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Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia.
Breast J. 2015 May-Jun; 21(3):224-32.BJ

Abstract

Flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) are precursors of breast malignancy. Management of FEA or ADH after image-guided core needle biopsy (CNB) remains controversial. The aim of this study was to evaluate malignancy underestimation rates after FEA or ADH diagnosis using image-guided CNB and to identify clinical characteristics and imaging features associated with malignancy as well as identify cases with low underestimation rates that may be treatable by observation only. We retrospectively reviewed 2,875 consecutive image-guided CNBs recorded in an electronic data base from January 2010 to December 2011 and identified 128 (4.5%) FEA and 83 (2.9%) ADH diagnoses (211 total cases). Of these, 64 (30.3%) were echo-guided CNB procedures and 147 (69.7%) mammography-guided CNBs. Twenty patients (9.5%) were upgraded to malignancy. Multivariate analysis indicated that age (OR = 1.123, p = 0.002, increase of 1 year), mass-type lesion with calcifications (OR = 8.213, p = 0.006), and ADH in CNB specimens (OR = 8.071, p = 0.003) were independent predictors of underestimation. In univariate analysis of echo-guided CNB (n = 64), mass with calcifications had the highest underestimation rate (p < 0.001). Multivariate analysis of 147 mammography-guided CNBs revealed that age (OR = 1.122, p = 0.040, increase of 1 year) and calcification distribution were significant independent predictors of underestimation. No FEA case in which, complete calcification retrieval was recorded after CNB was upgraded to malignancy. Older age at diagnosis on image-guided CNB was a predictor of malignancy underestimation. Mass with calcifications was more likely to be associated with malignancy, and in cases presenting as calcifications only, segmental distribution or linear shapes were significantly associated with upgrading. Excision after FEA or ADH diagnosis by image-guided CNB is warranted except for FEA diagnosed using mammography-guided CNB with complete calcification retrieval.

Authors+Show Affiliations

Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Study
Journal Article

Language

eng

PubMed ID

25772033

Citation

Yu, Chi-Chang, et al. "Predictors of Underestimation of Malignancy After Image-guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia." The Breast Journal, vol. 21, no. 3, 2015, pp. 224-32.
Yu CC, Ueng SH, Cheung YC, et al. Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia. Breast J. 2015;21(3):224-32.
Yu, C. C., Ueng, S. H., Cheung, Y. C., Shen, S. C., Kuo, W. L., Tsai, H. P., Lo, Y. F., & Chen, S. C. (2015). Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia. The Breast Journal, 21(3), 224-32. https://doi.org/10.1111/tbj.12389
Yu CC, et al. Predictors of Underestimation of Malignancy After Image-guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia. Breast J. 2015 May-Jun;21(3):224-32. PubMed PMID: 25772033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia. AU - Yu,Chi-Chang, AU - Ueng,Shir-Hwa, AU - Cheung,Yun-Chung, AU - Shen,Shih-Che, AU - Kuo,Wen-Lin, AU - Tsai,Hsiu-Pei, AU - Lo,Yung-Feng, AU - Chen,Shin-Cheh, Y1 - 2015/03/13/ PY - 2015/3/17/entrez PY - 2015/3/17/pubmed PY - 2016/5/4/medline KW - atypical ductal hyperplasia KW - breast core needle biopsy KW - flat epithelial atypia KW - underestimation SP - 224 EP - 32 JF - The breast journal JO - Breast J VL - 21 IS - 3 N2 - Flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) are precursors of breast malignancy. Management of FEA or ADH after image-guided core needle biopsy (CNB) remains controversial. The aim of this study was to evaluate malignancy underestimation rates after FEA or ADH diagnosis using image-guided CNB and to identify clinical characteristics and imaging features associated with malignancy as well as identify cases with low underestimation rates that may be treatable by observation only. We retrospectively reviewed 2,875 consecutive image-guided CNBs recorded in an electronic data base from January 2010 to December 2011 and identified 128 (4.5%) FEA and 83 (2.9%) ADH diagnoses (211 total cases). Of these, 64 (30.3%) were echo-guided CNB procedures and 147 (69.7%) mammography-guided CNBs. Twenty patients (9.5%) were upgraded to malignancy. Multivariate analysis indicated that age (OR = 1.123, p = 0.002, increase of 1 year), mass-type lesion with calcifications (OR = 8.213, p = 0.006), and ADH in CNB specimens (OR = 8.071, p = 0.003) were independent predictors of underestimation. In univariate analysis of echo-guided CNB (n = 64), mass with calcifications had the highest underestimation rate (p < 0.001). Multivariate analysis of 147 mammography-guided CNBs revealed that age (OR = 1.122, p = 0.040, increase of 1 year) and calcification distribution were significant independent predictors of underestimation. No FEA case in which, complete calcification retrieval was recorded after CNB was upgraded to malignancy. Older age at diagnosis on image-guided CNB was a predictor of malignancy underestimation. Mass with calcifications was more likely to be associated with malignancy, and in cases presenting as calcifications only, segmental distribution or linear shapes were significantly associated with upgrading. Excision after FEA or ADH diagnosis by image-guided CNB is warranted except for FEA diagnosed using mammography-guided CNB with complete calcification retrieval. SN - 1524-4741 UR - https://www.unboundmedicine.com/medline/citation/25772033/Predictors_of_underestimation_of_malignancy_after_image_guided_core_needle_biopsy_diagnosis_of_flat_epithelial_atypia_or_atypical_ductal_hyperplasia_ L2 - https://doi.org/10.1111/tbj.12389 DB - PRIME DP - Unbound Medicine ER -