.008). and ≥ 3 separate ADH foci found on biopsy (p = 0.024). Mammographic parenchymal density (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.005–0.35; p = 0.014), presence of a mass on ultrasound (HR, 10.50; 95% CI, 9.21–25.2; p = 0.010), and number of ADH foci (HR, 1.877; 95% CI, 1.831–1.920; p = 0.002) remained significant in multivariate analysis and were included in the nomogram. Conclusion Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74–0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.
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Affiliation(s)
- Tiffany Sin Hui Bong
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Jun Kiat Thaddaeus Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Wing Sze Lau
- Department of Clinical Laboratory, Gleneagles Hospital Hong Kong, Hong Kong
| | - Tuan Meng Tan
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Jill Su Lin Wong
- Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore
| | - Veronique Kiak Mien Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
| | - Benita Kiat Tee Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Preetha Madhukumar
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
| | - Wei Sean Yong
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
| | - Sue Zann Lim
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
| | - Chow Yin Wong
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
| | - Kong Wee Ong
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
| | - Yirong Sim
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Breast Centre, Singapore
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Nicosia L, Latronico A, Addante F, De Santis R, Bozzini AC, Montesano M, Frassoni S, Bagnardi V, Mazzarol G, Pala O, Lazzeroni M, Lissidini G, Mastropasqua MG, Cassano E. Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate? Diagnostics (Basel) 2021; 11:diagnostics11061120. [PMID: 34205428 PMCID: PMC8259513 DOI: 10.3390/diagnostics11061120] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients’ characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.
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Affiliation(s)
- Luca Nicosia
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Antuono Latronico
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Francesca Addante
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70124 Bari, Italy;
| | - Rossella De Santis
- Postgraduate School in Radiology, University of Milan, 20122 Milan, Italy;
| | - Anna Carla Bozzini
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Marta Montesano
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Giovanni Mazzarol
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.M.); (O.P.)
| | - Oriana Pala
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.M.); (O.P.)
| | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Germana Lissidini
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Mauro Giuseppe Mastropasqua
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-0805594414
| | - Enrico Cassano
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
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El Sanharawi I, Bataillon G, Journo G, Farkhondeh F, Sebbag-Sfez D, Malhaire C, Tardivon A, Mosseri V, Thibault FE. Clinical management of atypical ductal hyperplasia on vacuum-assisted biopsy of microcalcifications: External validation study of a decision tree selecting patients eligible for surveillance. Eur J Radiol 2021; 141:109826. [PMID: 34174485 DOI: 10.1016/j.ejrad.2021.109826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atypical lesions found on percutaneous breast biopsy raise specific management issues. The aim of this study was to validate the previous performance of a decision tree defined by Forgeard et al to select a subset of patients at low-risk of surgical diagnostic upgrade that would be eligible for surveillance. METHODS A consecutive series of 211 patients diagnosed with ADH on vacuum-assisted biopsy (VAB) of clustered microcalcifications alone, then operated in our institution, was reviewed. Histological findings on percutaneous cores were compared with definitive diagnoses on surgical specimens. The rate of cancer underestimation on VAB was analyzed in the four arms and two management attitudes defined in the scheme, using size and quality of microcalcification removal and the number of ADH foci. RESULTS Ninety-eight women with ADH met the inclusion criteria. Overall, 20 cancers were diagnosed at surgery, showing a malignancy rate of 44% (17/39 patients) in the surgery group and of 5% (3/59 patients) in the surveillance group, which was not significantly different from the 2% rate in the monitored reference group (p > 0.64). The malignancy rate increased significantly with the size of clustered microcalcifications (0% when < 6mm, 17% when between 6mm and 21 mm, 48% when > 21 mm, p < 0001) and the number of ADH foci on VAB (14% when ≤ 2, 45% when > 2, p < 0.005). CONCLUSION Our results corroborate - within the limits of large confidence intervals - those obtained with the reference decision tree. Due to statistical uncertainty, however, they need to be prospectively validated in a broader series.
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Affiliation(s)
- Imane El Sanharawi
- Département d'Imagerie Médicale, Institut Curie, 26 rue d'Ulm, F-75005, Paris, France
| | - Guillaume Bataillon
- Pôle de Médecine Diagnostique et Théranostique, Institut Curie, 26 rue d'Ulm, F-75005, Paris, France
| | - Gabrielle Journo
- Département d'Imagerie Médicale, Institut Curie, 35 rue Dailly, F-92210, Saint-Cloud, France
| | - Fereshteh Farkhondeh
- Pôle de Médecine Diagnostique et Théranostique, Institut Curie, 26 rue d'Ulm, F-75005, Paris, France
| | - Delphine Sebbag-Sfez
- Département d'Imagerie Médicale, Institut Curie, 26 rue d'Ulm, F-75005, Paris, France
| | - Caroline Malhaire
- Département d'Imagerie Médicale, Institut Curie, 26 rue d'Ulm, F-75005, Paris, France; Laboratoire d'Imagerie Translationnelle en Oncologie, INSERM, Institut Curie, 91401, Orsay, France
| | - Anne Tardivon
- Département d'Imagerie Médicale, Institut Curie, 26 rue d'Ulm, F-75005, Paris, France
| | - Véronique Mosseri
- PSL Research University, DRCI, Biométrie, 35 Rue Dailly, F-92210, Saint-Cloud, France
| | - Fabienne E Thibault
- Département d'Imagerie Médicale, Institut Curie, 26 rue d'Ulm, F-75005, Paris, France.
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Upgrade Rate of Atypical Ductal Hyperplasia: Ten Years Experience and Predictive Factors. J Surg Res 2021; 266:311-318. [PMID: 34044175 DOI: 10.1016/j.jss.2021.03.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/13/2021] [Accepted: 03/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atypical ductal hyperplasia (ADH) is a benign epithelial proliferative lesion with histologic features resembling those seen in low grade ductal carcinoma in situ (DCIS). Surgical excision of the biopsy site is the standard management approach. The objective of this study was to determine the upgrade rate from ADH on stereotactic breast biopsies to DCIS or invasive carcinoma (IC) in our institution. We also sought to identify clinical, pathologic and radiologic predictive factors associated with risk of upgrade. MATERIALS AND METHODS Clinical charts, mammograms and pathology reports were reviewed for all women with a stereotactic breast biopsy showing ADH and subsequent surgery at our institution between 2008 and 2018. When available, mammograms were re-reviewed by a radiologist for this study. RESULTS 295 biopsies were analyzed in 290 patients. Mean age was 56 y old. Upgrade rate was 10.5% of which 7.5% were DCIS and 3.1% IC. Mammograms were reviewed by a radiologist in 161 patients from 2013 to 2018. In this subset of patients, the rate of upgrade was 8.7% (4.35% DCIS and 4.35% IC). A statistically significant difference he largest size of the microcalcification clusters on mammogram was observed between the upgraded and the non-upgraded subgroups (14.2 mm versus 8.9 mm, P = 0.03) CONCLUSIONS: The evaluation of the largest size of microcalcification clusters on mammogram as a cut-off feature could be considered to choose between an observational versus a surgical approach. This large series provides contemporary data to assist informed decision making regarding the treatment of our patients.
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7
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Zhang C, Wang EY, Liu F, Ruhul Quddus M, James Sung C. Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases. Int J Surg Pathol 2021; 29:716-721. [PMID: 33881947 DOI: 10.1177/10668969211010954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The literature shows a wide range in the frequencies of finding breast carcinoma in the excised specimens following a biopsy diagnosis of atypical ductal hyperplasia (ADH), likely due to a poor diagnostic reproducibility among different pathologists as well as an inherent heterogeneity in ADH. We evaluated whether histologic subtyping of ADH would help predict the risk of breast carcinoma. Our study consisted of 143 cases of ADH diagnosed by core needle biopsy and followed by excision. Of these, 54 cases (37.8%) showed carcinoma in the excised specimens (47 cases of ductal carcinoma in situ alone, 3 cases of invasive ductal carcinoma alone, and 4 cases of mixed invasive ductal carcinoma and ductal carcinoma in situ). We arbitrarily divided ADH into two subtypes: type A was considered when one or more ducts were completely replaced by low-grade ductal carcinoma in situ type cells but the lesion was <2 mm and type B was considered when one or more ducts were partially involved by low-grade ductal carcinoma in situ type cells regardless of lesion size. Type A was associated with a significantly higher frequency of breast carcinoma (63.6%) than type B (30.0%). ADH containing punctate necrosis showed a higher association of carcinoma (66.7%) compared to those without necrosis (35.1%). Within type B ADH, involvement of 3 or more foci had a higher frequency of carcinoma (50.0%) than involvement of fewer foci (26.6%). These histologic features of ADH may prove useful in predicting the likelihood of breast carcinoma and provide helpful information for patient's management.
