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High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up.
Br J Radiol. 2018 Oct; 91(1090):20180300.BJ

Abstract

OBJECTIVE:

To determine whether breast MRI-guided vacuum-assisted biopsy (MRI-VAB) high-risk lesion histology influences surgical or long-term imaging follow-up outcomes.

METHODS:

Patients with imaging-concordant high-risk findings on 9-gauge breast MRI-VAB between January 2007 and July 2012 who had surgical histopathology or 2 year imaging follow-up were retrospectively reviewed.

RESULTS:

90 patients with 99 lesions were included. Lesions were atypical ductal hyperplasia (ADH) (n = 21), lobular neoplasia [n = 36; atypical lobular hyperplasia (ALH) (n = 22), lobular carcinoma in situ (LCIS) (n = 6), and ALH plus LCIS (n = 8)], and other high-risk lesion (n = 42; papillary lesions, radial scar, flat epithelial atypia, atypia unspecified). Of 53 excised lesions, 6 (11%) were upgraded to invasive cancer or ductal carcinoma in situ (DCIS). 4 of 21 (19%) ADH lesions were upgraded to DCIS. 2 of 36 (6%) lobular neoplasia lesions, both combined ALH and LCIS, were upgraded to DCIS, and invasive lobular carcinoma, respectively. The remaining 46 lesions were managed conservatively with imaging follow-up: 17 (37%) had mammography only, while 29 (63%) had mammography and MRI follow-up. There was no evidence of breast cancer development at the site of MRI-VAB in the cases with only imaging follow-up.

CONCLUSION:

We conclude that the upgrade rate for high-risk lesions at MRI-VAB at surgical excision is low. Surgical excision is warranted for ADH and combined ALH-LCIS lesions. For other lesions, a multidisciplinary approach to decide on personalized management may be appropriate.

ADVANCES IN KNOWLEDGE:

Surgical excision is warranted for ADH lesions and combined ALH-LCIS lesions identified at breast MRI-VAB. A multidisciplinary approach to patient management of other high-risk lesions may be appropriate.

Authors+Show Affiliations

1 Department of Diagnostic Radiology, Section of Breast Imaging, The University of Texas MD Anderson Cancer Center , Houston, TX , USA.1 Department of Diagnostic Radiology, Section of Breast Imaging, The University of Texas MD Anderson Cancer Center , Houston, TX , USA.2 Department of Diagnostic Radiology, Division of Breast Imaging, The University of Texas Southwestern Medical Center , Dallas, TX , USA.1 Department of Diagnostic Radiology, Section of Breast Imaging, The University of Texas MD Anderson Cancer Center , Houston, TX , USA.1 Department of Diagnostic Radiology, Section of Breast Imaging, The University of Texas MD Anderson Cancer Center , Houston, TX , USA.3 Department of Biostatistics, Division of Science, The University of Texas MD Anderson Cancer Center , Houston, TX , USA.4 Department of Diagnostic Radiology, Division of Breast Imaging, King Chulalongkorn Memorial Hospital , Bangkok , Thailand.1 Department of Diagnostic Radiology, Section of Breast Imaging, The University of Texas MD Anderson Cancer Center , Houston, TX , USA.1 Department of Diagnostic Radiology, Section of Breast Imaging, The University of Texas MD Anderson Cancer Center , Houston, TX , USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29947265

Citation

Speer, Megan E., et al. "High Risk Breast Lesions Identified On MRI-guided Vacuum-assisted Needle Biopsy: Outcome of Surgical Excision and Imaging Follow-up." The British Journal of Radiology, vol. 91, no. 1090, 2018, p. 20180300.
Speer ME, Huang ML, Dogan BE, et al. High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up. Br J Radiol. 2018;91(1090):20180300.
Speer, M. E., Huang, M. L., Dogan, B. E., Adrada, B. E., Candelaria, R. P., Hess, K. R., Hansakul, P., Yang, W. T., & Rauch, G. M. (2018). High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up. The British Journal of Radiology, 91(1090), 20180300. https://doi.org/10.1259/bjr.20180300
Speer ME, et al. High Risk Breast Lesions Identified On MRI-guided Vacuum-assisted Needle Biopsy: Outcome of Surgical Excision and Imaging Follow-up. Br J Radiol. 2018;91(1090):20180300. PubMed PMID: 29947265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up. AU - Speer,Megan E, AU - Huang,Monica L, AU - Dogan,Basak E, AU - Adrada,Beatriz E, AU - Candelaria,Rosalind P, AU - Hess,Kenneth R, AU - Hansakul,Palita, AU - Yang,Wei T, AU - Rauch,Gaiane M, Y1 - 2018/07/05/ PY - 2018/6/28/pubmed PY - 2018/10/5/medline PY - 2018/6/28/entrez SP - 20180300 EP - 20180300 JF - The British journal of radiology JO - Br J Radiol VL - 91 IS - 1090 N2 - OBJECTIVE:: To determine whether breast MRI-guided vacuum-assisted biopsy (MRI-VAB) high-risk lesion histology influences surgical or long-term imaging follow-up outcomes. METHODS:: Patients with imaging-concordant high-risk findings on 9-gauge breast MRI-VAB between January 2007 and July 2012 who had surgical histopathology or 2 year imaging follow-up were retrospectively reviewed. RESULTS:: 90 patients with 99 lesions were included. Lesions were atypical ductal hyperplasia (ADH) (n = 21), lobular neoplasia [n = 36; atypical lobular hyperplasia (ALH) (n = 22), lobular carcinoma in situ (LCIS) (n = 6), and ALH plus LCIS (n = 8)], and other high-risk lesion (n = 42; papillary lesions, radial scar, flat epithelial atypia, atypia unspecified). Of 53 excised lesions, 6 (11%) were upgraded to invasive cancer or ductal carcinoma in situ (DCIS). 4 of 21 (19%) ADH lesions were upgraded to DCIS. 2 of 36 (6%) lobular neoplasia lesions, both combined ALH and LCIS, were upgraded to DCIS, and invasive lobular carcinoma, respectively. The remaining 46 lesions were managed conservatively with imaging follow-up: 17 (37%) had mammography only, while 29 (63%) had mammography and MRI follow-up. There was no evidence of breast cancer development at the site of MRI-VAB in the cases with only imaging follow-up. CONCLUSION:: We conclude that the upgrade rate for high-risk lesions at MRI-VAB at surgical excision is low. Surgical excision is warranted for ADH and combined ALH-LCIS lesions. For other lesions, a multidisciplinary approach to decide on personalized management may be appropriate. ADVANCES IN KNOWLEDGE:: Surgical excision is warranted for ADH lesions and combined ALH-LCIS lesions identified at breast MRI-VAB. A multidisciplinary approach to patient management of other high-risk lesions may be appropriate. SN - 1748-880X UR - https://www.unboundmedicine.com/medline/citation/29947265/High_risk_breast_lesions_identified_on_MRI_guided_vacuum_assisted_needle_biopsy:_outcome_of_surgical_excision_and_imaging_follow_up_ L2 - https://www.birpublications.org/doi/10.1259/bjr.20180300?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -