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Langman EL, Johnson KS, Dinome ML. Retained Biopsy Site Markers After Breast Lesion Surgical Resection: Associations With Residual Malignancy. AJR Am J Roentgenol 2024; 222:e2329670. [PMID: 37646391 DOI: 10.2214/ajr.23.29670] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND. Biopsy site markers (BSMs) placed during image-guided core needle biopsy (CNB) are typically targeted for surgical excision, along with the breast imaging abnormality. Retained BSMs raise concern of incomplete resection of the breast abnormality. OBJECTIVE. The purpose of our study was to assess the frequency of residual malignancy in patients with retained BSMs identified on the initial mammography performed after breast lesion surgical excision. METHODS. This retrospective study included 30 patients (median age, 59 years) who underwent surgical resection between August 2015 and April 2022 of a borderline, high-risk, or malignant breast lesion after CNB and technically adequate preoperative image-guided localization, in whom the initial postoperative mammography report described a retained nonmigrated BSM. EMR data were extracted. The index pathology from CNB and initial surgical resection was classified as malignant or nonmalignant. The presence of residual malignancy after initial surgical resection required pathologic confirmation from subsequent tissue sampling; the absence of residual malignancy required 2 years of benign imaging follow-up. RESULTS. Thirteen specimen radiographs were interpreted intraoperatively by a surgeon with later radiologist interpretation, and 17 underwent real-time radiologist interpretation. Eighteen patients had malignant index pathology from the initially resected lesion. The frequency of residual malignancy on subsequent follow-up after initial surgical resection was higher in patients with malignant than nonmalignant index pathology (39% [7/18] vs 0% [0/12], respectively; p = .02). Among patients with malignant index pathology, the frequency of residual malignancy was higher in those without, than with, malignancy in the initial surgical specimen (80% [4/5] vs 23% [3/13]; p = .047). Also in these patients, the frequency of a positive interpretation of the initial postoperative mammography (BI-RADS category 4 or 6) was not significantly different between those with and without residual malignancy (57% [4/7] vs 55% [6/11]; p > .99). CONCLUSION. Patients with retained BSMs associated with malignant index lesions are at substantial risk of having residual malignancy. Initial postoperative mammography is not sufficient for excluding residual malignancy. CLINICAL IMPACT. Retained BSMs associated with index malignancy should be considered suspicious for residual malignancy. In this scenario, timely additional tissue sampling targeting the retained BSM is warranted, given the greater-than-2% chance of malignancy. Active surveillance is a reasonable management strategy in patients with retained BSMs from nonmalignant index lesions.
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Affiliation(s)
- Eun L Langman
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Karen S Johnson
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Maggie L Dinome
- Department of Surgery, Duke University School of Medicine, Durham, NC
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Turkyilmaz Z, Sarisik E, Ozkurt E, Tukenmez M, Emiroglu S, Emiroglu B, Onder S, Yilmaz R, Muslumanoglu M, Igci A, Ozmen V, Cabioglu N. Evaluation of Benign Breast Diseases With or Without Atypical Epithelial Hyperplasia Accompanying Radial Scars. Eur J Breast Health 2023; 19:166-171. [PMID: 37025577 PMCID: PMC10071881 DOI: 10.4274/ejbh.galenos.2023.2022-10-4] [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: 10/19/2022] [Accepted: 02/28/2023] [Indexed: 04/05/2023]
Abstract
Objective: A radial scar (RS) is a benign breast lesion (BBL) that has an obscure etiology. RS is easily confused with breast carcinoma and therefore correct identification radiologically and pathologically is important. The aim of this study was to determine the incidence of atypical lesions by evaluating RS detected with BBL and to investigate whether atypia and RS are related to their characteristics. Materials and Methods: A total of 1.370 patients with a diagnosis of BBL postoperatively in a single department were analyzed retrospectively. Forty-six confirmed RS/complex sclerosing lesion (CSL) cases were selected. The demographic and clinical characteristics of the patients and the relationship between RS and other BBL were evaluated. In addition, the relationship between RS/CSL and the presence of atypia was interpreted. Results: The mean age was 45.17±8.72 years. Spiculated lesion (34.8%) on mammography and microcalcification (37%) on histopathological examination were the most common features. The most common BBL accompanying RS/CSL was adenosis. Atypical epithelial hyperplasia (AEH) was presented in 15 (32.6%) of those diagnosed with RS. Although all patients were benign, the frequency of AEH accompanying RS was found to be significantly higher. The mean size of RS was 10.8±8.4 mm (2-30 mm). The size of RS/CSL was not significantly associated with atypia. Conclusion: RS/CSLs usually present as suspicious lesions that must be distinguished radiologically from malignancy. However RS, which can be present with malign breast lesions, can be also seen with all BBL. Therefore, core biopsy and/or excisional biopsy continue to be important for definitive histopathological diagnosis.
