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Ho CP, Gillis JE. Best Practice Approaches to Breast Radiology–Pathology Correlation and Management. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ugurlu MU, Yoldemir T, Gulluoglu BM. Assessment and management of B3 breast lesions with atypia: a focused review. Climacteric 2019; 23:17-23. [PMID: 31566023 DOI: 10.1080/13697137.2019.1660637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Breast lesions with atypia are a spectra of diseases that confer increased risk of breast cancer because of an increased probability of finding concomitant cancer after excision, or evolution toward in situ or invasive cancer over the long term. The widespread use of radiologic tools and core needle breast biopsies, in recent years, has led to an increase in the diagnosis of these atypical breast lesions. Concurrent with this has been an improvement in the classification and pathogenesis of these lesions. Current evidence suggests that the recognition and treatment of patients with atypical histology after biopsy and surgical excision requires a multidisciplinary approach to decrease the overdiagnosis and overtreatment risks. This focused review investigates the controversy and current management of atypical ductal hyperplasia, lobular neoplasia, flat epithelial atypia, and intraductal papilloma with atypia along with the risk-reducing strategies.
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Affiliation(s)
- M U Ugurlu
- Department of General Surgery, Breast and Endocrine Surgery Unit, Marmara University Hospital, Istanbul, Turkey
| | - T Yoldemir
- Department of Obstetrics and Gynecology, Marmara University Hospital, Istanbul, Turkey
| | - B M Gulluoglu
- Department of General Surgery, Breast and Endocrine Surgery Unit, Marmara University Hospital, Istanbul, Turkey
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Kuo CY, Lin SH, Lee KD, Cheng SJ, Chu JS, Tu SH. Transcatheter arterial chemoembolization improves the resectability of malignant breast phyllodes tumor with angiosarcoma component: a case report. BMC Surg 2019; 19:100. [PMID: 31351458 PMCID: PMC6660949 DOI: 10.1186/s12893-019-0562-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background A giant phyllodes tumor of the breast is a rare fibroepithelial lesion, and its treatment is controversial. Many case reports have reported performing skin graft reconstruction after tumor excision. Chest wall resection may be required if the tumor has invaded the chest muscle layer. We speculated that transcatheter arterial chemoembolization (TACE) can improve the resectability of malignant phyllodes tumor of the breast without requiring skin grafting. The English literature contains only one case report similar to our experience. Case presentation We report a rare case of a 51-year-old woman who had a giant malignant phyllodes tumor with heterologous sarcomatous differentiation in her right breast. The tumor was 19.43 × 12.98 × 21.47 cm. Whole-body computed tomography (CT) and bone scan did not reveal distant metastasis. Chest magnetic resonance imaging showed chest wall tumor invasion. Considering that skin defects after mastectomy can be extensive, we administered four courses of chemoembolization in the 5 weeks before surgery (30 mg of epirubicin and embozene microspheres [400, 500, and 700 μm]/week). Each process was well tolerated, with no serious complications. Only fever and local pain at the tumor site were noted, and these symptoms resolved with time. The follow-up CT scan showed a 45% reduction in tumor volume. Therefore, simple mastectomy was performed without skin grafting reconstruction. Wound healing was satisfactory, and the patient was discharged 1 week after surgery. Pathological and immunohistochemistry (IHC) findings showed a malignant phyllodes tumor with an angiosarcoma component. Because of tumor invasion of the chest wall, we recommended the patient receive radiotherapy, but she refused. Two months after surgery, recurrence of the malignant phyllodes tumor with right axillary lymph node involvement and lung metastasis was confirmed. Conclusion Initial surgical resection of giant phyllodes tumors is often challenging. For initial presentation with unresectable giant phyllodes tumor, we recommend to perform TACE prior to surgery. In our patient, preoperative TACE was effective and safe. If the tumor has invaded the chest wall, early radiotherapy after surgery may be recommended for preventing recurrence.
