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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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Zhang X, Liu W, Hai T, Li F. Upgrade Rate and Predictive Factors for Breast Benign Intraductal Papilloma Diagnosed at Biopsy: A Meta-Analysis. Ann Surg Oncol 2021; 28:8643-8650. [PMID: 34331160 DOI: 10.1245/s10434-021-10188-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Current standard management for intraductal papilloma (IDP) diagnosed at biopsy indicates complete surgical resection, but there are increasing controversies over whether and when routine excision is indeed necessary. OBJECTIVE The aim of this study was to determine the carcinoma upgrade rate and identify the associated predictive factors for IDP diagnosed at biopsy by meta-analysis. METHODS We searched the PubMed and EMBASE databases for studies published from 2009 to 2020 that investigated the upgrade rate and predictive factors of IDP diagnosed at biopsy. RESULTS A total of 7016 IDP cases diagnosed at biopsy and histologically examined after surgical excision were pooled from 44 original studies. The pooled prevalence of IDP in breast biopsy findings was 4.6% [95% confidence interval (CI) 4.4-4.7%] and the majority of IDP tumors were benign. The pooled upgrade rates to carcinoma for benign IDP and atypical IDP were 5.0% (95% CI 4.4-5.5%) and 36.0% (95% CI 32.7-39.2%), respectively. In addition, we identified 10 predictive upgrade factors for benign IDP, including Breast Imaging Reporting and Data System (BI-RADS) 5, BI-RADS 4C, mass and calcification in the mammographic finding, bloody nipple discharge, imaging-histological discordance, peripheral IDP, palpable mass, BI-RADS 4B, microcalcification, and lesion size ≥ 1 cm. The upgrade rates associated with these predictive factors ranged from 7.3 to 31.1%. CONCLUSION Surgical excision appears a reasonable recommendation for atypical IDP. Patients with benign IDP exhibiting one or more predictive factors might benefit from surgical excision, while patients with asymptomatic benign IDP without these predictive factors can be managed by imaging surveillance.
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Affiliation(s)
- Xiaoli Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenqing Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Hai
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Li X, Sun K, Chai W, Zhu H, Yan F. Role of breast MRI in predicting histologic upgrade risks in high-risk breast lesions: A review. Eur J Radiol 2021; 142:109855. [PMID: 34303150 DOI: 10.1016/j.ejrad.2021.109855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This article reviews the frequency, upgrade rate and valuable imaging characteristics for predicting the histologic upgrade risks of high-risk lesions on MRI, so as to provide a reference for the management of the lesions. METHODS A comprehensive search for relevant publications from January 2011 to January 2021 was conducted in the PubMed database. The frequency, upgrade rate and valuable imaging characteristics for predicting the upgrade risks of high-risk lesions on MRI included in the articles were reviewed, and the management of high-risk lesions was provided with a reference according to the review results. RESULTS AND CONCLUSIONS In terms of management options, Atypical ductal hyperplasia (ADH) and Lobular neoplasia (LN) (the top two high-risk lesions with the highest upgrade rate and frequency) were treated with surgical resection. However, the final treatment decision for other high-risk lesions should be made by a multidisciplinary committee. In terms of the value of breast MRI in predicting the upgrade risks of high-risk lesions, the lesions that were confirmed to upgrade after surgery showed some enhancement characteristics, especially for ADH and LN. At the same time, Dynamic contrast-enhanced MRI (DCE-MRI) has a high negative predictive value (NPV) in predicting the upgrade risks of the high-risk lesions, hence misdiagnosis and overtreatment can be reduced. Diffusion-weighted imaging (DWI) and relative apparent diffusion coefficient (rADC) can be used to predict the upgrade risks of the lesions, and the ADC of upgraded lesions is lower than that of non-upgraded lesions. However, these conclusions should be confirmed by further studies.