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Affiliation(s)
- Zeliha Turkyilmaz
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
- * Address for Correspondence: E-mail:
| | - Elif Sarisik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Enver Ozkurt
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selman Emiroglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Emiroglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ravza Yilmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdullah Igci
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vahit Ozmen
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Wang LC, Philip M, Bhole S, Rao S, Gupta D, Schacht D, Friedewald SM, Anders R. Pathologic Outcomes in Single Versus Multiple Areas of Architectural Distortion on Digital Breast Tomosynthesis. AJR Am J Roentgenol 2023; 220:50-62. [PMID: 35895298 DOI: 10.2214/AJR.22.27625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. Digital breast tomosynthesis (DBT) has led to increased detection of architectural distortion (AD). Management of patients with multiple areas of AD is not established. OBJECTIVE. The purpose of this article is to compare pathologic outcomes between single and multiple areas of AD identified on DBT. METHODS. This retrospective study included 402 patients (mean age, 56 years) who underwent image-guided core needle biopsy of AD visualized on DBT between April 7, 2017, and April 16, 2019. Patients were classified as having a single or multiple areas of AD according to the presence of distinct areas of AD described in the clinical radiology reports. The pathologic diagnosis for each AD was on the basis of the most aggressive pathology identified on either biopsy or surgical excision, if performed. Patients with single and multiple areas of AD were compared. RESULTS. The sample included 372 patients with a single AD (145 benign, 121 high risk, 105 malignant, one other) and 30 patients with multiple visualized ADs, including 66 biopsied ADs (10 benign, 35 high risk, 21 malignant). At pathologic assessment on a per-lesion basis, multiple compared with single ADs showed higher frequency of high-risk pathology (53.0% vs 32.5%, p = .002) but no difference in frequency of malignancy (31.8% vs 28.2%, p = .56). In multivariable analysis of a range of patient-related characteristics, the presence of single versus multiple areas of AD was not independently associated with malignancy (p = .51). In patients with multiple areas of AD, the most aggressive pathology (benign, high risk, or malignant) across all ADs was not associated with the number of ADs (p = .73). In 8 of 24 patients with at least two ipsilateral biopsied ADs, the ipsilateral areas varied in terms of most aggressive pathology; in 5 of 10 patients with contralateral biopsied ADs, the contralateral areas varied in most aggressive pathology. CONCLUSION. The presence of multiple areas of AD, compared with a single AD, was significantly more likely to yield high-risk pathology but was not significantly different in yield of malignancy. In patients with multiple ADs, multiple ipsilateral or contralateral ADs commonly varied in pathologic classification (benign, high risk, or malignant). CLINICAL IMPACT. These findings may help guide management of AD visualized by DBT, including multiple ADs. For patients with multiple areas of AD, biopsy of all areas may be warranted given variation in pathologic diagnoses.
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Rahbar H. Demystifying Which High-risk Lesions Truly Require Surgical Excision-A Call to Action. J Breast Imaging 2021; 3:581-582. [PMID: 38424946 DOI: 10.1093/jbi/wbab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 03/02/2024]
Affiliation(s)
- Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
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Piraner M, D'Amico K, Gilliland LL, Newell MS, Cohen MA. Pure Radial Scars Do Not Require Surgical Excision When Concordant and Benign at Image-guided Breast Biopsy. J Breast Imaging 2021; 3:572-580. [PMID: 38424945 DOI: 10.1093/jbi/wbab048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/08/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To determine the best management option (surgical excision versus imaging surveillance) following the diagnosis of pure radial scars (RSs) and RSs with associated additional high-risk lesions (HRLs) encountered on percutaneous core-needle breast biopsy. METHODS An IRB-approved retrospective review of the breast imaging reporting system database was performed to identify all cases of pure RS alone or RS plus an additional HRL (papilloma, atypia, lobular neoplasia) diagnosed on core-needle biopsy, from 2007 to 2016, at four breast centers in our institution. Cases with associated malignancy, discordant radiologic-pathologic results, or those lost to follow-up were excluded. The remaining cases were evaluated to determine results of either subsequent surgical excision or long-term follow-up imaging (minimum of two years). Additional data recorded included clinical presentation, breast density, personal and family history of breast cancer, lesion imaging characteristics, and biopsy method. RESULTS The study cohort included 111 patients with 111 lesions: 56.8% (63/111) with RS alone (pure) and 43.2% (48/111) with RS plus additional HRL(s). Out of the 63 radiologic-pathologic concordant pure RSs, there were no upgrades to malignancy in 51 subsequent surgical excisions or 12 long-term surveillance cases (0/63, 0%). Out of the 48 RSs plus additional HRL(s), there were 2 upgrades to malignancy (2/48, 4.2%). CONCLUSION Cases of radiologic-pathologic concordant pure RS diagnosed at core-needle biopsy do not require surgical excision. On the other hand, surgical excision should be considered for RS plus additional HRLs diagnosed at core-needle biopsy.
