scholarly journals Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy – Results from a multicentric UK based study

2019 ◽  
Author(s):  
Emad Rakha ◽  
Francisco Beca ◽  
Mariangela D'Andrea ◽  
Areeg Abbas ◽  
William Petrou-Nunn ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Invasive Carcinoma ◽  
Surgical Excision ◽  
Lobular Neoplasia ◽  
Radial Scar ◽  
Complex Sclerosing Lesion ◽  
Ductal Hyperplasia ◽  
Epithelial Atypia

AIMS: The clinical significance of radial scar/complex sclerosing lesion (RS/CSL) with high risk lesions (epithelial atypia) diagnosed on needle core biopsy (NCB) is not well defined. We aimed at assessing the upgrade rate to carcinoma in-situ (DCIS) and invasive on the surgical excision specimen in a large cohort of RS/CSL associated with atypia. METHODS: 161 women with NCB diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings including different forms of the atypical lesions and final histological outcome in the excision specimens were retrieved and analysed and the upgrade rate for malignancy and invasive carcinoma calculated. RESULTS: 76% of the cases were associated with an atypical ductal hyperplasia (ADH) whereas lobular neoplasia was seen in 24%. On final histology 38 cases were malignant (overall upgrade rate of 25%); 12 invasive and 27 DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia the upgrade rate was 12%. The upgrade rates variability was also considerably lower and showing less variability when considering the upgrade to invasive carcinoma alone. CONCLUSION: The upgrade rate for ADH diagnosed on NCB with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with LN is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion.

scholarly journals Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study

2019 ◽  
Vol 72 (12) ◽  
pp. 800-804 ◽  
Author(s):  
Emad Rakha ◽  
Francisco Beca ◽  
Mariangela D'Andrea ◽  
Areeg Abbas ◽  
William Petrou-Nunn ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Lobular Neoplasia ◽  
Radial Scar ◽  
Needle Core Biopsy ◽  
Complex Sclerosing Lesion ◽  
Ductal Hyperplasia

AimsThe clinical significance of radial scar (RS)/complex sclerosing lesion (CSL) with high-risk lesions (epithelial atypia) diagnosed on needle core biopsy is not well defined. We aimed at assessing the upgrade rate to ductal carcinoma in situ (DCIS) and invasive carcinoma on the surgical excision specimen in a large cohort with RS/CSL associated with atypia.Methods157 women with a needle core biopsy diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings, including different forms of the atypical lesions and final histological outcome in the excision specimens, were retrieved and analysed, and the upgrade rates for malignancy and for invasive carcinoma were calculated.Results69.43% of the cases were associated with atypical ductal hyperplasia (ADH) or atypia not otherwise classifiable, whereas lobular neoplasia was seen in 21.66%. On final histology, 39 cases were malignant (overall upgrade rate of 24.84%); 12 were invasive and 27 had DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia, the upgrade rate was 11.76%. The upgrade rate’s variability was also considerably lower when considering the upgrade to invasive carcinoma alone for any associated lesion.ConclusionsThe upgrade rate for ADH diagnosed on needle core biopsy with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with lobular neoplasia is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed a similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion.

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

2015 ◽  
Vol 139 (9) ◽  
pp. 1137-1142 ◽  
Author(s):  
Cathleen Matrai ◽  
Timothy M. D'Alfonso ◽  
Lindsay Pharmer ◽  
Michele B. Drotman ◽  
Rache M. Simmons ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Radial Scar ◽  
Needle Core Biopsy ◽  
Ductal Hyperplasia

Context Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. Objective To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. Design Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. Results Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). Conclusions No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

scholarly journals Mucocele-like Lesion of the Breast Diagnosed on Core Biopsy: Histologic and Clinical Analysis of 78 Cases With Focus on Features Associated With Upgrade

2021 ◽  
Author(s):  
William S. Towne ◽  
Aya Y. Michaels ◽  
Paula S. Ginter
Keyword(s):  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Clinical Analysis ◽  
Atypical Lobular Hyperplasia ◽  
Ductal Hyperplasia

Context.— Mucocele-like lesion of the breast (MLL) is an uncommon entity, and recent studies show low rates of upgrade from core needle biopsy (CNB) to excision. Objective.— To evaluate features associated with upgrade of MLLs diagnosed on CNB. Design.— Seventy-eight MLLs diagnosed on CNB from 1998–2019 and subsequent excisions were reviewed. Histologic parameters evaluated included the presence of atypia, presence and morphology of calcifications, and morphologic variant (classic [C-MLL], duct ectasia–like [DEL-MLL], or cystic mastopathy–like [CML-MLL]). Results.— Overall, 45 MLLs lacked atypia and 33 were associated with atypia (atypical ductal hyperplasia, 32; atypical lobular hyperplasia, 1). Most were C-MLLs (61) with fewer DEL-MLLs (14) and CML-MLLs (3). Half showed both coarse and fine calcifications, with fewer showing only coarse or fine calcifications, and some showing none. Subsequent excision or clinical follow-up was available for 25 MLLs without atypia—of which 2 (8.0%) were upgraded to ductal carcinoma in situ (DCIS)—and 23 with atypia, of which 4 (17.4%) were upgraded to DCIS. No cases were upgraded to invasive carcinoma. All upgraded cases showed coarse calcifications on CNB, and all upgraded cases were associated with residual calcifications on post-CNB imaging. Conclusions.— Most MLLs present as calcifications and nearly half are associated with atypia. Upgrade to DCIS is twice as frequent in MLLs with atypia versus those without. A predominance of coarse calcifications and the presence of residual targeted calcifications following core biopsy may be associated with higher upgrade rates.