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Affiliation(s)
- Xue Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Kun Sun
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Weimin Chai
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Hong Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
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High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management. AJR Am J Roentgenol 2021; 216:622-632. [PMID: 33439046 DOI: 10.2214/ajr.20.23040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE. The purpose of our study was to evaluate the upgrade rates of high-risk lesions (HRLs) diagnosed by MRI-guided core biopsy and to assess which clinical and imaging characteristics are predictive of upgrade to malignancy. MATERIALS AND METHODS. A retrospective review was performed of all women who presented to an academic breast radiology center for MRI-guided biopsy between January 1, 2015, and November 30, 2018. Histopathologic results from each biopsy were extracted. HRLs-that is, atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), radial scar, papilloma, flat epithelial atypia (FEA), benign vascular lesion (BVL), and mucocelelike lesion-were included for analysis. Clinical history, imaging characteristics, surgical outcome, and follow-up data were recorded. Radiologic-pathologic correlation was performed. RESULTS. Of 810 MRI-guided biopsies, 189 cases (23.3%) met the inclusion criteria for HRLs. Of the 189 HRLs, 30 cases were excluded for the following reasons: 15 cases were lost to follow-up, six cases were in patients who received neoadjuvant chemotherapy after biopsy, two lesions that were not excised had less than 2 years of imaging follow-up, and seven lesions had radiologic-pathologic discordance at retrospective review. Of the 159 HRLs in our study cohort, 13 (8.2%) were upgraded to carcinoma. Surgical upgrade rates were high for ADH (22.5%, 9/40) and FEA (33.3%, 1/3); moderate for LCIS (6.3%, 3/48); and low for ALH (0.0%, 0/11), radial scar (0.0%, 0/28), papilloma (0.0%, 0/26), and BVL (0.0%, 0/3). Of the upgraded lesions, 69.2% (9/13) were upgraded to ductal carcinoma in situ (DCIS) or well-differentiated carcinoma. ADH lesions were significantly more likely to be upgraded than non-ADH lesions (p = .005). CONCLUSION. ADH diagnosed by MRI-guided core biopsy warrants surgical excision. The other HRLs, however, may be candidates for imaging follow-up rather than excision, especially after meticulous radiologic-pathologic correlation.
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Lin LH, Ozerdem U, Cotzia P, Lee J, Chun J, Schnabel F, Darvishian F. Upgrade rate of intraductal papilloma diagnosed on core needle biopsy in a single institution. Hum Pathol 2020; 110:43-49. [PMID: 33159966 DOI: 10.1016/j.humpath.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
The management of intraductal papilloma (IDP) diagnosed on core needle biopsy (CNB) is controversial due to the variable upgrade rates to breast carcinoma (BC) on subsequent surgical excision reported in the literature. The purpose of our study was to investigate the upgrade rate of IDP diagnosed on CNB to BC in subsequent surgical excision and the impact of clinical, pathologic, and radiologic variables. This is a retrospective cohort of all women who had a diagnosis of IDP on a CNB between 2005 and 2018 in a tertiary academic center with subsequent surgical excision. Upgrade was defined as ductal carcinoma in situ (DCIS) and invasive carcinoma on surgical excision. Statistical analyses included Pearson's chi-square, Wilcoxon rank-sum, and logistic regression. A total of 216 women with IDP in a CNB were included. Nineteen patients (8.8%) upgraded to BC in the overall cohort, including 14 DCIS and 5 invasive carcinomas. An upgrade rate of 27% was found in atypical IDP (14 of 51 cases), while only 3% of pure IDP upgraded to BC (5 of 165 cases). Older age (>53 years) at the time of biopsy (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.01-1.09, p = 0.027) and concomitant atypical ductal hyperplasia (ADH) (OR = 9.69, 95% CI = 3.37-27.81, p < 0.0001) were significantly associated with upgrade. Our results support surgical excision of IDP on CNB when associated with ADH or diagnosed in women aged older than 53 years. The low surgical upgrade rate of 3% for pure IDP on CNB in younger women should be part of the management discussion.