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Affiliation(s)
- Maria Piraner
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
| | - Kelly D'Amico
- Radiology Imaging Associates, PC, Englewood, CO, USA
| | - Lawrence L Gilliland
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
| | - Mary S Newell
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
| | - Michael A Cohen
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
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Woodward SG, Nimtz K, Hookim K, Sevrukov AB, Tsangaris TN, Willis A, Berger AC, Lazar M. Is radial scar on core needle biopsy a risk factor for malignancy? A single-center retrospective review and implications for management. Breast J 2020; 26:2011-2014. [PMID: 32657492 DOI: 10.1111/tbj.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/13/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Reported upgrade rate to malignancy of radial scars (RS) ranges widely (0%-40%) making management controversial. METHODS A retrospective chart review was performed on patients with RS on core needle biopsy (CNB). Upgrade rates to malignancy and atypia on surgical excision were evaluated. RESULTS Of 127 patients with RS on CNB, 53 were excluded due to malignancy or missing records. Of 74 patients reviewed, 52 (70.3%) had surgical excision with four (7.7%) upgraded to malignancy. Eight patients (10.8%) had atypia with RS on CNB with two (25%) upgraded to malignancy. When isolated RS was on CNB, 2 of 44 (4.5%) upgraded to malignancy while 15 of 44 (34%) had atypia on excision. Of 22 patients (29.7%) who did not have excision, zero developed cancer. CONCLUSION We found higher than expected upgrade rates of isolated RS to atypia which can alter management. Additionally, 25% of RS with atypia upgraded to malignancy suggesting these patients are at higher risk.
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Affiliation(s)
- Steven G Woodward
- Department of Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Karl Nimtz
- Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Kim Hookim
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander B Sevrukov
- Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Theodore N Tsangaris
- Department of Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA.,Cancer Center, Calvert Health, Prince Frederick, MD, USA
| | - Alliric Willis
- Department of Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam C Berger
- Department of Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA.,Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
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Alsharif S, Aldis A, Subahi A, Khoury ME, Mesurolle B. Breast MRI Does Not Help Differentiating Radial Scar With and Without Associated Atypia or Malignancy. Can Assoc Radiol J 2020; 72:759-766. [PMID: 32520588 DOI: 10.1177/0846537120930360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review breast magnetic resonance imaging (MRI) features of radial scar (RS) with and without associated atypia/malignancy. METHODS Twenty-eight (mean age 56.8) patients diagnosed with 30 biopsy-proven RS (n = 25, ultrasound-guided 14-gauge, n = 5, stereotactically guided 9-gauge) subsequently underwent breast MRI followed by surgery. Magnetic resonance imaging protocol included axial T1, axial fat sat T2, and postgadolinium in axial and sagittal planes. Two radiologists reviewed the mammographic and MRI findings in consensus according to the Breast Imaging Reporting and Data System lexicon. RESULTS Of the 30 RSs excised surgically, 14 (14/30, 47.7%) were not associated with atypia/malignancy while atypia/malignancy was found in 16 (16/30, 53.3%) RSs. Three (3/30, 10%) RS lesions did not enhance on dynamic MR. Mean lesion size on MRI was 1.4 cm (range, 0.5-5 cm). Seventeen (17/30, 56.7%) lesions presented as nonmass enhancement and 9 (9/30, 30%) as masses. Nonmass lesions showed focal distribution (13/17, 76.5%) and heterogeneous enhancement (15/17, 88.2%). Masses showed irregular shape and margins (6/9, 67%) and heterogeneous enhancement (8/9, 89%). Multivariate analysis did not show any significant difference in MRI presentation between RS only and RS associated with atypia/malignancy. CONCLUSION Breast MRI does not help differentiate between RS with or without associated atypia/malignancy.