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Affiliation(s)
- Cunxian Zhang
- Kent Hospital, Warwick, RI, USA.,22209Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Warren Alpert Medical School, 6752Brown University, Providence, RI, USA
| | - Edmond Y Wang
- 22209Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Now with Meditech, One Constitution Way, Foxborough, MA, USA
| | - Fang Liu
- 22209Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Warren Alpert Medical School, 6752Brown University, Providence, RI, USA.,Now with Saint Vincent Hospital, Worcester Medical Center, Worcester, MA, USA
| | - M Ruhul Quddus
- 22209Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Warren Alpert Medical School, 6752Brown University, Providence, RI, USA
| | - C James Sung
- 22209Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Warren Alpert Medical School, 6752Brown University, Providence, RI, USA
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8
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Atypical Ductal Hyperplasia on Ultrasonography-Guided Vacuum-Assisted Biopsy of the Breast: Considerations for Further Surgical Excision. Ultrasound Q 2021; 36:192-198. [PMID: 32511211 DOI: 10.1097/ruq.0000000000000478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purposes of this study are to evaluate the upgrade rate of atypical ductal hyperplasia (ADH) diagnosed with ultrasonography (US)-guided vacuum-assisted biopsy (VAB) to malignancy and to identify the factors behind the underestimation. We retrospectively reviewed the pathologic results of US-guided VAB of the breast. A total of 50 ADH lesions that were surgically excised or with more than 12 months of follow-up were included. The upgrade rate of ADH was determined by dividing the number of lesions that were proven malignant on surgical excision by the total number of ADH diagnosed on VAB. Clinical, radiologic, procedural, and pathologic variables were analyzed to identify the factors behind the underestimation. The upgrade rate of ADH was found to be 16.0% (8/50 lesions). In univariable and multivariable analyses, the upgrade rates of ADH did not significantly differ among variables. In a subgroup analysis, according to history of breast cancer, the upgrade rates of ADH were significantly lower for lesions of mass than for lesions of nonmass (0% [0/23 lesions] vs 28.6% [4/14 lesions], P = 0.015), and for lesions without calcifications than for lesions with calcifications (0% [0/22 lesions] vs 26.7% [4/15 lesions], P = 0.021) in the negative history subgroup. ADH lesions in masses or without calcifications in patients without a family or personal history of breast cancer were associated with low upgrade rates. Thus, we suggest that ADH with these features can be followed rather than surgically excised after US-guided VAB.
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9
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Huang YX, Chen YL, Li SP, Shen JP, Zuo K, Zhou SC, Chang C. Development and Validation of a Simple-to-Use Nomogram for Predicting the Upgrade of Atypical Ductal Hyperplasia on Core Needle Biopsy in Ultrasound-Detected Breast Lesions. Front Oncol 2021; 10:609841. [PMID: 33868984 PMCID: PMC8044403 DOI: 10.3389/fonc.2020.609841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background The rate of carcinoma upgrade for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) is variable on open excision. The purpose of the present study was to develop and validate a simple-to-use nomogram for predicting the upgrade of ADH diagnosed with ultrasound (US)-guided core needle biopsy in patients with US-detected breast lesions. Methods Two retrospective sets, the training set (n = 401) and the validation set (n = 186), from Fudan University Shanghai Cancer Center between January 2014 and December 2019 were retrospectively analyzed. Clinicopathological and US features were selected using univariate and multivariable logistic regression, and the significant features were incorporated to build a nomogram model. Model discrimination and calibration were assessed in the training set and validation set. Results Of the 587 ADH biopsies, 67.7% (training set: 267/401, 66.6%; validation set: 128/186, 68.8%) were upgraded to cancers. In the multivariable analysis, the risk factors were age [odds ratio (OR) 2.739, 95% confidence interval (CI): 1.525–5.672], mass palpation (OR 3.008, 95% CI: 1.624–5.672), calcifications on US (OR 4.752, 95% CI: 2.569–9.276), ADH extent (OR 3.150, 95% CI: 1.951–5.155), and suspected malignancy (OR 4.162, CI: 2.289–7.980). The model showed good discrimination, with an area under curve (AUC) of 0.783 (95% CI: 0.736–0.831), and good calibration (p = 0.543). The application of the nomogram in the validation set still had good discrimination (AUC = 0.753, 95% CI: 0.666–0.841) and calibration (p = 0.565). Instead of surgical excision of all ADHs, if those categorized with the model to be at low risk for upgrade were surveillanced and the remainder were excised, then 63.7% (37/58) of surgeries of benign lesions could have been avoided and 78.1% (100/128) malignant lesions could be treated in time. Conclusions This study developed a simple-to-use nomogram by incorporating clinicopathological and US features with the overarching goal of predicting the probability of upgrade in women with ADH. The nomogram could be expected to decrease unnecessary surgery by nearly two-third and to identify most of the malignant lesions, helping guide clinical decision making with regard to surveillance versus surgical excision of ADH lesions.
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Affiliation(s)
- Yun-Xia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Ling Chen
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shi-Ping Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ju-Ping Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ke Zuo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shi-Chong Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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10
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Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia. Breast Cancer Res Treat 2020; 184:873-880. [PMID: 32857242 DOI: 10.1007/s10549-020-05890-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Upgrade rates of conventional ADH are reported at 10-30%; however, rates for ADH bordering on DCIS (ADH-BD) are largely unknown. We examined the upgrade rate of ADH-BD and core needle biopsy (CNB) features associated with upgrade. Surgical management in patients with concurrent ipsilateral breast cancer (BC) was also examined. METHODS From 2000 to 2018, women with CNB diagnosis of ADH-BD were prospectively identified. Women with pure ADH-BD and concurrent ipsilateral ADH-BD/BC were analyzed separately, and upgrade rates were calculated. CNB features associated with upgrade and type of surgery were examined in women with pure ADH-BD; CNB features and concurrent pathology associated with upgrade were examined in women with ipsilateral BC. RESULTS 108/236 (46%) patients with pure ADH-BD on CNB had DCIS (40%) or invasive carcinoma (6%) on surgical excision. DCIS or invasive carcinoma was more frequently found on excision of a mass that yielded ADH-BD on biopsy than excision of calcifications (65% vs 38%; p < 0.001). The breast conservation success rate was high (80%) in patients who upgraded, despite a high re-excision rate of 46%. The upgrade rate of ADH-BD in women with concurrent ipsilateral BC was 41%. Most women (94%) with ADH-BD in the same quadrant as the BC were candidates for breast conserving surgery, with a success rate of 89%. CONCLUSION The upgrade rate for pure ADH-BD is significantly higher than that reported for women with conventional ADH, especially in women with a mass on imaging. The upgrade rate of concurrent ipsilateral ADH-BD and BC is similarly high. Excision with a margin of normal tissue and specimen inking should be routine to minimize the need for re-excision.