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Affiliation(s)
- Lawrence Hsu Lin
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States
| | - Ugur Ozerdem
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States
| | - Paolo Cotzia
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States
| | - Jiyon Lee
- New York University Langone Health, Department of Radiology, NYU Perlmutter Cancer Center, New York, NY, 10016, United States
| | - Jennifer Chun
- New York University Langone Health, Department of Surgery, Division of Breast Surgical Oncology, NYU Perlmutter Cancer Center, New York, NY, 10016, United States
| | - Freya Schnabel
- New York University Langone Health, Department of Surgery, Division of Breast Surgical Oncology, NYU Perlmutter Cancer Center, New York, NY, 10016, United States
| | - Farbod Darvishian
- New York University Langone Health, Department of Pathology, New York, NY, 10016, United States.
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Ma Z, Arciero CA, Styblo TM, Wang H, Cohen MA, Li X. Patients with benign papilloma diagnosed on core biopsies and concordant pathology-radiology findings can be followed: experiences from multi-specialty high-risk breast lesion conferences in an academic center. Breast Cancer Res Treat 2020; 183:577-584. [PMID: 32705378 DOI: 10.1007/s10549-020-05803-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND To determine whether patients with benign papilloma diagnosed on core biopsy can be spared from surgery. METHODS We prospectively reviewed 150 consecutive core biopsy-diagnosed papilloma cases at a multi-specialty high-risk breast lesion conference to determine whether surgical excision was necessary. Of these 150 cases, 148 had concordant radiologic-pathologic features. Six were excluded due to lack of the first imaging follow-up until analysis. 112 were benign papillomas; 17 were papillomas involved by atypical ductal hyperplasia (atypical papilloma); 6 papillomas had ADH in adjacent tissue but not involving the papilloma; 2 papillomas were involved by atypical lobular hyperplasia (ALH); and 5 papillomas had ALH in adjacent tissue. Two were radiology-pathology (rad-path) discordant. RESULTS Thirty-nine of the 112 benign papillomas were excised with no upgrade to carcinoma; 73 were followed with no disease progression during follow-up (185-1279 days). Fifteen of 17 atypical papillomas were surgically excised with 4 (26.7%) upgraded to carcinoma. Four of the 6 patients with ADH adjacent to a benign papilloma underwent excision with 2 upgrades to carcinoma. None of the patients with papilloma, which was either involved by ALH or had ALH in adjacent tissue had upgrade or disease progression during follow-up (204-1159 days). Finally, the two cases with discordant path-rad discordant were excised with no upgrade. CONCLUSIONS Our data confirm that rad-path concordant benign papillomas diagnosed on core biopsy do not require surgery. It also supports the value of a formal multi-specialty review of all benign papilloma cases to create a consensus management plan.
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Affiliation(s)
- Zhongliang Ma
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | | | | | - Haibo Wang
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Michael A Cohen
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road, Atlanta, GA, USA.
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA.
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Li X, Aho M, Newell MS, Clifford K, Patel JG, Jou S, Cohen MA. Papilloma diagnosed on core biopsies has a low upgrade rate. Clin Imaging 2019; 60:67-74. [PMID: 31864203 DOI: 10.1016/j.clinimag.2019.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022]
Abstract
CONTEXT Surgical excision of benign intraductal papillomas (IDP) diagnosed on core needle biopsy (CNB) remains controversial. OBJECTIVE To examine the upgrade rate of IDPs diagnosed at core needle biopsy to carcinoma at surgical excision. DESIGN We identified 188 consecutive IDPs diagnosed at CNB from 2011 to 2016 with subsequent surgical excision. Radiologic, clinical, and histologic features were evaluated and correlated with upgrade rate at surgical excision. RESULTS Two of the 188 IDPs (1.1%) were upgraded to ductal carcinoma in situ or invasive carcinoma at excision. Features associated with upgrade rate include patient age (P = .03), largest size of papilloma on a single core at CNB (P = .04), and the presence of additional masses noted at ultrasound (P = .03). CONCLUSIONS Our study demonstrated a low 1.1% upgrade rate of surgically excised benign, concordant papillomas with no atypia or concurrent ipsilateral malignancy originally diagnosed on core biopsy. This data suggests that observation may be appropriate for radiologic-pathologic concordant benign IDPs diagnosed at CNB.