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Affiliation(s)
- Shaza Alsharif
- Cedar Breast Clinic, 54473McGill University Health Center, Royal Victoria Hospital, Montréal, Québec, Canada.,Department of Medical Imaging, King Abdulaziz Medical City, Jeddah, Saudi Arabia.,48149King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ann Aldis
- Cedar Breast Clinic, 54473McGill University Health Center, Royal Victoria Hospital, Montréal, Québec, Canada
| | - Ahmad Subahi
- 48149King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mona El Khoury
- Department of Radiology, Breast Centre, 25443Centre Hospitalier Universitaire de Montréal, Québec, Canada
| | - Benoit Mesurolle
- Cedar Breast Clinic, 54473McGill University Health Center, Royal Victoria Hospital, Montréal, Québec, Canada
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8
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Bacci J, MacGrogan G, Alran L, Labrot-Hurtevent G. Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum-assisted large-core biopsy: is surgery always necessary? Histopathology 2019; 75:900-915. [PMID: 31286532 DOI: 10.1111/his.13950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/05/2019] [Revised: 06/10/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022]
Abstract
AIMS The diagnosis of radial scars/complex sclerosing lesions (RSs/CSLs) onpercutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of 'upgrade to carcinoma' upon subsequent surgical excision of RS/CSL cases diagnosed on vacuum-assisted large-core biopsy (VALCB). We also analysed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from conservative management with clinical and imaging follow-up. METHODS AND RESULTS This was a retrospective observational single-centre study on 174 consecutive RS/CSL cases diagnosed on VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade. Surgical excision was performed following VALCB diagnosis of 88 RS/CSL cases with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia was surgically upgraded. Additional to atypia, risk factors for upgrade were non-incidental finding of the RS/CSL, the mammographic appearance, and the number of fragments obtained during the biopsy procedure (P < 0.05). CONCLUSION We demonstrate that VALCB revealing an RS/CSL is reliable for excluding malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favour of clinical and imaging follow-up. When an RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors.
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Affiliation(s)
- Julia Bacci
- Medical Imaging Department, Institut Bergonié, Bordeaux, France
| | | | - Léonie Alran
- Department of Biopathology, Institut Bergonié, Bordeaux, France
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Rakha E, Beca F, D'Andrea M, Abbas A, Petrou-Nunn W, Shaaban AM, Kandiyil A, Smith S, Menon S, Elsheikh S, ElSayed ME, Lee AH, Sharma N. Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study. J Clin Pathol 2019; 72:800-804. [PMID: 31350292 DOI: 10.1136/jclinpath-2019-205764] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/04/2019] [Revised: 05/13/2019] [Accepted: 06/10/2019] [Indexed: 11/04/2022]
Abstract
AIMS The clinical significance of radial scar (RS)/complex sclerosing lesion (CSL) with high-risk lesions (epithelial atypia) diagnosed on needle core biopsy is not well defined. We aimed at assessing the upgrade rate to ductal carcinoma in situ (DCIS) and invasive carcinoma on the surgical excision specimen in a large cohort with RS/CSL associated with atypia. METHODS 157 women with a needle core biopsy diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings, including different forms of the atypical lesions and final histological outcome in the excision specimens, were retrieved and analysed, and the upgrade rates for malignancy and for invasive carcinoma were calculated. RESULTS 69.43% of the cases were associated with atypical ductal hyperplasia (ADH) or atypia not otherwise classifiable, whereas lobular neoplasia was seen in 21.66%. On final histology, 39 cases were malignant (overall upgrade rate of 24.84%); 12 were invasive and 27 had DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia, the upgrade rate was 11.76%. The upgrade rate's variability was also considerably lower when considering the upgrade to invasive carcinoma alone for any associated lesion. CONCLUSIONS The upgrade rate for ADH diagnosed on needle core biopsy with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with lobular neoplasia is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed a similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion.