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11
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Meucci R, Pistolese Chiara A, Perretta T, Vanni G, Portarena I, Manenti G, Ryan Colleen P, Castrignanò A, Di Stefano C, Ferrari D, Lamacchia F, Pellicciaro M, Materazzo M, Buonomo Oreste C. MR imaging-guided vacuum assisted breast biopsy: Radiological-pathological correlation and underestimation rate in pre-surgical assessment. Eur J Radiol Open 2020; 7:100244. [PMID: 32715029 PMCID: PMC7369605 DOI: 10.1016/j.ejro.2020.100244] [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: 03/13/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Magnetic Resonance(MR) guided percutaneous procedures(MRgVABB) have been developed and largely employed to reduce the need of surgical biopsies for suspicious lesions which can be detected only by MR(MR-only lesion). The present study aims to investigate correlation between imaging, histological features of MRgVABB and surgical specimens of MR-only lesions. METHODS We retrospectively enrolled 56 patients with a total of 61 lesions. Each finding was defined as Mass-Enhancement(ME) or Non-ME(NME) and classified according to BI-RADS. MRgVABB and surgical data were collected. Concordance between MR, MRgVABB and open biopsy was calculated. Underestimation Rate(UR) of MRgVABB with surgery was obtained. RESULTS B2 and B5b lesions were statistically associated with NME and ME, respectively. No statistical association was found to B3 nor to B5a with radiological features. UR was 10 %; underestimated lesions were strongly associated with the presence of a ME on MR imaging. Moreover, B3 lesions are associated with higher UR. CONCLUSION Radiological features should influence patient management aiming to construct a correct diagnostic and therapeutic plan. When MR is prescribed for breast cancer staging for ME-MR-only lesions, we suggest surgical open biopsy instead of MRgVABB when upfront surgery is the treatment of choice.
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Affiliation(s)
- Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Adriana Pistolese Chiara
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Guglielmo Manenti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Patricia Ryan Colleen
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Antonella Castrignanò
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Donatella Ferrari
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Claudio Buonomo Oreste
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
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12
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Schiaffino S, Calabrese M, Melani EF, Trimboli RM, Cozzi A, Carbonaro LA, Di Leo G, Sardanelli F. Upgrade Rate of Percutaneously Diagnosed Pure Atypical Ductal Hyperplasia: Systematic Review and Meta-Analysis of 6458 Lesions. Radiology 2019; 294:76-86. [PMID: 31660803 DOI: 10.1148/radiol.2019190748] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Management of percutaneously diagnosed pure atypical ductal hyperplasia (ADH) is an unresolved clinical issue. Purpose To calculate the pooled upgrade rate of percutaneously diagnosed pure ADH. Materials and Methods A search of MEDLINE and EMBASE databases was performed in October 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines were followed. A fixed- or random-effects model was used, along with subgroup and meta-regression analyses. The Newcastle-Ottawa scale was used for study quality, and the Egger test was used for publication bias. Results Of 521 articles, 93 were analyzed, providing data for 6458 ADHs (5911 were managed with surgical excision and 547 with follow-up). Twenty-four studies used core-needle biopsy; 44, vacuum-assisted biopsy; 21, both core-needle and vacuum-assisted biopsy; and four, unspecified techniques. Biopsy was performed with stereotactic guidance in 29 studies; with US guidance in nine, with MRI guidance in nine, and with mixed guidance in eight. Overall heterogeneity was high (I2 = 80%). Subgroup analysis according to management yielded a pooled upgrade rate of 29% (95% confidence interval [CI]: 26%, 32%) for surgically excised lesions and 5% (95% CI: 4%, 8%) for lesions managed with follow-up (P < .001). Heterogeneity was entirely associated with surgically excised lesions (I2 = 78%) rather than those managed with follow-up (I2 = 0%). Most variability was explained by guidance and needle caliper (P = .15). At subgroup analysis of surgically excised lesions, the pooled upgrade rate was 42% (95% CI: 31%, 53%) for US guidance, 23% (95% CI: 19%, 27%) for stereotactic biopsy, and 32% (95% CI: 22%, 43%) for MRI guidance, with heterogeneity (52%, 63%, and 56%, respectively) still showing the effect of needle caliper. When the authors considered patients with apparent complete lesion removal after biopsy (subgroups in 14 studies), the pooled upgrade rate was 14% (95% CI: 8%, 23%). Study quality was low to medium; the risk of publication bias was low (P = .10). Conclusion Because of a pooled upgrade rate higher than 2% (independent of biopsy technique, needle size, imaging guidance, and apparent complete lesion removal), atypical ductal hyperplasia diagnosed with percutaneous needle biopsy should be managed with surgical excision. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Brem in this issue.
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Affiliation(s)
- Simone Schiaffino
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Massimo Calabrese
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Enrico Francesco Melani
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Rubina Manuela Trimboli
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Andrea Cozzi
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Luca Alessandro Carbonaro
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Giovanni Di Leo
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Francesco Sardanelli
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
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13
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Radiologic and Pathologic Features Associated With Upgrade of Atypical Ductal Hyperplasia at Surgical Excision. Acad Radiol 2019; 26:893-899. [PMID: 30318287 DOI: 10.1016/j.acra.2018.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate radiologic and pathologic features associated with upgrade of atypical ductal hyperplasia (ADH) to ductal carcinoma in situ or invasive breast cancer at surgical excision, in order to identify patients who may consider alternatives to excision. MATERIALS AND METHODS This retrospective analysis examined patients who underwent surgical excision of biopsy-proven ADH at our institution. Imaging and pathology from biopsy were reviewed to determine radiologic (lesion size, radiologic abnormality, biopsy type, needle gauge, number of cores, percent of lesion removed) and pathologic features (histologic calcifications, presence of necrosis, micropapillary features, extent of ADH) associated with ADH upgrade. RESULTS One hundred twenty four cases of percutaneous biopsy-proven ADH with subsequent excision were included. The overall upgrade rate was 17.7% (n = 22), with 17 cases to ductal carcinoma in situ and five to invasive cancer. Radiologic features associated with a lower upgrade rate were smaller lesion size (p = 0.032) and larger percent of lesion removed at biopsy (p = 0.047). Larger needle gauge at biopsy (p = 0.070), absence of necrosis (p = 0.051) and focal ADH (<3 foci, p = 0.12) were nearly associated with a lower rate of upgrade and were included for the purpose of multi parameter analyses. CONCLUSION For women with ADH identified on percutaneous biopsy, the risk of upgrade may in part be determined by lesion size, percent of lesion removed at biopsy, presence of necrosis, and extent of ADH. Using a combination of these radiographic and pathologic features to stratify patients with biopsy-proven ADH may help identify women who could be considered for alternative treatment options.
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14
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Tozbikian G, George M, Zynger DL. Diagnostic terminology used to describe atypia on breast core needle biopsy: correlation with excision and upgrade rates. Diagn Pathol 2019; 14:69. [PMID: 31253155 PMCID: PMC6599335 DOI: 10.1186/s13000-019-0842-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background Subjective qualitative descriptors are sometimes used to describe atypical breast lesions diagnosed on core needle biopsy (CNB) which are limited in extent. In clinical practice, this terminology is used to imply a lower expected risk of upgrade on surgical excision (EXC). It is uncertain how subjective terminology impacts clinical management. Methods We conducted a retrospective review of CNB with atypia and compared the EXC and upgrade rates of atypical ductal hyperplasia (ADH) and flat epithelial atypia (FEA) to lesions described as “focal” atypical ductal hyperplasia (FADH), to determine the impact of this diagnostic phrasing on surgical management and risk of malignancy. Results FADH and ADH were excised at similar rates (82% vs. 78%). FADH lesions showed a similar upgrade rate (13%) compared to non-focal ADH (10%), and both showed a trend towards higher upgrade and EXC rates compared to FEA. ADH, FADH and FEA all had an upgrade risk that warranted EXC. In non-upgraded EXC, for each diagnostic category we observed similar rates of residual atypia in the EXC. Conclusions Pathologists should avoid the use of qualitative descriptors when describing ADH on CNB because of the potential of this terminology to influence clinical decision making which is unwarranted.
