Aims and objectives
This study aims to retrospectively assess the results of surgical excision versus long-term imaging follow-upof high-riskbreast lesions after the diagnosis on core-needlebiopsy (CNB) and to discuss the results in association with the review of the literature.High-risk breast lesions are rare,
borderline lesions with a potential of malignancy.
Core-needle biopsy is the primary diagnostic tool to reveal them (1).
These lesionsinclude atypical ductal hyperplasia (ADH),
lobular neoplasia (LN),
papillary lesions,
radial scars and columnar cell lesions (CCL).
There are not clear guidelines formanagement of these lesions....
Methods and materials
The radiologic and surgical records of 391 patients who underwent image-guided percutaneous biopsy from January 2008 toSeptember 2014 were reviewed.
33 patients with a biopsy-proven high-riskbreast lesionin the absence ofductal carcinoma in situ(DCIS) or invasive breast carcinoma in the samples obtained,
were included in the study.
Patients >40 years-old had mammography and whole-breast ultrasound (US) while only US was performed for patients younger.For the mammographicexamination,
two-view standard mammograms(and additional projections when necessary) were obtained usinga film-screen unit ora full-field digital unit.
The choice of imaging...
Results
All 33 patients included in the study were female with a mean age of 53 years (range 25 to 77 years).
High-risk lesions diagnosed in these cases were ADH in 16 (4.09%),
intraductal papilloma in 12(3.06%),
CCL in 4 (1.02 %) and LN in 1 (0.25%) as showed on Figure 1.
21 patients (63.6 %) proceeded to excisional biopsy.
10 of them (47.6 %)upgraded to malignancy afterwards while 11 (52.3%) remained to be benign (Fig.2).9 of the 10 malignancy-upgraded lesions were diagnosed as DCIS/IDC.
The...
Conclusion
It looks like,
there is a consensus in the literature regarding the management of some high-risklesions (e.g.
ADH) diagnosed at CNB as to surgically excise,
based on the risk ofunderestimation of malignancy,
while for others (e.g.
CCL,LN) definitive decisions are not yet defined as to excise or to follow-up radiologically (2,3,4,5,6,7).
ADH has been assigned as a moderately increased risk for development of both ipsilateral and contralateral breast cancer.
Besides,
itmay coexist withDCIS and/or invasive carcinoma.
The rate of underestimation of carcinoma,
on core-needle biopsy,...
References
1.O’Neil M,
Madan R,
Tawfik O.W.
et al.Lobular carcinoma in situ/atypical lobular hyperplasia on breast needlebiopsies: does it warrant surgical excisional biopsy? A study of 27 cases.
Annals of Diagnostic Pathology 2010;14: 251–255.
2.Kunju L.P,
Kleer C.G.Significance of flat epithelial atypia on mammotome coreneedle biopsy: should it be excised ?.Human Pathology 2007 ; 38: 35–41.
3.Deshaies I,
Provencher L,
Jacob S et.al.Factors associated with upgrading to malignancy at surgery of atypical ductalhyperplasia diagnosed on core biopsy.
The Breast 2011; 20 : 50-55.
4.Seo M,Chang J.M,Kim...