Tags

Type your tag names separated by a space and hit enter

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review.
Mod Pathol. 2016 12; 29(12):1471-1484.MP

Abstract

Optimal management of high-risk breast lesions detected by mammogram yielding atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia on core needle biopsy is controversial. This is a single-institution retrospective review of 5750 core needle biopsy cases seen over 14.5 years, including 249 (4.3%), 72 (1.3%), 50 (0.9%), 37 (0.6%), and 54 (0.9%) cases of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia, respectively. Patient age, radiologic characteristics, needle gauge, and excision diagnoses were recorded. Of 462 high-risk cases analyzed, 333 (72%) underwent excision. Upgrade rate to ductal carcinoma in situ, pleomorphic carcinoma in situ, or invasive mammary carcinoma was 18% for atypical ductal hyperplasia, 11% for flat epithelial atypia, 9% for atypical lobular hyperplasia, 28% for lobular carcinoma in situ, and 16% for radial scar. Carcinoma diagnosed on excision was more likely to be in situ than invasive, and if invasive, more likely to be low grade than high grade. Overall, cases that were benign (vs high risk or carcinoma) on excision were less likely to have residual calcifications after biopsy (17% vs 27%, P=0.013), and more likely to have a smaller mass size (<1 cm) (82% vs 50%, P=0.001). On subgroup analysis, atypical ductal hyperplasia cases that were benign (vs high risk or carcinoma) on excision were more likely to have smaller mass size (<1 cm) (P=0.025). Lobular neoplasia diagnosed incidentally (vs targeted) on core needle biopsy was less likely to upgrade on excision (5% vs 39%, P=0.002). A comprehensive literature review was performed, identifying 116 studies reporting high-risk lesion upgrade rates, and our upgrade rates were similar to those of more recent larger studies. Careful radiological-pathological correlation is needed to identify high-risk lesion subgroups that may not need excision.

Authors+Show Affiliations

David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.Department of Pathology & Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27538687

Citation

Mooney, Kelly L., et al. "Upgrade Rates of High-risk Breast Lesions Diagnosed On Core Needle Biopsy: a Single-institution Experience and Literature Review." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 29, no. 12, 2016, pp. 1471-1484.
Mooney KL, Bassett LW, Apple SK. Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 2016;29(12):1471-1484.
Mooney, K. L., Bassett, L. W., & Apple, S. K. (2016). Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 29(12), 1471-1484. https://doi.org/10.1038/modpathol.2016.127
Mooney KL, Bassett LW, Apple SK. Upgrade Rates of High-risk Breast Lesions Diagnosed On Core Needle Biopsy: a Single-institution Experience and Literature Review. Mod Pathol. 2016;29(12):1471-1484. PubMed PMID: 27538687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. AU - Mooney,Kelly L, AU - Bassett,Lawrence W, AU - Apple,Sophia K, Y1 - 2016/08/19/ PY - 2016/02/28/received PY - 2016/05/31/revised PY - 2016/06/02/accepted PY - 2016/8/20/pubmed PY - 2018/1/11/medline PY - 2016/8/20/entrez SP - 1471 EP - 1484 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod Pathol VL - 29 IS - 12 N2 - Optimal management of high-risk breast lesions detected by mammogram yielding atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia on core needle biopsy is controversial. This is a single-institution retrospective review of 5750 core needle biopsy cases seen over 14.5 years, including 249 (4.3%), 72 (1.3%), 50 (0.9%), 37 (0.6%), and 54 (0.9%) cases of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia, respectively. Patient age, radiologic characteristics, needle gauge, and excision diagnoses were recorded. Of 462 high-risk cases analyzed, 333 (72%) underwent excision. Upgrade rate to ductal carcinoma in situ, pleomorphic carcinoma in situ, or invasive mammary carcinoma was 18% for atypical ductal hyperplasia, 11% for flat epithelial atypia, 9% for atypical lobular hyperplasia, 28% for lobular carcinoma in situ, and 16% for radial scar. Carcinoma diagnosed on excision was more likely to be in situ than invasive, and if invasive, more likely to be low grade than high grade. Overall, cases that were benign (vs high risk or carcinoma) on excision were less likely to have residual calcifications after biopsy (17% vs 27%, P=0.013), and more likely to have a smaller mass size (<1 cm) (82% vs 50%, P=0.001). On subgroup analysis, atypical ductal hyperplasia cases that were benign (vs high risk or carcinoma) on excision were more likely to have smaller mass size (<1 cm) (P=0.025). Lobular neoplasia diagnosed incidentally (vs targeted) on core needle biopsy was less likely to upgrade on excision (5% vs 39%, P=0.002). A comprehensive literature review was performed, identifying 116 studies reporting high-risk lesion upgrade rates, and our upgrade rates were similar to those of more recent larger studies. Careful radiological-pathological correlation is needed to identify high-risk lesion subgroups that may not need excision. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/27538687/Upgrade_rates_of_high_risk_breast_lesions_diagnosed_on_core_needle_biopsy:_a_single_institution_experience_and_literature_review_ L2 - https://doi.org/10.1038/modpathol.2016.127 DB - PRIME DP - Unbound Medicine ER -