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Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary?
Clin Breast Cancer. 2022 10; 22(7):699-704.CB

Abstract

INTRODUCTION

B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years routine radiological or clinical follow-up of patients who had "high-risk" B3 lesions surgically excised, by analyzing recurrence and subsequent development of invasive/in-situ cancer.

PATIENTS AND METHODS

A 10-year retrospective review from 2010 to 2019 was performed of B3 lesions diagnosed on core needle biopsy, including patients who proceeded to surgical excision with a high-risk lesion on final histology. The database recorded 6 specific B3 lesion categories: 1. Atypical ductal hyperplasia (ADH), 2. Radial scars/complex sclerosing lesions (CSLs) with epithelial atypia 3. Classical Lobular neoplasia (ALH/LCIS), 4. Papillary lesions with epithelial atypia, 5. Mixed, 6. Flat epithelial atypia (FEA), including radiological and clinical follow-up data.

RESULTS

Six hundred sixteen patients had a B3 lesion after core biopsy. 110 patients had "high risk" lesions. This included 17 (15.5%) Atypical Ductal Hyperplasia (ADH), 22 (20%) radial scars/CSLs with epithelial atypia, 47 (42.7%) classical lobular neoplasia (LCIS/ALH), 7 (6.4%) papillary lesions with epithelial atypia, 13 (11.8%) mixed lesions & 4 (3.6%) Flat Epithelial Atypia (FEA) lesions. 4 of 110 (3.6%) developed invasive/in-situ disease and 4 of 110 (3.6%) developed recurrence during follow-up. 33 of 616 (5.4%) upgraded to invasive/preinvasive disease after surgical excision.

CONCLUSION

Five years of routine radiological surveillance may not be necessary in patients who undergo surgical excision of "high-risk" B3 lesions. Clinical surveillance appears to be of little benefit, especially in patients with radial scars, papillary lesions, and FEA. Subsequent development of invasive/in-situ disease in patients who undergo surgical excision of atypical B3 lesions remains low.

Authors+Show Affiliations

Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland.Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland. Electronic address: michaelboland@rcsi.ie.Department of Breast Radiology, Beaumont Hospital, Dublin, Ireland.Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland.Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland.Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland.Department of Breast Radiology, Beaumont Hospital, Dublin, Ireland.Department of Pathology, Beaumont Hospital, Dublin, Ireland.Department of Breast Radiology, Beaumont Hospital, Dublin, Ireland.Department of Breast Radiology, Beaumont Hospital, Dublin, Ireland.Department of Breast Radiology, Beaumont Hospital, Dublin, Ireland.Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland.Department of Breast Radiology, Beaumont Hospital, Dublin, Ireland.Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland. Electronic address: adkhill@rcsi.ie.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35732544

Citation

Hennessy, Grace, et al. "Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary?" Clinical Breast Cancer, vol. 22, no. 7, 2022, pp. 699-704.
Hennessy G, Boland MR, Bambrick M, et al. Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary? Clin Breast Cancer. 2022;22(7):699-704.
Hennessy, G., Boland, M. R., Bambrick, M., Crone, L., Lloyd, A., Abdelwahab, S., Downey, E., Staunton, M., Hambly, N., Mhuircheartaigh, N. N., Kerr, J., Power, C., Duke, D., & Hill, A. D. (2022). Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary? Clinical Breast Cancer, 22(7), 699-704. https://doi.org/10.1016/j.clbc.2022.05.009
Hennessy G, et al. Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary. Clin Breast Cancer. 2022;22(7):699-704. PubMed PMID: 35732544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary? AU - Hennessy,Grace, AU - Boland,Michael R, AU - Bambrick,Marie, AU - Crone,Lauren, AU - Lloyd,Angus, AU - Abdelwahab,Sami, AU - Downey,Eithne, AU - Staunton,Marie, AU - Hambly,Niamh, AU - Mhuircheartaigh,Neasa Ni, AU - Kerr,Jennifer, AU - Power,Colm, AU - Duke,Deirdre, AU - Hill,Arnold Dk, Y1 - 2022/06/02/ PY - 2021/08/26/received PY - 2022/04/30/revised PY - 2022/05/29/accepted PY - 2022/6/23/pubmed PY - 2022/9/28/medline PY - 2022/6/22/entrez KW - High-risk KW - Indeterminate KW - Mammary KW - Neoplasm KW - Recurrence KW - Upgrade SP - 699 EP - 704 JF - Clinical breast cancer JO - Clin Breast Cancer VL - 22 IS - 7 N2 - INTRODUCTION: B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years routine radiological or clinical follow-up of patients who had "high-risk" B3 lesions surgically excised, by analyzing recurrence and subsequent development of invasive/in-situ cancer. PATIENTS AND METHODS: A 10-year retrospective review from 2010 to 2019 was performed of B3 lesions diagnosed on core needle biopsy, including patients who proceeded to surgical excision with a high-risk lesion on final histology. The database recorded 6 specific B3 lesion categories: 1. Atypical ductal hyperplasia (ADH), 2. Radial scars/complex sclerosing lesions (CSLs) with epithelial atypia 3. Classical Lobular neoplasia (ALH/LCIS), 4. Papillary lesions with epithelial atypia, 5. Mixed, 6. Flat epithelial atypia (FEA), including radiological and clinical follow-up data. RESULTS: Six hundred sixteen patients had a B3 lesion after core biopsy. 110 patients had "high risk" lesions. This included 17 (15.5%) Atypical Ductal Hyperplasia (ADH), 22 (20%) radial scars/CSLs with epithelial atypia, 47 (42.7%) classical lobular neoplasia (LCIS/ALH), 7 (6.4%) papillary lesions with epithelial atypia, 13 (11.8%) mixed lesions & 4 (3.6%) Flat Epithelial Atypia (FEA) lesions. 4 of 110 (3.6%) developed invasive/in-situ disease and 4 of 110 (3.6%) developed recurrence during follow-up. 33 of 616 (5.4%) upgraded to invasive/preinvasive disease after surgical excision. CONCLUSION: Five years of routine radiological surveillance may not be necessary in patients who undergo surgical excision of "high-risk" B3 lesions. Clinical surveillance appears to be of little benefit, especially in patients with radial scars, papillary lesions, and FEA. Subsequent development of invasive/in-situ disease in patients who undergo surgical excision of atypical B3 lesions remains low. SN - 1938-0666 UR - https://www.unboundmedicine.com/medline/citation/35732544/Value_of_Long_term_Follow_up_in_Surgically_Excised_Lesions_of_Uncertain_Malignant_Potential_in_the_Breast___Is_5_Years_Necessary DB - PRIME DP - Unbound Medicine ER -