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Affiliation(s)
- Xiaoxian Li
- Department of Pathology, Emory Healthcare, Atlanta, GA, USA
| | - Michael Aho
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA.
| | - Mary S Newell
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
| | - Kelly Clifford
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
| | - Jay G Patel
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
| | | | - Michael A Cohen
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, GA, USA
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Raj SD, Phillips J, Mehta TS, Quintana LM, Fishman MD, Dialani V, Slanetz PJ. Management of BIRADS 3, 4A, and 4B Lesions Diagnosed as Pure Papilloma by Ultrasound-Guided Core Needle Biopsy: Is Surgical Excision Necessary? Acad Radiol 2019; 26:909-914. [PMID: 30297308 DOI: 10.1016/j.acra.2018.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES There is lack of consensus on managing papillomas due to varied upgrade rates in the literature related to variability in the studied populations. We specifically studied upgrade rates of pure papilloma diagnosed with ultrasound core biopsy (UCB) using spring-loaded (SLB) and vacuum-assisted (VAB) biopsy devices in patients with low-to-intermediate pre-test probability for malignancy on imaging. MATERIALS & METHODS From 01/01/2008 to 06/30/2016, 227 patients with 248 pure papillomas classified as BI-RADS 3, 4a, and 4b were diagnosed by UCB and underwent surgical excision or clinical and/or imaging follow-up. Imaging features, biopsy device, and final pathology were documented. RESULTS 177 lesions were biopsied with SLB (14-gauge) and 71 lesions with VAB (9-13 gauges). At surgery, upgrade rates to high-risk lesions and malignancy for SLB were 14.3% (22/154) and 1.9% (3/154), and for VAB were 3.5% (2/57) and 0% (0/57), respectively (p < 0.05). The combined surgical upgrade rate to high-risk lesions and malignancy was 11.4% (24/211) and 1.4% (3/211), respectively. The overall upgrade rate (including surgical and clinical and/or imaging follow-up) to high-risk lesions and malignancy was 9.7% (24/248) and 1.2% (3/248), respectively. No ultrasound features were predictive of upgrade. Rates of complete excision were 7.1% (11/154) for SLB and 19.3% (11/57) for VAB (p < 0.05). CONCLUSION BI-RADS 3, 4a, or 4b masses biopsied with UCB revealed pure papilloma upgrade to malignancy in less than 2% of cases. SLB was associated with greater upgrades compared with VAB. Therefore, follow-up imaging is a reasonable alternative to excision, particular in those sampled by VAB. Excision could be considered if the diagnosis of a high-risk lesion would change clinical management.
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Ring NY, diFlorio‐Alexander RM, Bond JS, Rosenkranz KM, Cervantes E, Sohn JH, Marotti JD. Papillary and sclerosing lesions of the breast detected and biopsied by MRI: Clinical management, upgrade rate, and association with apocrine metaplasia. Breast J 2019; 25:393-400. [DOI: 10.1111/tbj.13238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Natalie Y. Ring
- Department of Radiology Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Roberta M. diFlorio‐Alexander
- Department of Radiology Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Jesse S. Bond
- Department of Pathology and Laboratory Medicine Dartmouth‐Hitchcock Medical Center, Lebanon, NH, and Geisel School of Medicine Hanover New Hampshire
| | - Kari M. Rosenkranz
- Department of Surgery Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Eduardo Cervantes
- Department of Radiology Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Jae Ho Sohn
- Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California
| | - Jonathan D. Marotti
- Department of Pathology and Laboratory Medicine Dartmouth‐Hitchcock Medical Center, Lebanon, NH, and Geisel School of Medicine Hanover New Hampshire
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Hao N, Yuan X, Wang Q, Zhu J, Zheng Y, Zhang Y, Liu M, Cheng L, Li X. The role of magnetic resonance imaging in detection and surgical treatment of breast intraductal papillomas. Transl Cancer Res 2019; 8:635-646. [PMID: 35116796 PMCID: PMC8798582 DOI: 10.21037/tcr.2019.03.27] [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: 04/10/2018] [Accepted: 03/08/2019] [Indexed: 11/06/2022]
Abstract