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Affiliation(s)
- Chih-Yu Kuo
- Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shing-Huey Lin
- Division of Family Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Kuan-Der Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jan-Show Chu
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Hsin Tu
- Division of Breast Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
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Is bigger better? Twenty-year institutional experience of atypical ductal hyperplasia discovered by core needle biopsy. Am J Surg 2019; 217:906-909. [PMID: 30771862 DOI: 10.1016/j.amjsurg.2019.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The increasing accuracy of large-bore (11- or 8-gauge) vacuum-assisted core needle biopsies (VACNB) has challenged the commonly-accepted practice that surgery is needed for definitive diagnosis when atypical ductal hyperplasia (ADH) is found on VACNB. This study seeks to demonstrate the impact of increased VACNB caliber on the pathologic upgrade rate of ADH. METHODS Patients diagnosed with isolated ADH by VACNB who subsequently underwent surgical excision at our tertiary medical center were retrospectively studied. Demographics, needle gauge, number of needle passes, and pathology results were analyzed. RESULTS From June 1996 to June 2016, approximately 3740 VACNBs were performed. 139 patients were diagnosed with isolated ADH on VACNB and underwent surgical excision. 30 patients (22%) were upgraded to ductal carcinoma in-situ or invasive cancer; 17 upgrades (21%) from 11-gauge CNB vs. 13 upgrades (23%) from 8-gauge CNB (p = 0.67). CONCLUSION Increasing core needle biopsy size from 11 g to 8 g does not decrease the rate of pathologic upstaging at the time of surgical excision. Surgical excision of ADH is still required for complete diagnosis.
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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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Wu X, Lin Q, Lu J, Chen G, Zeng YI, Lin Y, Chen Y, Wang Y, Yan J. Comparison of mammography and ultrasound in detecting residual disease following bioptic lumpectomy in breast cancer patients. Mol Clin Oncol 2016; 4:419-424. [PMID: 26998296 DOI: 10.3892/mco.2016.729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/06/2015] [Indexed: 11/06/2022] Open
Abstract
Surgical biopsy is a method for diagnosing breast cancer. The aim of this study was to prospectively evaluate the relative accuracies of mammography (MMG) and ultrasound (US) in predicting residual disease following bioptic lumpectomy. Each prediction method was compared with the gold standard of surgical pathology. The results of MMG and US from 312 consecutive breast cancer patients diagnosed by surgical excision were analyzed. All the patients underwent re-excision mastectomy or lumpectomy and the imaging results were compared with the histopathological findings. The accuracy and sensitivity of each modality were investigated. A total of 312 patients with 312 primary breast cancers were investigated. Residual disease was identified in 118 patients. Of the 118 cases with residual disease, MMG and US were able to detect 77 (65.3%) and 32 (27.1%), respectively (chi-square P<0.001). MMG was also more sensitive compared with US in estimating residual ductal carcinoma in situ (DCIS) (94.2 vs. 33.3%, respectively; P<0.001). MMG was more accurate compared with US in detecting residual disease following bioptic lumpectomy and the diagnostic accuracy of MMG was associated with the presence of residual DCIS.
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Affiliation(s)
- Xiufeng Wu
- Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Qingzhong Lin
- Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Jianping Lu
- Department of Pathology, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Gang Chen
- Department of Pathology, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Y I Zeng
- Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Yinglan Lin
- Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Ying Chen
- Department of Radiology, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Yaoqin Wang
- Department of Ultrasound, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian 350014, P.R. China
| | - Jun Yan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Improving Patient Care by Incorporation of Multidisciplinary Breast Radiology-Pathology Correlation Conference. Can Assoc Radiol J 2015; 67:122-9. [PMID: 26632099 DOI: 10.1016/j.carj.