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High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management.
AJR Am J Roentgenol. 2021 03; 216(3):622-632.AA

Abstract

OBJECTIVE.

The purpose of our study was to evaluate the upgrade rates of high-risk lesions (HRLs) diagnosed by MRI-guided core biopsy and to assess which clinical and imaging characteristics are predictive of upgrade to malignancy. MATERIALS AND

METHODS.

A retrospective review was performed of all women who presented to an academic breast radiology center for MRI-guided biopsy between January 1, 2015, and November 30, 2018. Histopathologic results from each biopsy were extracted. HRLs-that is, atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), radial scar, papilloma, flat epithelial atypia (FEA), benign vascular lesion (BVL), and mucocelelike lesion-were included for analysis. Clinical history, imaging characteristics, surgical outcome, and follow-up data were recorded. Radiologic-pathologic correlation was performed.

RESULTS.

Of 810 MRI-guided biopsies, 189 cases (23.3%) met the inclusion criteria for HRLs. Of the 189 HRLs, 30 cases were excluded for the following reasons: 15 cases were lost to follow-up, six cases were in patients who received neoadjuvant chemotherapy after biopsy, two lesions that were not excised had less than 2 years of imaging follow-up, and seven lesions had radiologic-pathologic discordance at retrospective review. Of the 159 HRLs in our study cohort, 13 (8.2%) were upgraded to carcinoma. Surgical upgrade rates were high for ADH (22.5%, 9/40) and FEA (33.3%, 1/3); moderate for LCIS (6.3%, 3/48); and low for ALH (0.0%, 0/11), radial scar (0.0%, 0/28), papilloma (0.0%, 0/26), and BVL (0.0%, 0/3). Of the upgraded lesions, 69.2% (9/13) were upgraded to ductal carcinoma in situ (DCIS) or well-differentiated carcinoma. ADH lesions were significantly more likely to be upgraded than non-ADH lesions (p = .005).

CONCLUSION.

ADH diagnosed by MRI-guided core biopsy warrants surgical excision. The other HRLs, however, may be candidates for imaging follow-up rather than excision, especially after meticulous radiologic-pathologic correlation.

Authors+Show Affiliations

Department of Radiology, Weill Cornell Medicine, New York, NY 10065. Present address: Newton Wellesley Hospital, 2014 Washington St, Newton, MA 02462.Department of Pathology, Weill Cornell Medicine, New York, NY.Department of Radiology, Weill Cornell Medicine, New York, NY 10065.Department of Otolaryngology, Harvard Medical School, Boston, MA. Massachusetts Eye and Ear Infirmary, Boston, MA.Department of Radiology, Weill Cornell Medicine, New York, NY 10065.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33439046

Citation

Michaels, Aya Y., et al. "High-Risk Lesions Detected By MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management." AJR. American Journal of Roentgenology, vol. 216, no. 3, 2021, pp. 622-632.
Michaels AY, Ginter PS, Dodelzon K, et al. High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management. AJR Am J Roentgenol. 2021;216(3):622-632.
Michaels, A. Y., Ginter, P. S., Dodelzon, K., Naunheim, M. R., & Abbey, G. N. (2021). High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management. AJR. American Journal of Roentgenology, 216(3), 622-632. https://doi.org/10.2214/AJR.20.23040
Michaels AY, et al. High-Risk Lesions Detected By MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management. AJR Am J Roentgenol. 2021;216(3):622-632. PubMed PMID: 33439046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management. AU - Michaels,Aya Y, AU - Ginter,Paula S, AU - Dodelzon,Katerina, AU - Naunheim,Matthew R, AU - Abbey,Genevieve N, Y1 - 2021/01/13/ PY - 2021/1/14/pubmed PY - 2021/3/13/medline PY - 2021/1/13/entrez KW - MRI-guided core biopsy KW - breast MRI KW - high-risk breast lesions SP - 622 EP - 632 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 216 IS - 3 N2 - OBJECTIVE. The purpose of our study was to evaluate the upgrade rates of high-risk lesions (HRLs) diagnosed by MRI-guided core biopsy and to assess which clinical and imaging characteristics are predictive of upgrade to malignancy. MATERIALS AND METHODS. A retrospective review was performed of all women who presented to an academic breast radiology center for MRI-guided biopsy between January 1, 2015, and November 30, 2018. Histopathologic results from each biopsy were extracted. HRLs-that is, atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), radial scar, papilloma, flat epithelial atypia (FEA), benign vascular lesion (BVL), and mucocelelike lesion-were included for analysis. Clinical history, imaging characteristics, surgical outcome, and follow-up data were recorded. Radiologic-pathologic correlation was performed. RESULTS. Of 810 MRI-guided biopsies, 189 cases (23.3%) met the inclusion criteria for HRLs. Of the 189 HRLs, 30 cases were excluded for the following reasons: 15 cases were lost to follow-up, six cases were in patients who received neoadjuvant chemotherapy after biopsy, two lesions that were not excised had less than 2 years of imaging follow-up, and seven lesions had radiologic-pathologic discordance at retrospective review. Of the 159 HRLs in our study cohort, 13 (8.2%) were upgraded to carcinoma. Surgical upgrade rates were high for ADH (22.5%, 9/40) and FEA (33.3%, 1/3); moderate for LCIS (6.3%, 3/48); and low for ALH (0.0%, 0/11), radial scar (0.0%, 0/28), papilloma (0.0%, 0/26), and BVL (0.0%, 0/3). Of the upgraded lesions, 69.2% (9/13) were upgraded to ductal carcinoma in situ (DCIS) or well-differentiated carcinoma. ADH lesions were significantly more likely to be upgraded than non-ADH lesions (p = .005). CONCLUSION. ADH diagnosed by MRI-guided core biopsy warrants surgical excision. The other HRLs, however, may be candidates for imaging follow-up rather than excision, especially after meticulous radiologic-pathologic correlation. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/33439046/High_Risk_Lesions_Detected_by_MRI_Guided_Core_Biopsy:_Upgrade_Rates_at_Surgical_Excision_and_Implications_for_Management_ L2 - https://www.ajronline.org/doi/10.2214/AJR.20.23040 DB - PRIME DP - Unbound Medicine ER -