Background Intraductal papillomas are discrete benign tumors of the breast duct epithelium. Due to the risk of subsequent carcinoma, a surgical excision is generally recommended as a precaution. However, it is difficult to initially diagnose and accurately locate the lesions both in pre-surgery and surgery periods. Methods Retrospectively analyzed 245 patients, with a pathologically proven breast intraductal papillomas. All the patients underwent magnetic resonance imaging (MRI) scans and ultrasound examination(s) pre-surgery and/or in surgery. All the patients who underwent surgery were divided into four groups according to the following operation method type(s): ultrasound & clinical examination excision, methylene blue notation excision, methylene blue notation & MRI guide excision, and MRI guide excision. Then, the differences between the last two MRI guide excisions and the first two conventional methods were analyzed. Afterwards, 238 patients were followed up for recurrence checks. SPSS 19.0 statistical software was used and the results of P<0.05 being considered statistically significant. Results A total of 161 (65.7%) and 48 (19.6%) patients were pathological diagnosed of solitary and multiple papilloma separately, and 36 (14.7%) patients had papillomatosis; 168 and 243 cases with positive signs, which were detected in all 245 patients who had underwent ultrasound and MRI examination(s), with the detection rate being 68.6% and 99.0% respectively. MRI imaging could clearly present mass-like lesions (solitary and multiple mass) and non-mass like lesions (ductal and regional). Whereas, ultrasound imaging could barely show mass-like (solitary and multiple mass) lesions. In surgery, when compared with traditional methods, MRI imaging could also more accurately locate the lesions and guide the excision. MRI guidance is both applicable to patients with and without nipple discharge, in addition to those who show no abnormal signs in ultrasound imaging. The recurrence-free survival time with traditional surgery methods was significantly lower than those in the MRI guide groups. Conclusions MRI is accurate at the detection, localization and resection range of intraductal papilloma lesions; all capabilities which are critical to successful breast surgery.
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Affiliation(s)
- Na Hao
- Department of Immunology, School of Medicine, Nankai University, Tianjin 300071, China.,Department of General Surgery, Peoples Liberation Army General Hospital, Beijing 100001, China
| | - Xiaoyan Yuan
- Department of General Surgery, Peoples Liberation Army General Hospital, Beijing 100001, China.,Department of Surgery, Tongzhou Maternity and Child Health Care Hospital, Beijing 100001, China
| | - Quansheng Wang
- Department of General Surgery, Peoples Liberation Army General Hospital, Beijing 100001, China
| | - Junyong Zhu
- Department of General Surgery, Peoples Liberation Army General Hospital, Beijing 100001, China
| | - Yiqiong Zheng
- Department of General Surgery, Peoples Liberation Army General Hospital, Beijing 100001, China
| | - Yanjun Zhang
- Department of General Surgery, Peoples Liberation Army General Hospital, Beijing 100001, China
| | - Mei Liu
- Department of Pathology, Peoples Liberation Army General Hospital, Beijing 100001, China
| | - Liuquan Cheng
- Department of Radiology, Peoples Liberation Army General Hospital, Beijing 100001, China
| | - Xiru Li
- Department of Immunology, School of Medicine, Nankai University, Tianjin 300071, China.,Department of General Surgery, Peoples Liberation Army General Hospital, Beijing 100001, China
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Wang S, Lou J. A case of giant complicated intraductal papilloma of breast on MRI and literature review. Cancer Rep (Hoboken) 2018; 1:e1136. [PMID: 32729233 DOI: 10.1002/cnr2.1136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/04/2018] [Accepted: 08/10/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND With the increasing use of image-guided biopsy, more breast intraductal papillomas are found than ever. Most intraductal papillomas are small, ranging from several milimeters to 2 cm. CASE We described a case of giant intraductal papilloma of breast in a 19-year-old girl with nipple bloody discharge and rapid growth. Magnetic resonance imaging diagnostic evaluation and pathologic correlation along with review of relevant literatures are documented. The lesion was characterized by presence of mixture of cystic and solid component with cystic component occupying a large space. The solid component showed morphologic, kinetic, and diffusion weighted imaging features suggestive of malignancy. Infarction with no enhancement was noted. Cystic compartments contained hemorrhage with fluid-fluid level formation. The patient undertook lumpectomy. CONCLUSION For a giant breast tumor with mixed solid and cystic component, intraductal papilloma should be considered in the differential diagnosis.
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Affiliation(s)
- Siqi Wang
- Radiology Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jianjuan Lou
- Radiology Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Grimm LJ, Bookhout CE, Bentley RC, Jordan SG, Lawton TJ. Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature. Clin Imaging 2018; 51:180-185. [PMID: 29859481 DOI: 10.1016/j.clinimag.2018.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Non-atypical papillomas (NAPs) diagnosed on core needle biopsy (CNB) frequently undergo surgical excision due to highly variable upstaging rates. The purpose of this study is to document our dual-institution upgrade rates of NAPs diagnosed on core needle biopsy and review the upgrade rates reported in the literature. MATERIALS AND METHODS Following IRB approval, CNB results from Duke University (7/1/2004-6/30/2014) and the University of North Carolina Chapel Hill (1/1/04-6/30/2013) were reviewed to identify non-atypical papillomas. All cases with surgical excision or 2 years of imaging follow up were included. In addition, a literature review identified 60 published studies on upgrades of NAPs diagnosed at CNB. Cases in our cohort and the published literature were reviewed for confounding factors: [1] missing radiologic-pathologic concordance and/or discordance, [2] papillomas included with high-risk lesions, [3] high risk lesions counted as upgrades, [4] review by a nonspecialized breast pathologist, and [5] cancer incidentally detected. RESULTS Of the 388 CNBs in our dual-institution cohort, 136 (35%) patients underwent surgical excision and 252 (65%) patients had imaging follow up. After controlling for confounders, no cancers (0/388) were found at surgical excision or during follow up imaging. The literature review upstaging rate was 4.0% (166/4157) but 1.8% (4/227) after excluding studies with confounders. The combined upstaging rate from the literature and this study was 0.6% (4/615). CONCLUSION The upstaging rate for CNB diagnosed NAPs was 0% in our cohort and 0.6% overall after adjusting for confounders. This low rate does not warrant reflexive surgical excision and diagnostic imaging follow up should be discretionary.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University, DUMC Box 3808, Durham, NC 27710, USA.
| | - Christine E Bookhout
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, 101 Manning Dr, Cb #7525, Chapel Hill, NC 27514, USA
| | - Rex C Bentley
- Department of Pathology, Duke University, DUMC Box 3712, Durham, NC 27710, USA
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina at Chapel Hill, 430 Waterstone Drive, First Floor, Hillsborough, NC 27278, USA
| | - Thomas J Lawton
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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Moon SM, Jung HK, Ko KH, Kim Y, Lee KS. Management of Clinically and Mammographically Occult Benign Papillary Lesions Diagnosed at Ultrasound-Guided 14-Gauge Breast Core Needle Biopsy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2325-2332. [PMID: 27629753 DOI: 10.7863/ultra.15.11049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine how to manage clinically and mammographically occult benign papillary lesions diagnosed at ultrasound (US)-guided 14-gauge breast core needle biopsy (CNB) by evaluating their upgrade rates. METHODS From our pathologic database of US-guided 14-gauge breast CNB, 69 benign papillomas and 9 atypical papillomas with available subsequent excisional findings (surgery or vacuum-assisted removal with additional US follow-up for ≥2 years) or US follow-up alone (≥2 years) were included in this study. We analyzed their upgrade rates by using excisional or US follow-up findings, with no change at 2 years as the reference standard. Patient age, lesion size, lesion distance from the nipple, multiplicity, imaging-histologic concordance, and histologic findings were compared between groups with and without upgrades by statistical analysis. RESULTS Surgical excision was performed in 53 (67.9%) of 78 benign papillary lesions and revealed 5 upgrades (11.4%) to atypical papillomas in 44 benign papillomas and 2 upgrades (22.2%) to ductal carcinomas in situ in 9 atypical papillomas. Among 12 benign papillomas (15.4%) with vacuum-assisted removal and US follow-up (≥2 years), 1 (8.3%) was upgraded to atypical papilloma. The remaining 13 benign papillomas (16.7%) were followed with US and were stable after a 2-year follow-up period. There were no significant differences in the variables between the groups. CONCLUSIONS Uniform surgical excision is not a reasonable management strategy for clinically and mammographically occult benign papillary lesions diagnosed at US-guided 14-gauge breast CNB. Clinically and mammographically occult benign papillary lesions may be subsequently managed by vacuum-assisted removal or imaging follow-up if atypia is not found.