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/11/2015] [Accepted: 07/05/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE It is well known that radiologic-pathologic correlation is critical in managing patients with breast disease. Although regular multidisciplinary conferences addressing radiologic-pathologic correlation are common at most major academic institutions, this approach is not universal in community-based settings or even some of the smaller academic practices. This study was performed to assess the impact of a weekly multidisciplinary conference on patient care to determine whether all breast practices should adopt this approach as a means to streamline and improve the quality of patient care. METHODS We reviewed cases of percutaneous breast core biopsies presented at our weekly breast radiology-pathology correlation conference from July 1, 2008, to June 30, 2012. Each reviewed case was assigned to 1 of 4 categories (concordant → concordant, concordant → discordant, discordant → discordant, and discordant → concordant) based on the "initial" and "final" impressions of concordance between radiology and pathology. Changes in concordance, histopathological diagnosis, or management that occurred during the conference were recorded prospectively and analysed. Changes in management that were considered significant included changes in recommendations for surgery, repeat core biopsy, or follow-up imaging. RESULTS Of 1387 presented at the conference, 1313 (94.7%) had no change during the meeting, confirming 1279 (92.2%) concordant and 34 (2.4%) discordant cases. A total of 74 (5.3%) cases had a change during the conference: 22 of 74 (29.7%) were changed from discordant to concordant, avoiding surgical excision in 15 and short interval imaging in 7; 23 of 74 (31.1%) were changed from concordant to discordant; on excision 3 were cancer, 3 atypia, 10 benign, 2 stable on follow-up imaging, and 5 lost to follow-up; the remaining 29 of 74 (39.2%) stayed concordant after review, but had a change in management, avoiding surgery in 14 and short interval imaging in 15. Overall, as a result of this conference, repeat biopsy or excision was recommended in 23, surgery was avoided in 29, short interval imaging avoided in 22, and cancer detected in 3 cases. CONCLUSIONS Our weekly breast radiology-pathology correlation conference impacted patient management in up to 5.3% of cases. These results support the need to incorporate a weekly multidisciplinary case review of breast core biopsies into all breast care practices. Such a conference maximizes cancer detection, identifies discordant cases in a timely manner, decreases follow-up imaging, and avoids unnecessary surgical intervention.
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Borderline atypical ductal hyperplasia/low-grade ductal carcinoma in situ on breast needle core biopsy should be managed conservatively. Am J Surg Pathol 2013; 37:913-23. [PMID: 23598968 DOI: 10.1097/pas.0b013e31828ba25c] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The differential diagnosis of low-nuclear grade intraductal epithelial proliferations of the breast includes atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS). This distinction can be difficult on core needle biopsy (CNB) but can have significant clinical ramifications. We examined the clinical course of patients diagnosed on CNB with borderline ADH/DCIS lesions [marked ADH (MADH)] at our institution. A total of 74 patients were diagnosed with MADH on CNB and underwent an excisional biopsy (EB). The majority of these CNBs reviewed at outside hospitals had been classified as DCIS. Twenty patients (27%) had benign findings or lobular neoplasia in their EB, 18 (24%) had ADH, 33 (45%) had DCIS, and 3 (4%) had DCIS and invasive ductal carcinoma (IDC). Among the 38 patients who were not diagnosed with DCIS or IDC on EB, no patient underwent further surgery or radiation postoperatively. Thirty-seven of these 38 patients had no recurrences, whereas 1 patient developed a "recurrence" that on our review was likely residual localized MADH. The mean follow-up for these patients was 54 months. Of the 36 patients diagnosed with DCIS or IDC on EB, <20% required mastectomy. On review, MADH involving an intermediate-sized duct on CNB and the amount of residual lesion on imaging was significantly associated with DCIS or IDC on EB. Conversely, MADH involving columnar cell lesions and the presence of calcification on CNB were significantly associated with benign pathology on EB. In conclusion, our study provides preliminary data that justify a conservative approach to borderline ADH/DCIS lesions on CNB: that is, diagnose as MADH and treat by conservative excision.
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Abstract
High-risk lesions of the breast are lesions that confer an increased risk of breast cancer, either because of an increased probability of finding cancer associated with percutaneous biopsy findings or because of an increased probability of developing breast cancer over the long term. Atypical ductal hyperplasia found on percutaneous biopsy is generally excised, whereas lobular neoplasia lesions, including both atypical lobular hyperplasia and lobular carcinoma in situ, may be observed if radiologic and pathologic findings are concordant and there is no other high-risk lesion present.
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Affiliation(s)
- Amy C Degnim
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Current management practice of breast borderline lesions—need for further research and guidelines. Am J Surg 2012; 203:721-5. [DOI: 10.1016/j.amjsurg.2011.06.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/03/2011] [Accepted: 06/03/2011] [Indexed: 11/19/2022]
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