scholarly journals The growing fibroadenoma

2015 ◽  
Vol 4 (4) ◽  
pp. 204798161557227 ◽  
Author(s):  
Linda M Sanders ◽  
Rana Sara
Keyword(s):  
Young Women ◽  
Retrospective Review ◽  
Core Biopsy ◽  
Surgical Excision ◽  
Know How ◽  
Phyllodes Tumors ◽  
Stereotactic Guidance ◽  
Risk Of Cancer

Background Fibroadenomas (FAs) are the most common tumors of the breast clinically and pathologically in adolescent and young women but may be discovered at any age. With increasing use of core biopsy rather than excision for diagnosis, it is now commonplace to follow these lesions with imaging. Purpose To assess the incidence of epithelial abnormalities (atypia, in situ or invasive, ductal or lobular malignancies) in FAs diagnosed by core biopsy and to re-evaluate the management paradigm for any growing FA. Material and Methods A retrospective review of the senior author’s pathology results over 19 years identified 2062 nodular FAs (biopsied by ultrasound or stereotactic guidance). Eighty-three core biopsied FAs were identified which subsequently enlarged. Results Twelve of 2062 of core biopsied nodules demonstrated atypia, in situ, or invasive malignancy (ductal or lobular) within or adjacent to the FA (0.58%). Eighty-three FAs enlarged and underwent either surgical excision ( n = 65), repeat core biopsy ( n = 9), or imaging follow-up ( n = 9). The incidence of atypia, in situ or invasive malignancy was 0/83 (0%). Two enlarging FAs were subsequently surgically diagnosed as benign phyllodes tumors (PT). Conclusion Malignancy in or adjacent to a core biopsied FA is rare. The risk of cancer in a growing FA is even rarer; none were present in our series. FAs with abnormal epithelial abnormalities require excision. Otherwise, FAs without epithelial abnormality diagnosed by core biopsy need no specific follow-up considering the negligible incidence of conversion to malignancy. The breast interventionalist must know how to manage discordant pathology results.

scholarly journals Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

Breast Care ◽  
2014 ◽  
Vol 10 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Aykut Soyder ◽  
Füsun Taşkın ◽  
Serdar Ozbas
Keyword(s):  
Core Biopsy ◽  
Breast Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Breast Lesions ◽  
Core Needle ◽  
Ductal Carcinomas ◽  
Histological Results

Background: The objectives of this study were to determine the frequency of imaging-histological discordance and to compare the frequency of carcinoma between discordant lesions at ultrasound (US)-guided core needle biopsy. Materials and Methods: From November 2009 to June 2012, we performed US-guided 14-gauge core needle biopsies on 989 breast lesions in 961 women. We reviewed 58 (5.8%) cases that had imaging-histological discordance after percutaneous breast biopsy and underwent subsequent excisional biopsy. The clinical, radiological, and histological findings were reviewed for those 58 cases. Results: Among the 58 cases, subsequent excisions revealed 16 (27.5%) malignancies, which were categorized as 9 (15.5%) invasive ductal carcinomas, 4 (6.9%) malignant phyllodes tumors, and 3 (5.1%) ductal carcinomas in situ. Conclusion: The malignancy rate of 27.5% suggests that surgical excision should be performed in those cases presenting with imaging-histological discordance after US-guided core biopsy. Careful correlation of clinical, radiological, and histological results as well as appropriate follow-up are essential.

scholarly journals Surgical Excision of Benign Papillomas Diagnosed with Core Biopsy: A Community Hospital Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Eka Rozentsvayg ◽  
Kristen Carver ◽  
Sunita Borkar ◽  
Melvy Mathew ◽  
Sean Enis ◽  
...  
Keyword(s):  
High Risk ◽  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Surgical Pathology ◽  
Ductal Hyperplasia ◽  
Benign Papilloma

Our goal was to assess the value of surgical excision of benign papillomas of the breast diagnosed on percutaneous core biopsy by determining the frequency of upgrade to malignancies and high risk lesions on a final surgical pathology. We reviewed 67 patients who had biopsies yielding benign papilloma and underwent subsequent surgical excision. Surgical pathology of the excised lesions was compared with initial core biopsy pathology results. 54 patients had concordant benign core and excisional pathology. Cancer (ductal carcinoma in situ and invasive ductal carcinoma) was diagnosed in five (7%) patients. Surgery revealed high-risk lesions in 8 (12%) patients, including atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ. Cancer and high risk lesions accounted for 13 (19%) upstaging events from benign papilloma diagnosis. Our data suggests that surgical excision is warranted with core pathology of benign papilloma.

scholarly journals Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1120
Author(s):  
Luca Nicosia ◽  
Antuono Latronico ◽  
Francesca Addante ◽  
Rossella De Santis ◽  
Anna Carla Bozzini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Univariate Analysis ◽  
Surgical Excision ◽  
P Value ◽  
Ductal Hyperplasia

(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.

0-60. Differentiation of benign radial scar (complex sclerosing lesion) from carcinoma by 14G core biopsy (CB): is surgical excision of radial scars necessary?

The Breast ◽  
1997 ◽  
Vol 6 (4) ◽  
pp. 241
Author(s):  
M.J. Michell ◽  
S. Humphreys ◽  
D.A. Andrews ◽  
G.P. Howes ◽  
J.V. Roberts ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Surgical Excision ◽  
Radial Scar ◽  
Complex Sclerosing Lesion
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