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Affiliation(s)
- Sung Mo Moon
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Kyung Hee Ko
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Youdong Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Kyong Sik Lee
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
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14
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Abstract
The detection of intraductal breast papillomas can be difficult; however, it is very important for diagnosis and treatment. Although intraductal papillomas are usually benign growths, a small percentage may be malignant. No imaging modality can distinguish between benign and malignant papillomas; that is done only with a biopsy. The symptoms vary greatly, ranging from asymptomatic to nipple discharge to a palpable mass. Multiple modalities, including mammography and ductography, have been used to identify papillomas, while magnetic resonance imaging is used to further evaluate known papillomas. Sonography has been proven crucial in identifying these masses, thereby providing information for proper treatment including ultrasound-guided biopsies. The uses of various sonographic techniques, such as color Doppler, harmonic imaging, ballottement, use of stand-off pads, echo palpation, and elastography, have improved the detection of these masses.
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15
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Outcomes of benign breast papillomas diagnosed at image-guided vacuum-assisted core needle biopsy. Clin Imaging 2015; 39:576-81. [PMID: 25691147 DOI: 10.1016/j.clinimag.2015.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/29/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the upgrade rate of benign papillomas diagnosed at image-guided vacuum-assisted core needle biopsy (VACNB) and to compare our results with the summarized literature. MATERIALS AND METHODS A database search was performed to identify patients older than 18 years of age with benign papillomas diagnosed at VACNB between 2004 and 2013. A total of 199 papillomas in 184 patients were identified. Clinical, imaging, and pathological features for each were analyzed. Patients who were subsequently diagnosed with malignancy at the site of papilloma, either at surgical excision or upon imaging follow-up, were compared with those not upgraded. Upgrade was defined as a diagnosis of invasive carcinoma or ductal carcinoma in situ (DCIS). RESULTS Of 199 papillomas, 110 (55.3%) were diagnosed at ultrasound-guided VACNB, 78 (39.2%) were diagnosed at stereotactic-guided VACNB, and 11 (5.5%) were diagnosed at magnetic resonance imaging-guided VACNB. Surgical excision was performed for 89 (44.7%), and the remaining 110 (55.3%) underwent imaging follow-up. Two patients were subsequently diagnosed with invasive carcinoma and 4 were found with DCIS. The upgrade rate across both groups was 3% (6 of 199). Masses with calcifications (P=.001) and smaller needle gauge at VACNB (P=.02) had a significant association with upgrade. CONCLUSION Benign papillomas diagnosed with VACNB demonstrated a 3% upgrade rate to malignancy, which is similar to the 2.9% upgrade rate calculated by compiling applicable published literature. Conservative management with imaging follow-up as opposed to surgical excision may be appropriate in cases where an initial diagnosis of benign papilloma is made with VACNB. Benign papillomas associated with calcifications on imaging should be considered for surgical excision given their increased association with malignancy.
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Abstract
The indications, technique, results and limitations of MRI vacuum-assisted breast biopsies are discussed from a review of the literature. This was initially a home-grown technique and its development was slowed down by several factors. As a result of major technical advances, it has become a reliable and very consistent procedure with a low rate of underestimation. It is now an undisputed technique when suspicious MRI enhancement is seen with no corresponding mammography or ultrasound features.
