Tags

Type your tag names separated by a space and hit enter

Impact of Non-Calcified Specimen Pathology on the Underestimation of Malignancy for the Incomplete Retrieval of Suspicious Calcifications Diagnosed as Flat Epithelial Atypia or Atypical Ductal Hyperplasia by Stereotactic Vacuum-Assisted Breast Biopsy.
Korean J Radiol. 2020 11; 21(11):1220-1229.KJ

Abstract

OBJECTIVE

Stereotactic vacuum-assisted breast biopsy (VABB) is considered a reliable alternative to surgical biopsy for suspicious calcifications. In most cases, the management of flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) after VABB with residual calcifications requires surgical excision. This study aimed to evaluate the impact of pathology of non-calcified specimens on the underestimation of malignancy.

MATERIALS AND METHODS

We retrospectively reviewed 1147 consecutive cases of stereotactic VABB of suspicious calcifications without mass from January 2010 to December 2016 and identified 46 (4.0%) FEA and 52 (4.5%) ADH cases that were surgically excised for the retrieval of residual calcifications. Mammographic features and pathology of the calcified and non-calcified specimens were reviewed.

RESULTS

Seventeen specimens (17.3%) were upgraded to malignancy. Mammographic features associated with the underestimation of malignancy were calcification extent (> 34.5 mm: odds ratio = 6.059, p = 0.026). According to the pathology of calcified versus non-calcified specimens, four risk groups were identified: Group A (ADH vs. high-risk lesions), Group B (ADH vs. non-high-risk lesions), Group C (FEA vs. high-risk lesions), and Group D (FEA vs. non-high-risk lesions). The lowest underestimation rate was observed in Group D (Group A vs. Group B vs. Group C vs. Group D: 35.0% vs. 20.0% vs. 15.0% vs. 3.6%, p = 0.041, respectively).

CONCLUSION

Considering that the calcification extent and pathology of non-calcified specimens may be beneficial in determining the likelihood of malignancy underestimation, excision after FEA or ADH diagnosis by VABB is required, except for the diagnoses of FEA coexisting without atypia lesions in non-calcified specimens.

Authors+Show Affiliations

Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan. kenneth0609@cgmh.org.tw.Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32729266

Citation

Yu, Chi Chang, et al. "Impact of Non-Calcified Specimen Pathology On the Underestimation of Malignancy for the Incomplete Retrieval of Suspicious Calcifications Diagnosed as Flat Epithelial Atypia or Atypical Ductal Hyperplasia By Stereotactic Vacuum-Assisted Breast Biopsy." Korean Journal of Radiology, vol. 21, no. 11, 2020, pp. 1220-1229.
Yu CC, Cheung YC, Ueng SH, et al. Impact of Non-Calcified Specimen Pathology on the Underestimation of Malignancy for the Incomplete Retrieval of Suspicious Calcifications Diagnosed as Flat Epithelial Atypia or Atypical Ductal Hyperplasia by Stereotactic Vacuum-Assisted Breast Biopsy. Korean J Radiol. 2020;21(11):1220-1229.
Yu, C. C., Cheung, Y. C., Ueng, S. H., & Chen, S. C. (2020). Impact of Non-Calcified Specimen Pathology on the Underestimation of Malignancy for the Incomplete Retrieval of Suspicious Calcifications Diagnosed as Flat Epithelial Atypia or Atypical Ductal Hyperplasia by Stereotactic Vacuum-Assisted Breast Biopsy. Korean Journal of Radiology, 21(11), 1220-1229. https://doi.org/10.3348/kjr.2019.0786
Yu CC, et al. Impact of Non-Calcified Specimen Pathology On the Underestimation of Malignancy for the Incomplete Retrieval of Suspicious Calcifications Diagnosed as Flat Epithelial Atypia or Atypical Ductal Hyperplasia By Stereotactic Vacuum-Assisted Breast Biopsy. Korean J Radiol. 2020;21(11):1220-1229. PubMed PMID: 32729266.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Non-Calcified Specimen Pathology on the Underestimation of Malignancy for the Incomplete Retrieval of Suspicious Calcifications Diagnosed as Flat Epithelial Atypia or Atypical Ductal Hyperplasia by Stereotactic Vacuum-Assisted Breast Biopsy. AU - Yu,Chi Chang, AU - Cheung,Yun Chung, AU - Ueng,Shir Hwa, AU - Chen,Shin Cheh, Y1 - 2020/07/22/ PY - 2019/10/19/received PY - 2020/04/10/revised PY - 2020/04/14/accepted PY - 2020/7/31/pubmed PY - 2021/2/16/medline PY - 2020/7/31/entrez KW - Biopsy KW - Breast disease KW - Precancerous conditions KW - Stereotactic techniques SP - 1220 EP - 1229 JF - Korean journal of radiology JO - Korean J Radiol VL - 21 IS - 11 N2 - OBJECTIVE: Stereotactic vacuum-assisted breast biopsy (VABB) is considered a reliable alternative to surgical biopsy for suspicious calcifications. In most cases, the management of flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) after VABB with residual calcifications requires surgical excision. This study aimed to evaluate the impact of pathology of non-calcified specimens on the underestimation of malignancy. MATERIALS AND METHODS: We retrospectively reviewed 1147 consecutive cases of stereotactic VABB of suspicious calcifications without mass from January 2010 to December 2016 and identified 46 (4.0%) FEA and 52 (4.5%) ADH cases that were surgically excised for the retrieval of residual calcifications. Mammographic features and pathology of the calcified and non-calcified specimens were reviewed. RESULTS: Seventeen specimens (17.3%) were upgraded to malignancy. Mammographic features associated with the underestimation of malignancy were calcification extent (> 34.5 mm: odds ratio = 6.059, p = 0.026). According to the pathology of calcified versus non-calcified specimens, four risk groups were identified: Group A (ADH vs. high-risk lesions), Group B (ADH vs. non-high-risk lesions), Group C (FEA vs. high-risk lesions), and Group D (FEA vs. non-high-risk lesions). The lowest underestimation rate was observed in Group D (Group A vs. Group B vs. Group C vs. Group D: 35.0% vs. 20.0% vs. 15.0% vs. 3.6%, p = 0.041, respectively). CONCLUSION: Considering that the calcification extent and pathology of non-calcified specimens may be beneficial in determining the likelihood of malignancy underestimation, excision after FEA or ADH diagnosis by VABB is required, except for the diagnoses of FEA coexisting without atypia lesions in non-calcified specimens. SN - 2005-8330 UR - https://www.unboundmedicine.com/medline/citation/32729266/Impact_of_Non_Calcified_Specimen_Pathology_on_the_Underestimation_of_Malignancy_for_the_Incomplete_Retrieval_of_Suspicious_Calcifications_Diagnosed_as_Flat_Epithelial_Atypia_or_Atypical_Ductal_Hyperplasia_by_Stereotactic_Vacuum_Assisted_Breast_Biopsy_ DB - PRIME DP - Unbound Medicine ER -