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High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: imaging characteristics, outcome of surgical excision or imaging follow-up.
Breast Cancer. 2020 May; 27(3):405-414.BC

Abstract

BACKGROUND

To evaluate imaging characteristics, outcome of surgical excision or imaging follow-up on high-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy (MRI-VABB).

METHODS

We retrospectively reviewed 598 lesions undergoing 9-gauge MRI-VABB from January 2015 to April 2018 to identify high risk breast lesions. We collected patient demographics, breast MRI BI-RADS descriptors, histopathological diagnosis at MRI-VABB and surgical excision, frequency of upgrade to malignancy and imaging follow-up of high-risk lesions. The x2 test and Fisher exact tests were performed for univariate analysis.

RESULTS

114 patients with 124/598 findings (20.7%) had high-risk lesions at MRI-VABB, including atypical ductal hyperplasia (ADH) (21/124, 16.9%), lobular neoplasia (40/124, 32.3%), radial scar/complex sclerosing lesion (RS/CSL) (13/124, 10.5%), papillary lesions (49/124, 39.5%), and flat epithelial atypia (FEA) (1/124, 0.8%). 84/124 (67.7%) high-risk lesions were excised. 19/84 (22.6%) were upgraded to malignancy (7 invasive cancer, 12 DCIS). The upgrade rate for ADH and lobular neoplasia was 7/18 (38.9%) and 9/31 (29.0%), respectively. The upgrade rate for RS/CSL was 1/10 (10%). Of the 25 papillary lesions excised, 2 (8%) demonstrated pathologic atypia and were upgraded to DCIS. The other 23 papillary lesions had no upgrade or atypia. Excised high-risk lesions showing upgrade varied from 0.4 to 6 cm in length (mean 1.6 cm). There was a non-significant trend (p = 0.054) between larger lesion and upgrade to malignancy; however, there were no other specific imaging features to predict malignancy upgrade.

CONCLUSIONS

There were no specific MRI imaging characteristics of high-risk lesions to predict malignancy upgrade. Therefore, surgical excision is recommended for high-risk lesions, especially ADH or lobular neoplasia.

Authors+Show Affiliations

Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. satoko.o@marianna-u.ac.jp.Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31838725

Citation

Okamoto, Satoko, et al. "High-risk Lesions Diagnosed at MRI-guided Vacuum-assisted Breast Biopsy: Imaging Characteristics, Outcome of Surgical Excision or Imaging Follow-up." Breast Cancer (Tokyo, Japan), vol. 27, no. 3, 2020, pp. 405-414.
Okamoto S, Chen ST, Covelli JD, et al. High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: imaging characteristics, outcome of surgical excision or imaging follow-up. Breast Cancer. 2020;27(3):405-414.
Okamoto, S., Chen, S. T., Covelli, J. D., DeMartini, W. B., Daniel, B. L., & Ikeda, D. M. (2020). High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: imaging characteristics, outcome of surgical excision or imaging follow-up. Breast Cancer (Tokyo, Japan), 27(3), 405-414. https://doi.org/10.1007/s12282-019-01032-8
Okamoto S, et al. High-risk Lesions Diagnosed at MRI-guided Vacuum-assisted Breast Biopsy: Imaging Characteristics, Outcome of Surgical Excision or Imaging Follow-up. Breast Cancer. 2020;27(3):405-414. PubMed PMID: 31838725.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: imaging characteristics, outcome of surgical excision or imaging follow-up. AU - Okamoto,Satoko, AU - Chen,Shu-Tian, AU - Covelli,James D, AU - DeMartini,Wendy B, AU - Daniel,Bruce L, AU - Ikeda,Debra M, Y1 - 2019/12/14/ PY - 2019/09/03/received PY - 2019/12/04/accepted PY - 2019/12/16/pubmed PY - 2021/2/3/medline PY - 2019/12/16/entrez KW - Atypical KW - Breast KW - High-risk lesion KW - MRI KW - MRI-guided vacuum-assisted breast biopsy SP - 405 EP - 414 JF - Breast cancer (Tokyo, Japan) JO - Breast Cancer VL - 27 IS - 3 N2 - BACKGROUND: To evaluate imaging characteristics, outcome of surgical excision or imaging follow-up on high-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy (MRI-VABB). METHODS: We retrospectively reviewed 598 lesions undergoing 9-gauge MRI-VABB from January 2015 to April 2018 to identify high risk breast lesions. We collected patient demographics, breast MRI BI-RADS descriptors, histopathological diagnosis at MRI-VABB and surgical excision, frequency of upgrade to malignancy and imaging follow-up of high-risk lesions. The x2 test and Fisher exact tests were performed for univariate analysis. RESULTS: 114 patients with 124/598 findings (20.7%) had high-risk lesions at MRI-VABB, including atypical ductal hyperplasia (ADH) (21/124, 16.9%), lobular neoplasia (40/124, 32.3%), radial scar/complex sclerosing lesion (RS/CSL) (13/124, 10.5%), papillary lesions (49/124, 39.5%), and flat epithelial atypia (FEA) (1/124, 0.8%). 84/124 (67.7%) high-risk lesions were excised. 19/84 (22.6%) were upgraded to malignancy (7 invasive cancer, 12 DCIS). The upgrade rate for ADH and lobular neoplasia was 7/18 (38.9%) and 9/31 (29.0%), respectively. The upgrade rate for RS/CSL was 1/10 (10%). Of the 25 papillary lesions excised, 2 (8%) demonstrated pathologic atypia and were upgraded to DCIS. The other 23 papillary lesions had no upgrade or atypia. Excised high-risk lesions showing upgrade varied from 0.4 to 6 cm in length (mean 1.6 cm). There was a non-significant trend (p = 0.054) between larger lesion and upgrade to malignancy; however, there were no other specific imaging features to predict malignancy upgrade. CONCLUSIONS: There were no specific MRI imaging characteristics of high-risk lesions to predict malignancy upgrade. Therefore, surgical excision is recommended for high-risk lesions, especially ADH or lobular neoplasia. SN - 1880-4233 UR - https://www.unboundmedicine.com/medline/citation/31838725/High_risk_lesions_diagnosed_at_MRI_guided_vacuum_assisted_breast_biopsy:_imaging_characteristics_outcome_of_surgical_excision_or_imaging_follow_up_ L2 - https://dx.doi.org/10.1007/s12282-019-01032-8 DB - PRIME DP - Unbound Medicine ER -