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Affiliation(s)
- Gary Tozbikian
- Division of Breast Pathology, Department of Pathology, Wexner Medical Center at The Ohio State University, E414 Doan Hall, 410 W. 10th Ave, Columbus, OH, 43210, USA.
| | - Michael George
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debra L Zynger
- Division of Genitourinary Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, E401 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
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15
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Moseley TW, Shah SS, Nguyen CV, Rosenblat J, Resetkova E, Sneige N, Brandt KR, Huo L. Clinical Management of Mucocele-Like Lesions of the Breast with Limited or no Epithelial Atypia on Core Biopsy: Experience from Two Institutions. Ann Surg Oncol 2019; 26:3478-3488. [PMID: 31187364 DOI: 10.1245/s10434-019-07377-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Mucocele-like lesions of the breast identified on core biopsy are rare high-risk lesions associated with variable upgrade rates to carcinoma on excision. We aimed to identify the clinicoradiopathological features that can help optimize management of this lesion. METHODS We evaluated 50 mucocele-like lesions identified on core biopsies from two institutions, including 36 with no atypia and 14 with limited atypia. Outcome data from excision or clinicoradiological follow-up were reviewed with core biopsy results. RESULTS Radiological targets were calcifications in 74% of cases, calcifications with associated mass or density in 16%, and mass in 10%. One of the 16 excised lesions without atypia on core biopsy, which was a mass lesion, was upgraded to mucinous carcinoma on excision. Of the 12 excised lesions with limited atypia, none were upgraded on excision. Among the lesions not excised, 20 without atypia had a median follow-up of 61 months, and 2 with limited atypia had follow-up of 97 and 109 months. None of these 22 patients had new development of their lesions on follow-up. The upgrade rate was 2% in our entire cohort, 3% for lesions without atypia, and 0% for lesions with limited atypia. CONCLUSIONS Clinicoradiological surveillance can be appropriate when a mucocele-like lesion without atypia is identified on core biopsy for a non-mass lesion with pathological-radiological concordance. For mucocele-like lesions with limited atypia, a nonsurgical approach could be considered if the atypia by itself does not warrant excision. The latter recommendation requires careful clinicopathological correlation and support from additional studies.
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Affiliation(s)
- Tanya W Moseley
- Department of Diagnostic Radiology, Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sejal S Shah
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Christopher V Nguyen
- Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Juliana Rosenblat
- Department of Diagnostic Radiology, Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erika Resetkova
- Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Nour Sneige
- Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Kathy R Brandt
- Department of Radiology, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Lei Huo
- Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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16
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Sanderink WBG, Laarhuis BI, Strobbe LJA, Sechopoulos I, Bult P, Karssemeijer N, Mann RM. A systematic review on the use of the breast lesion excision system in breast disease. Insights Imaging 2019; 10:49. [PMID: 31049740 PMCID: PMC6497703 DOI: 10.1186/s13244-019-0737-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/20/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose To outline the current status of and provide insight into possible future research on the breast lesion excision system (BLES) as a diagnostic and therapeutic device. Methods A systematic search of the literature was performed using PubMed, Embase, and the Cochrane databases to identify relevant studies published between January 2002 and April 2018. Studies were considered eligible for inclusion if they evaluated the diagnostic or therapeutic accuracy or safety of BLES. Results Ultimately, 17 articles were included. The reported underestimation rates of atypical ductal hyperplasia and ductal carcinoma in situ (DCIS) ranged from 0 to 14.3% and from 0 to 22.2%, respectively. Complete excision rates for invasive ductal carcinoma and DCIS ranged from 5.3 to 76.3%. Bleeding was the most frequently reported complication (0–11.8%). Device-related complications may arise, with an empty basket being the most common (0.6–3.6%). Thermal damage of the specimen, caused by the use of a radiofrequency cutting wire, was reported in eight of the included studies. Most thermal artifacts were reported as superficial and small (0.1–1.9 mm). Conclusions The BLES, an automated, image-guided, single-pass biopsy system for breast lesions using radiofrequency is designed to excise and retrieve an intact tissue specimen. It is an efficient and safe breast biopsy method with acceptable complication rates, which may be used as an alternative to vacuum-assisted biopsies. The variable rate of complete excision raises questions about the possibility to use BLES as a therapeutic device for the excision of small lesions. Further research should focus on this aspect of BLES.
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Affiliation(s)
- Wendelien B G Sanderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Babette I Laarhuis
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
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Whitworth P, Schonholz S, Phillips R, Robertson Y, Ruiz A, Winchester S, Graham C, Simpson J, Wernecke C. Minimally Invasive Intact Excision of High-Risk Breast Lesions and Small Breast Cancers: The Intact Percutaneous Excision (IPEX) Registry. Ann Surg Oncol 2019; 26:954-960. [PMID: 30756327 DOI: 10.1245/s10434-019-07212-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aiming to minimize overtreatment of high-risk breast lesions (HRLs), including atypical ductal hyperplasia, and small breast cancers, including ductal carcinoma in situ (DCIS), we investigated a minimally invasive (MI) approach to definitive diagnosis and management of these conditions. METHODS In the prospective Intact Percutaneous Excision registry study, women aged 31-86 years had removal of small invasive cancers, DCIS, or HRLs using image-guided 12-20 mm radiofrequency basket capture (MI excision). Second-pass 20 mm basket capture obtained shaved margins in cancer patients. Standard imaging (specimen, breast) and histologic criteria were applied. Patient data were registered in an Institutional Review Board approved, Health Insurance Portability and Accountability Act-compliant registry. RESULTS Of 282 registered patients, 124 had DCIS (n = 52) or invasive cancer (n = 72) and 160 had HRLs. Among cancer patients, 101 (81%) had clear histologic margins [average lesion size was 11 mm for both invasive cancers (4-20 mm) and DCIS (1.5-20 mm)]; 29 patients had re-excision (six despite clear margins). Among 160 HRLs, two were upgraded to DCIS and had MI excision. Two other HRL patients had subsequent standard surgical excision (no cancer found). CONCLUSION For diminutive HRLs, DCIS, and invasive cancers, MI excision can achieve the same procedure goals as standard surgical excision. Because MI excision removes less tissue with small incisions, it may reduce the discomfort and expense associated with standard treatment.
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Affiliation(s)
| | | | | | | | - Antonio Ruiz
- Chesapeake Regional Medical Center, Chesapeake, VA, USA
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Yao K. Intact Excision of Breast Lesions Using BLES™: Is There a Clinical Indication Yet? Ann Surg Oncol 2019; 26:933-935. [PMID: 30737664 DOI: 10.1245/s10434-019-07214-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Katharine Yao
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA.
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Boateng S, Tirada N, Khorjekar G, Richards S, Ioffe O. Excision or Observation: The Dilemma of Managing High-Risk Breast Lesions. Curr Probl Diagn Radiol 2018; 49:124-132. [PMID: 30616911 DOI: 10.1067/j.cpradiol.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022]
Abstract
There is an enduring dilemma on the appropriate management of high-risk breast lesions; is surgical excision always warranted or can conservative management be utilized? We present cases of high-risk breast lesions diagnosed at core needle biopsy at our institution along with relevant factors to consider for appropriate management. We conclude that a nuanced approach is warranted over the broad stroke approach of surgical excision of all high-risk breast lesions.
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Affiliation(s)
- Sheila Boateng
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nikki Tirada
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | - Gauri Khorjekar
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Stephanie Richards
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Olga Ioffe
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
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20
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Leithner D, Kaltenbach B, Hödl P, Möbus V, Brandenbusch V, Falk S, Park C, Vogl TJ, Müller-Schimpfle M. Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision. Breast Care (Basel) 2018; 13:364-368. [PMID: 30498423 DOI: 10.1159/000489096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.
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Affiliation(s)
- Doris Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt/M., Germany
| | - Benjamin Kaltenbach
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt/M., Germany
| | - Petra Hödl
- Institute of Pathology, Klinikum Frankfurt Höchst, Frankfurt/M., Germany
| | - Volker Möbus
- Department of Obstetrics and Gynecology, Klinikum Frankfurt Höchst, Frankfurt/M., Germany
| | - Volker Brandenbusch
- Mammography Screening, Diagnostic Breast Center Turmcarée, Frankfurt/M., Germany
| | - Stephan Falk
- OptiPath, Pathology Associates, Frankfurt/M., Germany
| | - Clara Park
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt/M., Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt/M., Germany
| | - Markus Müller-Schimpfle
- Institute of Radiology (RZI), Klinikum Frankfurt Höchst, Academic Teaching Hospital of the University of Frankfurt, Frankfurt/M., Germany
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Abstract
Atypical ductal hyperplasia (ADH) is a proliferative, nonobligate precursor breast lesion and a marker of increased risk for breast carcinoma. Surgical excision remains the standard recommendation following a core needle biopsy result consistent with ADH. Recent research suggests that women with no mass lesion or discordance, removal of greater than or equal to 90% of calcifications at the time of core needle biopsy, involvement of less than or equal to 2 terminal duct lobular units, and absence of cytologic atypia or necrosis are likely to have a less than 5% chance of a missed cancer.
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Affiliation(s)
- Jennifer M Racz
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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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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Drouet Y, Le Gall J, Gervasoni J, Peix M, Faure C, Lasset C, Treilleux I. Prise en charge des hyperplasies canalaires atypiques sur macrobiopsies : une désescalade possible ? IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferreira VCCDS, Etchebehere ECSDC, Bevilacqua JLB, de Barros N. Suspicious amorphous microcalcifications detected on full-field digital mammography: correlation with histopathology. Radiol Bras 2018; 51:87-94. [PMID: 29743735 PMCID: PMC5935401 DOI: 10.1590/0100-3984.2017.0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate suspicious amorphous calcifications diagnosed on full-field
digital mammography (FFDM) and establish correlations with histopathology
findings. Materials and Methods This was a retrospective study of 78 suspicious amorphous calcifications (all
classified as BI-RADS® 4) detected on FFDM.
Vacuum-assisted breast biopsy (VABB) was performed. The histopathological
classification of VABB core samples was as follows: pB2 (benign); pB3
(uncertain malignant potential); pB4 (suspicion of malignancy); and pB5
(malignant). Treatment was recommended for pB5 lesions. To rule out
malignancy, surgical excision was recommended for pB3 and pB4 lesions.
Patients not submitted to surgery were followed for at least 6 months. Results Among the 78 amorphous calcifications evaluated, the histopathological
analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as
pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2).
The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were
precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat
epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions,
the underestimation rate was zero. Conclusion The diagnosis of precursor lesions (excluding atypical ductal hyperplasia,
which can be pB4 depending on the severity and extent of the lesion) should
not necessarily be considered indicative of underestimation of malignancy.
Suspicious amorphous calcifications correlated more often with precursor
lesions than with malignant lesions, at a ratio of 3:1.
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Affiliation(s)
| | | | | | - Nestor de Barros
- MD, PhD, Tenured Professor, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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25
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Gristina L, Rescinito G, Garlaschi A, Tosto S, Cevasco L, Calabrese M. Freehand 3T MR-guided vacuum-assisted breast biopsy (VAB): a five-year experience. Acta Radiol 2018; 59:540-545. [PMID: 28862025 DOI: 10.1177/0284185117730102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Magnetic resonance (MR) permits the detection of some malignant lesions that cannot be identified with mammography or ultrasonography. The characterization of these MR-only detectable lesions often requires a biopsy. Purpose To evaluate the technique, the feasibility and the accuracy of freehand 3T MR-guided VAB for the characterization of suspicious, MR-only detectable lesions and to compare VAB results with surgical pathology and follow-up imaging results. Material and Methods During 2010-2015, 118 women who were referred for MR-guided VAB were retrospectively reviewed. All BI-RADS MR 4 and 5 lesions and some BI-RADS MR 3 lesions (according to clinical context and patient anxiety) were scheduled to undergo biopsy. Results A total of 123 suspicious lesions were retrospectively selected. Technical failures occurred in only two cases (1.6%) due to the location of the lesions. Histopathological results revealed 59 benign lesions (48%), 27 high-risk lesions (22%), and 35 malignant lesions (28.4%). Surgical pathology results led to the reclassification of eight B3 lesions: one proved to be a ductal carcinoma in situ, while seven presented with invasive features. B3 underestimation also occurred in 29% of the cases. MR follow-up was achieved for all the benign lesions and no false-negative cases were observed. No complications, 3T-related artefacts, or difficulties were observed. Conclusion Freehand 3T MR-guided VAB was found to be a valid, safe, fast, and inexpensive alternative to surgical histology.
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Affiliation(s)
- Licia Gristina
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giuseppe Rescinito
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Alessandro Garlaschi
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Simona Tosto
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Luca Cevasco
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Massimo Calabrese
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Schiaffino S, Massone E, Gristina L, Fregatti P, Rescinito G, Villa A, Friedman D, Calabrese M. Vacuum assisted breast biopsy (VAB) excision of subcentimeter microcalcifications as an alternative to open biopsy for atypical ductal hyperplasia. Br J Radiol 2018; 91:20180003. [PMID: 29451396 DOI: 10.1259/bjr.20180003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Atypical ductal hyperplasia (ADH) is a proliferative lesion associated with a variable increased risk of breast malignancy, but the management of the patients is still not completely defined, with mandatory surgical excision in most cases. To report the results of the conservative management with mammographic checks of patients with ADH diagnosed by vacuum assisted breast biopsy (VAB), without residual calcifications. METHODS The authors accessed the institutional database of radiological, surgical and pathological anatomy. Inclusion criteria were: ADH diagnosed by VAB on a single group of microcalcifications, without residual post-procedure; follow-up at least of 12 months. Exclusion criteria were the presence of personal history of breast cancer or other high-risk lesions; association with other synchronous lesions, both more and less advanced proliferative lesions. RESULTS The 65 included patients were all females, with age range of 40-79 years (mean 54 years). The maximum diameter range of the groups of microcalcifications was 4-11 mm (mean 6.2 mm), all classified as BI-RADS 4b (Breast Imaging Reporting and Data System 4b) and defined as fine pleomorphic in 29 cases (45%) or amorphous in 36 cases (55%). The range of follow-up length was 12-156 months (mean 67 months). Only one patients developed new microcalcifications, in the same breast, 48 months after and 15 mm from the first VAB, interpreted as low-grade ductal carcinoma in situ (DCIS) at surgical excision. CONCLUSION These results could justify the conservative management, in a selected group of patients, being the malignancy rate lower than 2%, considered in the literature as the "probably benign" definition. Advances in knowledge: Increasing the length of follow-up of selected patients conservatively managed can improve the management of ADH cases.
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Affiliation(s)
| | - Elena Massone
- 1 Department of Radiology, University of Genoa , Genoa , Italy
| | - Licia Gristina
- 1 Department of Radiology, University of Genoa , Genoa , Italy
| | - Piero Fregatti
- 2 Department of Surgery, Policlinico San Martino , Genoa , Italy
| | | | - Alessandro Villa
- 4 Department of Radiology, Ospedale San Bartolomeo , Sarzana , Italy
| | - Daniele Friedman
- 2 Department of Surgery, Policlinico San Martino , Genoa , Italy
| | - Massimo Calabrese
- 1 Department of Radiology, University of Genoa , Genoa , Italy.,3 Department of Radiology, Policlinico San Martino , Genoa , Italy
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Co M, Kwong A, Shek T. Factors affecting the under-diagnosis of atypical ductal hyperplasia diagnosed by core needle biopsies – A 10-year retrospective study and review of the literature. Int J Surg 2018; 49:27-31. [DOI: 10.1016/j.ijsu.2017.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022]
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Schiaffino S, Gristina L, Villa A, Tosto S, Monetti F, Carli F, Calabrese M. Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy. Br J Radiol 2018; 91:20170484. [PMID: 29072858 PMCID: PMC5966211 DOI: 10.1259/bjr.20170484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/02/2017] [Accepted: 10/14/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine the malignancy rate (defined in this study as stability or absence of malignancy developed on close imaging follow-up post-biopsy) of conservative management in patients with a vacuum-assisted breast biopsy (VAB) diagnosis of flat epithelial atypia (FEA), performed on single group of microcalcifications, completely removed during procedure. METHODS This is a retrospective, monocentric, observational study, approved by IRB. Inclusion criteria were: VAB performed on a single group of microcalcifications; the absence of residual calcifications post-VAB; diagnosis of isolated FEA as the most advanced proliferative lesion; radiological follow-up at least of 12 months. The personal history of breast cancer or other high-risk lesions was an exclusion criteria. The patients enrolled were conservatively managed, without surgical excision, through close follow-up: the first two mammographies performed with an interval of 6 months after biopsy, followed by annual mammographic and clinical checks. RESULTS 48 consecutive patients were enrolled in the study, all females, with age range of 39-76 years (mean 53,3 years) and radiological follow-up range of 13-75 months (mean 41.5 months). All the lesions were classified as BI-RADS 4b. The diameter range of the group of calcifications was 3-10 mm (mean 5, 6 mm). In each patient, 7 to 15 samples (mean 11) were obtained. Among all the patients, there was only one case (2%) of new microcalcifications, developed in the same breast, 26 months after and 8 mm from the site of previous VAB, and interpreted as ADH at surgical excision. All the checks of the other patients were negative. CONCLUSION Even with a limited follow-up, we found a malignancy rate lower than 2%, through a defined population. Further studies with bigger number of patients and extended follow-up are needed to reinforce this hypothesis. Advances in knowledge: Surgical excision may not be necessary in patients with VAB diagnosis of isolated FEA, without residual microcalcifications post-procedure and considered concordant with the mammographic presentation, considering the low rate of malignancy at subsequent follow-ups.
