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Nicosia L, Mariano L, Pellegrino G, Ferrari F, Pesapane F, Bozzini AC, Frassoni S, Bagnardi V, Pupo D, Mazzarol G, De Camilli E, Sangalli C, Venturini M, Pizzamiglio M, Cassano E. Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention. Cancers (Basel) 2024; 16:837. [PMID: 38398228 PMCID: PMC10886664 DOI: 10.3390/cancers16040837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively, p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Luciano Mariano
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy;
| | - Federica Ferrari
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Davide Pupo
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Giovanni Mazzarol
- Division of Pathology, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (E.D.C.)
| | - Elisa De Camilli
- Division of Pathology, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (E.D.C.)
| | - Claudia Sangalli
- Data Management, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy;
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, (IEO) European Institute of Oncology IRCCS, 20141 Milan, Italy; (L.M.); (F.F.); (F.P.); (A.C.B.); (D.P.); (M.P.); (E.C.)
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