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Klassen CL, Viers LD, Ghosh K. Following the High-Risk Patient: Breast Cancer Risk-Based Screening. Ann Surg Oncol 2024; 31:3154-3159. [PMID: 38302622 DOI: 10.1245/s10434-024-14957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
Breast cancer (BC) is the most common cancer occurring in women in the USA today, and accounts for more than 40,000 deaths annually (Giaquinto in CA Cancer J Clin 72: 524-541, 2022). While breast cancer survival has improved over the past decades, incidence has increased, and diagnoses are being made at younger ages. This emphasizes the importance of risk evaluation, accurate prediction, and effective mitigation and risk reduction strategies. Enhanced screening can help detect cancers at an earlier stage, thus improving morbidity and mortality. This review addresses the recognition of women at high-risk for BC and monitoring strategies for those at high risk.
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Affiliation(s)
- Christine L Klassen
- Mayo School of Graduate Medical Education, Mayo Clinic- Rochester, Rochester, MN, USA.
| | - Lyndsay D Viers
- Mayo School of Graduate Medical Education, Mayo Clinic- Rochester, Rochester, MN, USA
| | - Karthik Ghosh
- Mayo School of Graduate Medical Education, Mayo Clinic- Rochester, Rochester, MN, USA
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The morphologic spectrum of lobular carcinoma in situ (LCIS) observations on clinical significance, management implications and diagnostic pitfalls of classic, florid and pleomorphic LCIS. Virchows Arch 2022; 481:823-837. [PMID: 35567633 DOI: 10.1007/s00428-022-03299-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
Lobular carcinoma in situ (LCIS) is a non-invasive proliferation of atypical dyscohesive epithelial cells characterized by loss or functional alteration of E-cadherin-mediated cell adhesion. The morphologic spectrum of LCIS encompasses classic (C-LCIS), florid (F-LCIS) and pleomorphic LCIS (P-LCIS), as recently defined by the World Health Organization (WHO) Expert Consensus Group. Atypical lobular hyperplasia (ALH) is also part of this spectrum.This article highlights the morphologic and immunohistochemical features of the three forms of LCIS and summarizes their management implications and prognosis, with emphasis on F-LCIS and P-LCIS.
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Miller KN, Thomas SM, Sergesketter AR, Rosenberger LH, DiLalla G, van den Bruele AB, Hwang ES, Plichta JK. The Influence of Body Mass Index on the Histopathology and Outcomes of Patients Diagnosed with Atypical Breast Lesions. Ann Surg Oncol 2022; 29:6484-6494. [PMID: 35951136 PMCID: PMC9942245 DOI: 10.1245/s10434-022-12313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/14/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Multiple studies have demonstrated a link between obesity and breast cancer; however, the potential association between obesity and atypical high-risk breast lesions has not been well characterized. We sought to evaluate the characteristics and clinical outcomes of patients with breast atypia based on a woman's body mass index (BMI). METHODS We retrospectively identified adult women diagnosed with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) at a single institution from 2008 to 2017. BMI groups were defined as a BMI 18.5 to < 30 or BMI ≥ 30 (obese). Adjusted logistic regression was used to estimate the association of BMI group with the odds of (1) upstage to cancer after atypia on needle biopsy, and (2) subsequent diagnosis of breast cancer. RESULTS Breast atypia was identified in 503 patients (most advanced atypia: 74.8% ADH, 4.6% ALH, 20.7% LCIS), and 41% of these patients were classified as obese. After adjustment, BMI group was not associated with upstage to breast cancer at surgical excision following needle biopsy (p = 0.16) or development of a subsequent breast cancer (p = 0.08). For those upstaged to breast cancer at the time of surgical excision, or those who developed a subsequent malignancy, tumor subtype, grade and stage were not associated with BMI group (p > 0.05). CONCLUSION In a large cohort of patients diagnosed with atypical breast histology, the risk of upstaging and/or subsequent progression to a breast malignancy was not associated with BMI. Factors other than obesity may influence breast cancer risk.
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Affiliation(s)
- Krislyn N Miller
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | | | - Amanda R Sergesketter
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Astrid Botty van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Kim WG, Cummings MC, Lakhani SR. Pitfalls and controversies in pathology impacting breast cancer management. Expert Rev Anticancer Ther 2020; 20:205-219. [PMID: 32174198 DOI: 10.1080/14737140.2020.1738222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Breast cancer is a heterogeneous disease, at morphological, molecular, and clinical levels and this has significant implications for the diagnosis and management of the disease. The introduction of breast screening, and the use of small tissue sampling for diagnosis, the recognition of new morphological and molecular subtypes, and the increasing use of neoadjuvant therapies have created challenges in pathological diagnosis and classification.Areas covered: Areas of potential difficulty include columnar cell lesions, particularly flat epithelial atypia, atypical ductal hyperplasia, lobular neoplasia and its variants, and a range of papillary lesions. Fibroepithelial, sclerosing, mucinous, and apocrine lesions are also considered. Established and newer prognostic and predictive markers, such as immune infiltrates, PD-1 and PD-L1 and gene expression assays are evaluated. The unique challenges of pathology assessment post-neoadjuvant systemic therapy are also explored.Expert opinion: Controversies in clinical management arise due to incomplete and sometimes conflicting data on clinicopathological associations, prognosis, and outcome. The review will address some of these challenges.
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Affiliation(s)
- Woo Gyeong Kim
- Department of Pathology, University of Inje College of Medicine, Busan, Korea.,University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Margaret C Cummings
- University of Queensland Centre for Clinical Research, Brisbane, Australia.,Department of Anatomical Pathology, Pathology Queensland, Brisbane, Australia
| | - Sunil R Lakhani
- University of Queensland Centre for Clinical Research, Brisbane, Australia.,Department of Anatomical Pathology, Pathology Queensland, Brisbane, Australia
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Abstract
Atypical ductal hyperplasia (ADH) is a proliferative, nonobligate precursor breast lesion and a marker of increased risk for breast carcinoma. Surgical excision remains the standard recommendation following a core needle biopsy result consistent with ADH. Recent research suggests that women with no mass lesion or discordance, removal of greater than or equal to 90% of calcifications at the time of core needle biopsy, involvement of less than or equal to 2 terminal duct lobular units, and absence of cytologic atypia or necrosis are likely to have a less than 5% chance of a missed cancer.
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Affiliation(s)
- Jennifer M Racz
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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