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Affiliation(s)
| | - Licia Gristina
- Department of Radiology, University of Genoa, Genoa, Italy
| | - Alessandro Villa
- Department of Radiology, Ospedale San Bartolomeo, Sarzana, Italy
| | - Simona Tosto
- Department of Radiology, Policlinico San Martino, Genoa, Italy
| | | | - Franca Carli
- Department of Pathologic Anatomy, Policlinico San Martino, Genoa, Italy
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Latronico A, Nicosia L, Faggian A, Abbate F, Penco S, Bozzini A, Cannataci C, Mazzarol G, Cassano E. Atypical ductal hyperplasia: Our experience in the management and long term clinical follow-up in 71 patients. Breast 2017; 37:1-5. [PMID: 29032282 DOI: 10.1016/j.breast.2017.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Atypical ductal hyperplasia (ADH) is a high-risk benign lesion found in approximately 1-10% of breast biopsies and associated with a variable incidence of carcinoma after surgical excision. The main goal of our study is to present our experience in the management and long-term follow-up of 71 patients with ADH diagnosed on breast biopsy. MATERIALS AND METHODS Results of 3808 breast biopsy specimens from 1 January 2000 to 31 December 2005 were analyzed to identify all biopsies which resulted in a diagnosis of ADH. The histopathological results of the 45 patients who underwent surgery were analyzed. Long-term follow-up for the remaining patients was carried out. RESULTS 45 of 71 (63.4%) patients with histological diagnosis of ADH on breast biopsy underwent surgery. Definitive histological results revealed invasive carcinoma in 7 cases (15.6%), high grade Ductal Carcinoma in situ (DCIS) in 10 (22.2%) patients, Lobular Carcinoma in situ (LCIS) in 4 cases (8.9%) and benign findings in 24 cases (53.3%). 12 of 71 (16.9%) patients underwent only long term follow-up; one (8,3%) of these developed invasive breast carcinoma after 6 years. CONCLUSION Atypical ductal hyperplasia diagnosed on breast biopsy is associated with a relatively high incidence of invasive carcinoma and high grade ductal carcinoma in situ at the time of surgical excision. Certain radiological and cytological criteria can be used to help determine which patients should forgo surgery and be followed up with good results. Long term follow-up is always crucial for patients who have not undergone surgery.
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MESH Headings
- Adult
- Aged
- Biopsy
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm Grading
- Time Factors
- Watchful Waiting
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Affiliation(s)
- Antuono Latronico
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Luca Nicosia
- Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Via Festa del Perdono 7, Milan, Italy.
| | - Angela Faggian
- Department of Radiology, Private Hospital "Villa dei Fiori", Acerra, Naples, Italy
| | - Francesca Abbate
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Silvia Penco
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Anna Bozzini
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Christine Cannataci
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, Msida, MSD 2090, Malta
| | - Giovanni Mazzarol
- European Institute of Oncology, Pathology Department, Via G. Ripamonti, 435, 20141, Milano, Italy
| | - Enrico Cassano
- European Institute of Oncology, Breast Imaging Unit, Via G. Ripamonti, 435, 20141, Milano, Italy
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Molecular profile of atypical hyperplasia of the breast. Breast Cancer Res Treat 2017; 167:9-29. [DOI: 10.1007/s10549-017-4488-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/28/2017] [Indexed: 12/11/2022]
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32
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Racz JM, Carter JM, Degnim AC. Lobular Neoplasia and Atypical Ductal Hyperplasia on Core Biopsy: Current Surgical Management Recommendations. Ann Surg Oncol 2017; 24:2848-2854. [DOI: 10.1245/s10434-017-5978-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 12/21/2022]
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33
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Peña A, Shah SS, Fazzio RT, Hoskin TL, Brahmbhatt RD, Hieken TJ, Jakub JW, Boughey JC, Visscher DW, Degnim AC. Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat 2017; 164:295-304. [DOI: 10.1007/s10549-017-4253-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/17/2017] [Indexed: 12/18/2022]
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Verheyden C, Pages-Bouic E, Balleyguier C, Cherel P, Lepori D, Laffargue G, Doutriaux I, Jalaguier A, Poncelet E, Millet I, Thomassin-Naggara I, Taourel P. Underestimation Rate at MR Imaging–guided Vacuum-assisted Breast Biopsy: A Multi-Institutional Retrospective Study of 1509 Breast Biopsies. Radiology 2016; 281:708-719. [DOI: 10.1148/radiol.2016151947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Badan GM, Roveda Júnior D, Piato S, Fleury EDFC, Campos MSD, Pecci CAF, Ferreira FAT, D'Ávila C. Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution. Radiol Bras 2016; 49:6-11. [PMID: 26929454 PMCID: PMC4770389 DOI: 10.1590/0100-3984.2014.0110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the rates of diagnostic underestimation at stereotactic
percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB)
of nonpalpable breast lesions, with histopathological results of atypical
ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently
submitted to surgical excision. As a secondary objective, the frequency of
ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis
of biopsies performed between February 2011 and July 2013, subsequently
submitted to surgery, whose histopathological reports were available in the
internal information system. Biopsy results were compared with those
observed at surgery and the underestimation rate was calculated by means of
specific mathematical equations. Results The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at
VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all
cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion The diagnostic underestimation rate at CNB is two times the rate at VABB.
Certainty that the target has been achieved is not the sole determining
factor for a reliable diagnosis. Removal of more than 50% of the target
lesion should further reduce the risk of underestimation.
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Affiliation(s)
- Gustavo Machado Badan
- PhD Fellow, Physician Assistant II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Decio Roveda Júnior
- PhD, Coordinator for the Sector of Breast Imaging, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Sebastião Piato
- PhD, Full Professor at School of Medical Sciences, Santa Casa de São Paulo, Chief of Medical Practice at Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Eduardo de Faria Castro Fleury
- PhD, Physician Assistant II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Mário Sérgio Dantas Campos
- Imaging Diagnosis Specialists, Physician Assistants II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Carlos Alberto Ferreira Pecci
- Imaging Diagnosis Specialists, Physician Assistants II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Felipe Augusto Trocoli Ferreira
- Imaging Diagnosis Specialists, Physician Assistants II at Unit of Imaging Diagnosis, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Camila D'Ávila
- Imaging Diagnosis Specialist, MD, Resident in General Radiology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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Clauser P, Marino MA, Baltzer PAT, Bazzocchi M, Zuiani C. Management of atypical lobular hyperplasia, atypical ductal hyperplasia, and lobular carcinoma in situ. Expert Rev Anticancer Ther 2016; 16:335-46. [PMID: 26780850 DOI: 10.1586/14737140.2016.1143362] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atypical hyperplasia and lobular carcinoma in situ are rare proliferative breast lesions, growing inside ducts and terminal ducto-lobular units. They represent a marker of increased risk for breast cancer and a non-obligate precursor of malignancy. Evidence available on diagnosis and management is scarce. They are frequently found incidentally associated with other lesions, but can be visible through mammography, ultrasound or magnetic resonance. Due to the risk of underestimation, surgical excision is often performed. The analysis of imaging and histopathological characteristics could help identifying low-risk cases, for which surgery is not necessary. Chemopreventive agents can be used for risk reduction. Careful imaging follow up is mandatory; the role of breast MRI as screening modality is under discussion.
