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.

scholarly journals A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-grade Ductal Carcinoma In Situ of the Breast

2021 ◽  
Author(s):  
Luca Nicosia ◽  
Anna Carla Bozzini ◽  
Silvia Penco ◽  
Chiara Trentin ◽  
Maria Pizzamiglio ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Surgical Excision ◽  
Low Grade ◽  
Multivariable Model

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: 3100 VABBs were retrospectively reviewed among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients&rsquo; features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate analysis. Finally, we developed a predictive multivariable model based on the features which were significantly associated with the univariate analysis outcome. Results: the upgrade rate to invasive carcinoma was 10.8 %. At univariate analysis, the risk of upgrade was significantly lower in the absence of post- biopsy residual lesion (p&lt;0.001), age &gt; 50 (p=0.029), and in presence of low-grade DCIS only in specimens with microcalcifications (p=0.002). According to the final multivariable model, the predicted probability of diagnostic underestimation for a patient with all the three favourable features selected at univariate analysis was 1% (95% CI: 0.3%-4%). Conclusions: An easy to use predictive model of radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

Minimal (≤0.1 cm) Invasive Carcinoma in Breast Core Needle Biopsies

2004 ◽  
Vol 128 (9) ◽  
pp. 996-999
Author(s):  
Andrew A. Renshaw
Keyword(s):  
Minimally Invasive ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Ductal Carcinomas ◽  
Invasive Carcinomas

Abstract Context.—Although minimally invasive (microinvasive) carcinoma (≤0.1 cm) of the breast is a well-known and well-characterized entity in excision specimens, the significance of small foci of invasion in breast core needle biopsies has not been well described. Objective.—To define the significance of minimally invasive carcinoma in breast core needle biopsies. Design.—Review of a large series of core needle biopsies for invasive carcinomas measuring 0.1 cm or less and correlation of the results with those of subsequent excision. Setting.—Large community hospital. Results.—From approximately 8500 biopsies, a total of 18 cases of minimally invasive carcinoma from 16 women aged 42 to 80 years were identified. All were present on only 1 of 8 slides made from the block. Overall, the incidence was approximately 0.1% of all biopsies and 1% of all invasive carcinomas. Six cases were invasive lobular carcinomas, 1 was tubulolobular carcinoma, 3 were tubular carcinomas, and the remaining 8 were ductal carcinomas. Eight cases were associated with high-grade comedo ductal carcinomas, 2 with low-grade ductal carcinoma in situ, 3 with atypical ductal hyperplasia, 3 with atypical ductal hyperplasia and lobular carcinoma in situ, and 2 with no other lesion. From a total of 8 sections done entirely through the block, the lesion was present on the first level in 4 cases and the fifth level in 5 cases. No cases were identified in the last 3 levels. Subsequent pathology was available for 16 of the 18 cases. Invasive carcinomas measuring more than 1 cm were present in 9 cases (64%; along with 2 positive lymph nodes), invasive carcinomas less than 1 cm in 2 cases (14%), ductal carcinoma alone in 4 cases (29%), and no carcinoma in 1 case (7%). No pathologic or radiologic features were associated with the finding of invasive carcinoma at excision. Conclusion.—Invasive carcinoma measuring 0.1 cm or less is a rare finding in breast core needle biopsies, is commonly associated with in situ carcinomas and atypical hyperplasias, and is often associated with larger invasive foci at excision. However, invasive carcinomas smaller than 0.1 cm can occur without any other significant findings and may require relatively extensive sampling to identify.

Histological Assessment of Breast Lesions Identified Exclusively by Magnetic Resonance

2014 ◽  
Vol 80 (10) ◽  
pp. 944-947
Author(s):  
Victoria O'connor ◽  
Elizabeth Arena ◽  
Joslyn Albright ◽  
Nefertiti Brown ◽  
Ryan O'connor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Low Grade ◽  
Breast Lesions ◽  
Significant Family History ◽  
Ductal Hyperplasia ◽  
Significant Pathology

Radiologic–pathologic correlation of lesions diagnosed by magnetic resonance (MR) is precluded by insufficient data on histological characteristics of lesions suspicious on MR but not visible on concurrent mammogram or ultrasound. The objective of this study was to describe histological features of breast lesions diagnosed exclusively by MR. The participants underwent MR-guided breast biopsy between 2007 and 2012 for a suspicious lesion not identified by mammography or ultrasound. Histology slides were interpreted retrospectively by a breast pathologist. Of 126 patients (126 lesions), 34 (27%) had new breast cancer, 51 (40.5%) previous breast cancer, and 41 (32.5%) dense breasts or a significant family history of breast cancer. MR identified 23 (18.3%) invasive cancers: 20 were Grade 1 and 17 were ductal. Of the 126 lesions, 16 (13%) were ductal carcinoma in situ (DCIS), four were atypical ductal hyperplasia and atypical lobular hyperplasia (3%), and 68 (54%) were benign. Fifteen biopsies (12%) had no significant pathology. Five DCIS lesions were upgraded to T1 invasive cancers. Approximately 30 per cent of suspicious lesions detected exclusively by MR are invasive or in situ cancers that are predominantly low grade. Further studies are needed to determine if malignant lesions can be prospectively distinguished by MR characteristics.

scholarly journals 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

2016 ◽  
Vol 49 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Gustavo Machado Badan ◽  
Decio Roveda Júnior ◽  
Sebastião Piato ◽  
Eduardo de Faria Castro Fleury ◽  
Mário Sérgio Dantas Campos ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Surgical Excision ◽  
Target Lesion ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Underestimation Rate

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.

Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ as Revealed by Large-Core Needle Breast Biopsy

2000 ◽  
Vol 175 (5) ◽  
pp. 1341-1346 ◽  
Author(s):  
Marla L. Rosenfield Darling ◽  
Darrell N. Smith ◽  
Susan C. Lester ◽  
Carolyn Kaelin ◽  
Donna-Lee G. Selland ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Large Core ◽  
Core Needle ◽  
Ductal Hyperplasia

scholarly journals Atypical ductal hyperplasia on percutaneous breast biopsy: Scoring system to identify the lowest risk for upgrade

2021 ◽  
Author(s):  
Amanda L Amin ◽  
Onalisa D Winblad ◽  
Allison H Zupon ◽  
Fang Fan ◽  
Ossama Tawfik ◽  
...  
Keyword(s):  
Scoring System ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Surgical Excision ◽  
Low Risk ◽  
Categorical Variables ◽  
Imaging Features ◽  
Continuous Variables ◽  
Ductal Hyperplasia

Abstract Purpose NCCN guidelines recommend surgical excision for all patients with atypical ductal hyperplasia (ADH) on percutaneous biopsy. Improved imaging and biopsy techniques have lower contemporary upgrade rates, challenging standard practice. Methods A retrospective analysis identified 87 percutaneous biopsies diagnosing ADH who underwent surgical excision at a single institution from 01/2008 to 10/2015. Imaging was reviewed for lesion size and residual calcifications. Biopsy slides were reviewed for ADH features. Categorical variables were analyzed using Chi-square and Fisher’s exact tests; continuous variables with T- and Wilcoxon tests. Logistic regression model was used to determine association between odds of upgrade and number of low-risk features. Results Upgrade was identified in 13 cases (14.9%; 11 ductal carcinoma in situ and 2 invasive breast cancer). Imaging features associated with lowest risk of upgrade included imaging size < 1cm (p = 0.004) and > 50% removed by biopsy (p = 0.03). The only pathologic feature significantly associated with upgrade was the presence of micropapillary features (p = 0.10), with lower extent of ADH (1–2 foci, p = 0.12) trending toward significance. Those with the lowest risk of upgrade (0%) had all 4 low risk features (n = 17, 20%). The loss of a low-risk feature increased the odds of upgrade by 189% (OR = 1.89, 95% CI 0.241,0.742, p = 0.001). Conclusion Contemporary imaging and biopsy techniques have resulted in lower upgrade rates for ADH. Patients at lowest risk for upgrade can be identified using a scoring system and may be safely offered active surveillance over surgical excision.

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 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.

Pathologic Review of Atypical Hyperplasia Identified by Image-Guided Breast Needle Core Biopsy

2003 ◽  
Vol 127 (1) ◽  
pp. 49-54 ◽  
Author(s):  
I-Tien Yeh ◽  
Diana Dimitrov ◽  
Pamela Otto ◽  
Alexander R. Miller ◽  
Morton S. Kahlenberg ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Needle Core Biopsy ◽  
Atypical Lobular Hyperplasia ◽  
Ductal Hyperplasia

Abstract Context.—Management of breast needle core biopsies diagnosed as atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ is controversial. Current recommendations involve excisional biopsy to rule out ductal carcinoma in situ and/or invasive carcinoma, which have been reported in more than 50% of cases in some series. Objective.—To determine how frequently these diagnoses made on needle core biopsy are ultimately found to represent in situ or invasive carcinoma based on excisional biopsy specimens, in order to identify predictive factors. Design.—One thousand eight hundred thirty-six image-guided needle core biopsies were performed between January 1, 1995 and May 1, 2001. Fifty-four (2.9%) patients diagnosed with atypical ductal hyperplasia (n = 36), atypical lobular hyperplasia (n = 12), atypical ductal hyperplasia + atypical lobular hyperplasia (n = 3), or lobular carcinoma in situ (n = 3) subsequently underwent breast excisions. Pathologic features were reviewed in each of the needle core biopsies using Page's criteria and were then correlated with excision specimens. Setting.—University medical center. Results.—Review of the needle core biopsy cases with either ductal carcinoma in situ or invasive carcinoma + ductal carcinoma in situ on final excision showed that nucleoli were evident in most of the needle core cases, with foci of nuclear pleomorphism and individual cell necrosis or apoptosis. Conclusion.—A more precise diagnosis can be made by using strict criteria for atypical ductal hyperplasia versus ductal carcinoma in situ on needle core biopsy. Cytologic atypia, even if in a small area, particularly when there is apoptosis/individual cell necrosis, correlates with the finding of a more serious lesion on excision.

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