It’s Risky Business: Imaging Features Predictive of Upgrading High-Risk Lesions at Surgery

Congress:

ECR 2020

Poster Number:

C-13887

Type:

Scientific Exhibit

Keywords:

Performed at one institution, Observational, Retrospective, Multidisciplinary cancer care, Calcifications / Calculi, Vacuum assisted biopsy, Surgery, Biopsy, Ultrasound, Mammography, Management, Breast

Authors:

J. Chalfant¹, B. Li², T. Chan¹; ¹Los Angeles/US, ²Santa Monica/US

DOI:

10.26044/ecr2020/C-13887

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-13887

Table 1: Imaging Features of ADH Cases

Table 2: Calcification Morphology and Distribution for ADH Cases with Calcifications Only

Fig. 1: ML view of the right breast demonstrates amorphous segmental calcifications....

Fig. 2: CC view of the left breast demonstrates a 4 mm round speculated mass. Core...

Purpose

Management of high-risk lesions remains controversial, and there islimited literature on features associated with lesion upgrade at time of surgical excision. Identifying imaging features associated with lesion upgrade will help risk stratify patients and identify subgroups that may not require surgical excision. Therefore, the objective of this study was toidentify features predictive ofatypical ductal hyperplasia (ADH)upgraded to malignancy at time of surgical excision.

Methods and materials

This institutional review board approved HIPAA compliant retrospective study identified 766 cases of high-risk lesions within our institution’s mammography information system (Magview, Burtonsville, MD) from 1/31/2017 to 9/1/2019, 188 of which demonstrated ADH on stereotactic-guided or ultrasound-guided core needle biopsy. Patients who had concurrent biopsy-proven ipsilateral (17 cases, 9.0%) or contralateral (7 cases, 3.7%) breast malignancy were excluded. Those without a surgical excision pathology report (48 cases, 25.5%) were also excluded; of those lacking surgical pathology reports, 19 did not undergo surgical consultation within our...

Results

Of the 116 core needle biopsies demonstrating ADH that proceeded to surgical excision, 19 cases (16.4%) were upgraded to malignancy at time of surgical excision (4 invasive ductal carcinoma and 15 ductal carcinoma in situ). Of the upgraded cases at surgery, 57.9% presented with calcifications alone (Figure 1), 15.8% mass (Figure 2), 15.8% architectural distortion, 5.3% focal asymmetry with architectural distortion, and 5.3% architectural distortion with calcifications. Of the benign cases at surgery, 79.4% presented with calcifications alone (Figure 3), 8.2% mass, 5.2% architectural distortion,...

Conclusion

While the majority of ADH cases present with calcifications alone, a large percentage of upgraded cases presented with a finding other than calcifications alone (42.1% compared to 20.6% of benign cases). When ADH presents as calcifications alone, a segmental distribution is more frequently associated with surgical upgrade.

Personal information and conflict of interest

T. Chan; Los Angeles/US - nothing to disclose B. Li; Santa Monica/US - nothing to disclose J. Chalfant; Los Angeles/US - nothing to disclose

References

Menes, T. S., Rosenberg, R., Balch, S., Jaffer, S., Kerlikowske, K., & Miglioretti, D. L. (2014). Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium.The American Journal of Surgery,207(1), 24-31. Kohr, J. R., Eby, P. R., Allison, K. H., DeMartini, W. B., Gutierrez, R. L., Peacock, S., & Lehman, C. D. (2010). Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications.Radiology,255(3), 723-730. Deshaies, I., Provencher, L., Jacob, S.,...