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Affiliation(s)
- Paola Clauser
- a Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging , Medical University of Vienna , Vienna , Austria
| | - Maria A Marino
- a Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging , Medical University of Vienna , Vienna , Austria
| | - Pascal A T Baltzer
- a Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging , Medical University of Vienna , Vienna , Austria
| | - Massimo Bazzocchi
- b Institute of Diagnostic Radiology , Department of Medical and Biological Sciences, University of Udine , Udine , Italy
| | - Chiara Zuiani
- b Institute of Diagnostic Radiology , Department of Medical and Biological Sciences, University of Udine , Udine , Italy
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[Benign proliferative breast disease with and without atypia]. ACTA ACUST UNITED AC 2015; 44:980-95. [PMID: 26545856 DOI: 10.1016/j.jgyn.2015.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 11/22/2022]
Abstract
In the last few years, diagnostics of high-risk breast lesions (atypical ductal hyperplasia [ADH], flat epithelial atypia [FEA], lobular neoplasia: atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], radial scar [RS], usual ductal hyperplasia [UDH], adenosis, sclerosing adenosis [SA], papillary breast lesions, mucocele-like lesion [MLL]) have increased with the growing number of breast percutaneous biopsies. The management of these lesions is highly conditioned by the enlarged risk of breast cancer combined with either an increased probability of finding cancer after surgery, either a possible malignant transformation (in situ or invasive cancer), or an increased probability of developing cancer on the long range. An overview of the literature reports grade C recommendations concerning the management and follow-up of these lesions: in case of ADH, FEA, ALH, LCIS, RS, MLL with atypia, diagnosed on percutaneous biopsies: surgical excision is recommended; in case of a diagnostic based on vacuum-assisted core biopsy with complete disappearance of radiological signal for FEA or RS without atypia: surgical abstention is a valid alternative approved by multidisciplinary meeting. In case of ALH (incidental finding) associated with benign lesion responsible of radiological signal: abstention may be proposed; in case of UDH, adenosis, MLL without atypia, diagnosed on percutaneous biopsies: the concordance of radiology and histopathology findings must be ensured. No data is available to recommend surgery; in case of non-in sano resection for ADH, FEA, ALH, LCIS (except pleomorphic type), RS, MLL: surgery does not seem to be necessary; in case of previous ADH, ALH, LCIS: a specific follow-up is recommended in accordance with HAS's recommendations. In case of FEA and RS or MLL combined with atypia, little data are yet available to differ the management from others lesions with atypia; in case of UDH, usual sclerosing adenosis, RS without atypia, fibro cystic disease: no specific follow-up is recommended in agreement with HAS's recommendations.
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Park AY, Son EJ, Kim JA, Han K, Youk JH. Lesion stiffness measured by shear-wave elastography: Preoperative predictor of the histologic underestimation of US-guided core needle breast biopsy. Eur J Radiol 2015; 84:2509-14. [PMID: 26467705 DOI: 10.1016/j.ejrad.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether lesion stiffness measured by shear-wave elastography (SWE) can be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses. METHODS This retrospective study enrolled 99 breast masses from 93 patients, including 40 high-risk lesions and 59 ductal carcinoma in situ (DCIS), which were diagnosed by US-guided 14-gauge CNB. SWE was performed for all breast masses to measure quantitative elasticity values before US-guided CNB. To identify the preoperative factors associated with histologic underestimation, patients' age, symptoms, lesion size, B-mode US findings, and quantitative SWE parameters were compared according to the histologic upgrade after surgery using the chi-square test, Fisher's exact test, or independent t-test. The independent factors for predicting histologic upgrade were evaluated using multivariate logistic regression analysis. RESULTS The underestimation rate was 28.3% (28/99) in total, 25.0% (10/40) in high-risk lesions, and 30.5% (18/59) in DCIS. All elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (P<0.001). On multivariate analysis, the mean (Odds ratio [OR]=1.021, P=0.001), maximum (OR=1.015, P=0.008), and minimum (OR=1.028, P=0.001) elasticity values were independently associated with histologic underestimation. The patients' age, lesion size, and final assessment category on US of the upgrade group were higher than those of the non-upgrade group (P=0.046 for age; P=0.021 for lesion size; P=0.030 for US category), but these were not independent predictors of histologic underestimation on multivariate analysis. CONCLUSION Breast lesion stiffness quantitatively measured by SWE could be helpful to predict the underestimation of malignancy in US-guided 14-gauge CNB.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan city, Gyeonggi-do 15355, Republic of Korea; Kangwon National University Graduate School, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do 24341, Republic of Korea.
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.
| | - Kyunghwa Han
- Yonsei Biomedical Research Institute, Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.
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Khoury T, Li Z, Sanati S, Desouki MM, Chen X, Wang D, Liu S, Karabakhtsian R, Kumar P, Reig B. The risk of upgrade for atypical ductal hyperplasia detected on magnetic resonance imaging-guided biopsy: a study of 100 cases from four academic institutions. Histopathology 2015; 68:713-21. [PMID: 26291517 DOI: 10.1111/his.12811] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/14/2015] [Indexed: 01/15/2023]
Abstract
AIMS To identify variables that can predict upgrade for magnetic resonance imaging (MRI)-detected atypical ductal hyperplasia (ADH). METHODS AND RESULTS We reviewed 1655 MRI-guided core biopsies between 2005 and 2013, yielding 100 (6%) cases with ADH. The pathological features of ADH and MRI findings were recorded. An upgrade was considered when the subsequent surgical excision yielded invasive carcinoma (IC) or ductal carcinoma in situ (DCIS). The rate of ADH between institutions was 3.3-7.1%, with an average of 6%. A total of 15 (15%) cases had upgrade, 12 DCIS and three IC. When all cases were included, only increased number of involved cores was statistically significant (P = 0.02). When cases with concurrent lobular neoplasia (LN) were excluded (n = 14), increased number of ADH foci and increased number of involved cores were statistically significant (P = 0.002, P = 0.009). We analysed the data separately from a single institution (n = 61). Increased number of foci, increased number of total cores and involved cores and larger ADH size predicted upgrade with statistical significance. CONCLUSIONS The incidence of ADH in MRI-guided core biopsy is rare. The rate of upgrade is comparable to mammographically detected ADH, warranting surgical excision. Similar to mammographically detected lesions, the volume of the ADH predicts the upgrade.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Zaibo Li
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | - Souzan Sanati
- Department of Pathology, Washington University, St Louis, MO, USA
| | | | - Xiwei Chen
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Dan Wang
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Song Liu
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Rouzan Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Prasanna Kumar
- Department of Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Beatriu Reig
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Current Multidisciplinary Management of High-Risk Breast Lesions. CURRENT BREAST CANCER REPORTS 2015. [DOI: 10.1007/s12609-015-0179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yu CC, Ueng SH, Cheung YC, Shen SC, Kuo WL, Tsai HP, Lo YF, Chen SC. Predictors of Underestimation of Malignancy after Image-Guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia. Breast J 2015; 21:224-32. [DOI: 10.1111/tbj.12389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Chi-Chang Yu
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Yun-Chung Cheung
- Department of Diagnostic Radiology; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shih-Che Shen
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Wen-Lin Kuo
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Hsiu-Pei Tsai
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Yung-Feng Lo
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shin-Cheh Chen
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
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Khoury T, Chen X, Wang D, Kumar P, Qin M, Liu S, Turner B. Nomogram to predict the likelihood of upgrade of atypical ductal hyperplasia diagnosed on a core needle biopsy in mammographically detected lesions. Histopathology 2015; 67:106-20. [DOI: 10.1111/his.12635] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/14/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Thaer Khoury
- Department of Pathology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Xiwei Chen
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Dan Wang
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Prasanna Kumar
- Department of Radiology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Maochun Qin
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Song Liu
- Department of Biostatistics and Bioinformatics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Bradley Turner
- Department of Pathology; Roswell Park Cancer Institute; Buffalo NY USA
- Department of Pathology; University of Rochester Medical Center; Rochester NY USA
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High-risk lesions at MRI-guided breast biopsy: frequency and rate of underestimation. AJR Am J Roentgenol 2014; 203:682-6. [PMID: 25148176 DOI: 10.2214/ajr.13.11905] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to determine the underestimation rate of high-risk lesions diagnosed at MRI-guided breast biopsy. MATERIALS AND METHODS This was a retrospective review of 446 MRI-guided breast biopsies from January 2006 through December 2010. Data were collected on examination indication, lesion size and type, and pathology results. Biopsies were performed with a 9-gauge vacuum-assisted device. Biopsy results of atypical ductal hyperplasia (ADH), papillary lesion, radial scar, lobular neoplasia, and atypia were identified and compared with final excisional pathology results. Underestimation rates were calculated and data were compared by patient and lesion characteristics using chi-square analysis. RESULTS Of the 446 MRI-guided biopsies, 96 (21.5%) were high-risk lesions. Forty-two of 96 lesions (44%) were masses, and 54 (56%) showed nonmass enhancement. Twenty of 96 lesions (20.8%) were ADH, nine (9.4%) were lobular neoplasia, 27 (28.1%) were papillary lesions, 20 (20.8%) were radial scar, and 20 (20.8%) were other atypias. Sixty-nine of 96 lesions (71.9%) had surgical excisional pathology results available. Sixteen of 69 (23.2%) lesions were upgraded to malignancy; 11 of the 16 (68.8%) were upgraded to ductal carcinoma in situ (DCIS) and five (31.2%) were upgraded to invasive carcinoma. The underestimation rate was 31.6% (6/19) for ADH, 5.9% (1/17) for papillary lesions, 23.1% (3/13) for radial scar, 28.6% (2/7) for lobular neoplasia, and 30.8% (4/13) for other atypias (p = 0.43). There was no statistically significant difference in underestimation rate by lesion type, size, or history of newly diagnosed breast cancer. CONCLUSION MRI-guided breast biopsy yielded high-risk lesions in 21.5% of cases, and the underestimation rate was 23.2%. No patient or lesion characteristics correlated with underestimation rate.