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Affiliation(s)
- Emad Rakha
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Faculty of Medicine, Menoufiya University, Al Minufya, Egypt
| | - Francisco Beca
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Mariangela D'Andrea
- Specialization School in Anatomic Pathology, University of Pavia, Pavia, Italy
| | - Areeg Abbas
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - William Petrou-Nunn
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Abeer M Shaaban
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aneeshya Kandiyil
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Samantha Smith
- South Birmingham Breast Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sindhu Menon
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Somaia Elsheikh
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Faculty of Medicine, Menoufiya University, Al Minufya, Egypt
| | - Maysa E ElSayed
- Faculty of Medicine, Menoufiya University, Al Minufya, Egypt
| | - Andrew Hs Lee
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nisha Sharma
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Bahl M, Lamb LR, Lehman CD. Pathologic Outcomes of Architectural Distortion on Digital 2D Versus Tomosynthesis Mammography. AJR Am J Roentgenol 2017; 209:1162-7. [PMID: 28834441 DOI: 10.2214/AJR.17.17979] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the risk of malignancy associated with architectural distortion detected on 2D digital mammography (DM) versus digital breast tomosynthesis (DBT). MATERIALS AND METHODS We performed a retrospective review of architectural distortion cases recommended for biopsy from September 2007 to February 2011, the period before DBT integration (hereafter known as the DM group), and from January 2013 to June 2016, the period after DBT integration (hereafter known as the DBT group). Medical records were reviewed for imaging findings and pathology results. RESULTS Architectural distortion was more commonly detected in the DBT group than the DM group (0.14% [274/202,438 examinations] vs 0.07% [121/166,661 examinations]; p < 0.001). The positive predictive value of architectural distortion for malignancy was significantly lower in the DBT group than the DM group (50.7% [139/274 cases] vs 73.6% [89/121 cases]; p < 0.001). Radial scar was the most common nonmalignant finding in both groups, but it was more common in the DBT group (33.2% [91/274] vs 11.6% [14/121]; p < 0.001). In the DBT group, architectural distortion without correlative findings on ultrasound was less likely to represent malignancy than was architectural distortion with correlative findings on ultrasound (29.2% [31/106] vs 66.5% [105/158]; p < 0.001). CONCLUSION Architectural distortion is more commonly detected on DBT than DM and is less likely to represent malignancy on DBT. Architectural distortion on DBT is less likely to represent malignancy if there is no sonographic correlate; however, biopsy is warranted even in the absence of a sonographic correlate, given the nearly 30% risk of malignancy in this setting.
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11
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Cohen MA, Newell MS. Radial Scars of the Breast Encountered at Core Biopsy: Review of Histologic, Imaging, and Management Considerations. AJR Am J Roentgenol 2017; 209:1168-77. [PMID: 28813198 DOI: 10.2214/AJR.17.18156] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this article are to place the controversy over the management of radial scars diagnosed at core biopsy in perspective and to define reasonable management options. CONCLUSION The management of radial scars after image-guided core biopsy of the breast for diagnosis remains controversial. Although current literature suggests no premalignant potential of these lesions, it does not fully explain the small but real percentage of these lesions that are upgraded to malignancy after surgical excision. This upgrade phenomenon is probably best explained by core biopsy sampling error. A recommendation minimizing this possibility based on lesion size seems reasonable.
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12
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Wilsher MJ, Owens TW, Allcock RJ. Next generation sequencing of the nidus of early (adenosquamous proliferation rich) radial sclerosing lesions of the breast reveals evidence for a neoplastic precursor lesion. J Pathol Clin Res 2017; 3:115-122. [PMID: 28451460 PMCID: PMC5402177 DOI: 10.1002/cjp2.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/22/2017] [Indexed: 12/27/2022]
Abstract
We sought to determine if adenosquamous proliferation of early cellular radial sclerosing lesions of the breast harbours hot spot mutations and to help clarify its relationship to low‐grade adenosquamous carcinoma as a potential form of early neoplasia. Four low‐grade adenosquamous carcinomas, early radial sclerosing lesions from 13 individuals, and 4 benign proliferative breast lesions were microdissected and assessed with a 50‐gene Hot‐spot cancer panel. Early radial sclerosing lesions were selectively microdissected concentrating on their adenosquamous proliferation (nidus). Hot spot mutations in PIK3CA were detected in ten (77% of) radial sclerosing lesions, in one low‐grade adenosquamous carcinoma, and in usual ductal hyperplasia and apocrine adenosis. Over three quarters of individuals with cellular (adenosquamous proliferation rich) early radial sclerosing lesions tested harboured somatic mutations in PIK3CA suggesting that adenosquamous proliferation is a clonal lesion. Its relationship to low‐grade adenosquamous carcinoma remains unclear in view of the small sample size and unmatched radial sclerosing lesions and low‐grade adenosquamous carcinomas.