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Affiliation(s)
- R Plantade
- Nice Europe Imaging Centre, 15, rue Alberti, 06000 Nice, France.
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, Paris Public Hospitals Health Service (AP-HP), Pierre et Marie Curie University Oncology Institute, 4, rue de la Chine, 75020 Paris, France
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17
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Chopier J, Dratwa C, Antoine M, Gonin J, Thomassin Naggara I. Radiopathological correlations: masses, non-masslike enhancements and MRI-guided biopsy. Diagn Interv Imaging 2014; 95:213-25. [PMID: 24456894 DOI: 10.1016/j.diii.2013.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MRI-guided biopsy is a recent interventional breast technique. Validating the procedure poses a new problem because the signal targeted is created by the injection of a paramagnetic contrast agent and is thus transitory. In the first instance, the procedure is validated by the radiologist, who checks that targeting is accurate and inserts a clip at the end of the procedure, and secondly by analysis of the histopathological results, which should be representative of the lesion. The pathologist needs to know the nature of the image, i.e. whether it is of mass or non-masslike enhancement, and its BI-RADS classification. The objective is that the image and the pathological result should concur. If the result is non-specific and benign, a follow-up MRI is required six months later.
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Affiliation(s)
- J Chopier
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France.
| | - C Dratwa
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France
| | - M Antoine
- Histopathology Department, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - J Gonin
- Histopathology Department, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - I Thomassin Naggara
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France
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18
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Outcome of High-Risk Lesions at MRI-Guided 9-Gauge Vacuum- Assisted Breast Biopsy. AJR Am J Roentgenol 2014; 202:237-45. [DOI: 10.2214/ajr.13.10600] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision. Clin Breast Cancer 2013; 13:439-49. [PMID: 24119786 DOI: 10.1016/j.clbc.2013.08.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/03/2013] [Accepted: 08/26/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The management of benign papilloma (BP) without atypia identified on breast core needle biopsy (CNB) is controversial. In this study, we determined the upgrade rate to malignancy for BPs without atypia diagnosed on CNB and whether there are factors associated with upgrade. METHODS Through our pathology database search, we studied 80 BPs without atypia identified on CNB from 80 patients from 1997 to 2010, including 30 lesions that had undergone excision and 50 lesions that had undergone ≥ 2 years of radiologic follow-up. Associations between surgery or upgrade to malignancy and clinical, radiologic, and pathologic features were analyzed. RESULTS Mass lesions, lesions sampled by ultrasound-guided CNB, and palpable lesions were associated with surgical excision. All 3 upgraded cases were mass lesions sampled by ultrasound-guided CNB. None of the lesions with radiologic follow-up only were upgraded to malignancy. The overall upgrade rate was 3.8%. None of the clinical, radiologic, or histologic features were predictive of upgrade. CONCLUSION Because the majority of patients can be safely managed with radiologic surveillance, a selective approach for surgical excision is recommended. Our proposed criteria for excision include pathologic/radiologic discordance or sampling by ultrasound-guided CNB without vacuum assistance when the patient is symptomatic or lesion size is ≥ 1.5 cm.
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Heller SL, Hernandez O, Moy L. Radiologic-pathologic correlation at breast MR imaging: what is the appropriate management for high-risk lesions? Magn Reson Imaging Clin N Am 2013; 21:583-99. [PMID: 23928247 DOI: 10.1016/j.mric.2013.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Breast magnetic resonance (MR) imaging is increasingly performed for a variety of indications, most commonly with the goal of detecting breast cancer. Percutaneous biopsy (usually under MR guidance or ultrasound if there is a correlating finding) is commonly used to evaluate suspicious imaging findings detected on MR imaging with the goal of identifying malignancy. It is important to be familiar with the characteristics and management of high-risk lesions detected or biopsied under MR guidance. This review focuses on the appearance of a variety of breast lesions detected on MR imaging that require excision with focus on pathologic correlation.
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Affiliation(s)
- Samantha L Heller
- Department of Radiology, St. George's Healthcare NHS Trust, London, UK
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