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Youn I, Kim MJ, Moon HJ, Kim EK. Absence of Residual Microcalcifications in Atypical Ductal Hyperplasia Diagnosed via Stereotactic Vacuum-Assisted Breast Biopsy: Is Surgical Excision Obviated? J Breast Cancer 2014; 17:265-9. [PMID: 25320625 PMCID: PMC4197357 DOI: 10.4048/jbc.2014.17.3.265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/23/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of our study was to evaluate the underestimation rate of atypical ductal hyperplasia (ADH) on vacuum-assisted breast biopsy (VABB), and to examine the correlation between residual microcalcifications and the underestimation rate of ADH. METHODS A retrospective study was performed on 27 women (mean age, 49.2±9.2 years) who underwent additional excision for ADH via VABB for microcalcifications observed by using mammography. The mammographic findings, histopathologic diagnosis of all VABB and surgical specimens, and association of malignancy with residual microcalcifications were evaluated. The underestimation rate of ADH was also calculated. RESULTS Of the 27 women with microcalcifications, nine were upgraded to ductal carcinoma in situ (DCIS); thus, the underestimation rate was 33.3% (9/27). There was no difference in age (p=0.40) and extent of microcalcifications (p=0.10) when comparing benign and malignant cases. Six of 17 patients (35.3%) with remaining calcifications after VABB were upgraded to DCIS, and three of 10 patients (30%) with no residual calcifications after VABB were upgraded (p=1.00). CONCLUSION The underestimation rate of ADH on VABB was 33.3%. Furthermore, 30% of patients with no remaining calcifications were upgraded to DCIS. Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.
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Affiliation(s)
- Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Caplain A, Drouet Y, Peyron M, Peix M, Faure C, Chassagne-Clément C, Beurrier F, Fondrevelle ME, Guérin N, Lasset C, Treilleux I. Management of patients diagnosed with atypical ductal hyperplasia by vacuum-assisted core biopsy: a prospective assessment of the guidelines used at our institution. Am J Surg 2014; 208:260-7. [DOI: 10.1016/j.amjsurg.2013.10.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/02/2013] [Accepted: 10/22/2013] [Indexed: 10/25/2022]
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Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol 2014; 202:1389-94. [PMID: 24848840 DOI: 10.2214/ajr.13.10864] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this article were to review the mammographic and sonographic features of breast masses yielding atypical ductal hyperplasia (ADH) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine whether clinical or imaging features can be used to predict upgrade to malignancy. MATERIALS AND METHODS Among 6325 sonographically guided biopsies (2003- 2010) (14-gauge cores), 56 yielded the diagnosis of ADH (0.9%). Six patients were excluded (lost to follow-up). Fifty lesions were surgically excised in 45 patients. Mammographic and sonographic features were analyzed in consensus by two radiologists using the BI-RADS lexicon. RESULTS Forty-five patients (mean age, 56 years; 12 < 50 years; six with synchronous breast carcinoma) had 50 ADH lesions (median size, 0.6 cm). Surgical excision yielded malignancy in 28 cases (56% underestimation rate). Among 42 mammograms (47 lesions), 30 lesions were identified (30/47, 64%) as masses (12/30, 40%), asymmetric densities (10/30, 33%), microcalcifications (4/30, 13%), and architectural distortions (4/30, 13%). Sonographically, most lesions appeared as hypoechoic masses (64%, 30/47) with irregular shape (51%, 24/47), microlobulated margins (49%, 23/47), no posterior acoustic feature (25/47, 53%), abrupt interface (70%, 33/47), and parallel orientation (57%, 27/47). No mammographic and sonographic features were associated with malignant outcome, whereas age less than 50 years (p = 0.03) and synchronous malignancy (p = 0.03) were associated with malignant outcome. CONCLUSION ADH diagnosed at sonographically guided 14-gauge core needle biopsy shows a high underestimation rate. Synchronous carcinoma or age less than 50 years is associated with malignant outcome.
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Frequency of Carcinoma at Secondary Imaging-Guided Percutaneous Breast Biopsy Performed After a High-Risk Pathologic Result at Primary Biopsy. AJR Am J Roentgenol 2013; 201:439-47. [DOI: 10.2214/ajr.11.7693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ceugnart L, Doualliez V, Chauvet MP, Robin YM, Bachelle F, Chaveron C, Rocourt N, Pouliquen G, Jarraya H, Taieb S. Pure flat epithelial atypia: is there a place for routine surgery? Diagn Interv Imaging 2013; 94:861-9. [PMID: 23474220 DOI: 10.1016/j.diii.2013.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine whether it is appropriate to routinely undertake surgery if flat epithelial atypia (FEA) or pure flat epithelial atypia (pFEA) is found on large-core biopsy. PATIENTS AND METHODS Between 2005 and 2010, 1678 large-core biopsy procedures were carried out, which led to 136 FEA sites being identified, 63 of which across 59 patients were pFEA (four patients had two sites of pFEA each). Forty-eight patients underwent further surgical excision, equating to 52 excised sites of pFEA. RESULTS Of the 52 operated sites, there were 20 benign lesions (38%), 26 borderline lesions (56%), and three ductal carcinomas in situ (6%). The rate of histologic underestimation was put at 3.8%. Of the three cases that were underestimated, one was discarded because the definitive histology was not representative of the site from which microcalcifications had initially been taken. The other two cases that were underestimated were found in patients with an increased individual risk of breast cancer. CONCLUSION In patients with no personal or first-degree family history of breast cancer, after complete or subtotal excision under radiology of the radiological lesion, and while excluding images fitting BI-RADS 5, annual monitoring may be offered as an alternative to surgical excision in view of the absence of underestimation found in our study.
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Affiliation(s)
- L Ceugnart
- Département d'imagerie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille cedex, France.
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Abstract
High-risk lesions of the breast are lesions that confer an increased risk of breast cancer, either because of an increased probability of finding cancer associated with percutaneous biopsy findings or because of an increased probability of developing breast cancer over the long term. Atypical ductal hyperplasia found on percutaneous biopsy is generally excised, whereas lobular neoplasia lesions, including both atypical lobular hyperplasia and lobular carcinoma in situ, may be observed if radiologic and pathologic findings are concordant and there is no other high-risk lesion present.
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Affiliation(s)
- Amy C Degnim
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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