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Affiliation(s)
- Mark J Wilsher
- Douglass Hanly Moir PathologyMacquarie ParkNew South Wales 2113Australia
| | - Thomas W Owens
- Discipline of Physiology, School of Medical Sciences & Bosch InstituteThe University of SydneyCamperdownNew South WalesAustralia
| | - Richard Jn Allcock
- School of Pathology and Laboratory MedicineUniversity of Western AustraliaNedlandsWestern Australia6009, Australia.,Pathwest Laboratory Medicine WAQEII Medical CentreNedlandsWestern Australia6009, Australia
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Abstract
Subareolar sclerosing duct hyperplasia (SSDH) remains to be fully characterized nearly 20 years after initial description. Thirty-five SSDH cases diagnosed over a 16-year period (January 2000 to December 2015) were reviewed. All patients were female (mean age = 59 years, range = 18-80) who had presented with a unilateral solitary lesion (left 22, right 13) with a mean size of 1.3 cm (range = 0.4-3.0 cm), and showed florid and papillary epithelial hyperplasia with dense sclerosis without involvement of nipple or areolar epidermis. Significant lesions concurrent within SSDH included low-grade adenosquamous carcinoma (n = 1), ductal carcinoma in situ (DCIS; n = 1), lobular carcinoma in situ (LCIS; n = 1), and atypical ductal hyperplasia (ADH; n = 13). No case of SSDH recurred in a mean follow-up of 44 months (range = 6-189). Subsequent significant lesions occurred in 6 patients: DCIS (n = 3; ipsilateral 2, contralateral 1), ipsilateral ADH (n = 2), and ipsilateral atypical lobular hyperplasia (n = 1). Long-term follow-up for patients with SSDH is indicated as DCIS can occur subsequently in either breast.
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Affiliation(s)
- Esther Cheng
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Timothy M D'Alfonso
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Maria Arafah
- 3 King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Rebecca Marrero Rolon
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Paula S Ginter
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Syed A Hoda
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
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14
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Abstract
Optimal management of a lesion yielding radial scar (RS) without epithelial atypia on breast biopsy is controversial. In this single-institution study spanning 17 years, 53 patients with this biopsy diagnosis were evaluated in terms of clinical, radiologic, and pathologic features and outcomes. RSs were categorized as either "incidental" or as the "targeted" lesion according to defined criteria. Of 48 patients who underwent surgical excision after a diagnosis of RS on biopsy, only 1 had an "upgrade" diagnosis of malignancy (2%). No "incidental" RS was associated with the presence of malignancy on surgical excision. Meta-analysis of 20 RS excision studies demonstrated an overall upgrade rate of 10.4%, with a higher rate in patients with a diagnosis of RS with atypia (26%). The upgrade rate for RS without atypia was 7.5% overall. The lower rate of upgrade to malignancy in this study (2%) is likely related to the thorough radiologic-pathologic review undertaken. In the setting of multidisciplinary agreement and careful radiologic-pathologic correlation, it may be appropriate for patients with a biopsy diagnosis of RS without atypia to forego surgical excision in favor of imaging follow-up.
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Affiliation(s)
- Niamh Conlon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clare D’Arcy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer B. Kaplan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zenica L. Bowser
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anibal Cordero
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adriana D. Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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15
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Colombo PE, Vincent-Salomon A, Chateau MC, Mourregot A, Gutowski M, Laffargue G, Masson B, Maran-Gonzalez A, Rouanet P. [Breast surgeon role in the management of high-risk breast lesions]. Bull Cancer 2014; 101:718-29. [PMID: 25091655 DOI: 10.1684/bdc.2014.2010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diagnostics of high-risk breast lesions have increased these last years with the augmentation of breast percutaneous biopsies. They are lesions that confer an enlarged risk of breast cancer, either because of an increased probability of finding cancer after open surgery, a possible evolution toward in situ or invasive cancer, or because of an increased probability of developing breast cancer over the long term. Much progress has been made these last years in their histological diagnostic, classification and pathogenesis. Nevertheless, no consensus exists to date on the management of these "high-risk" lesions. In particular, surgical indications and follow-up modalities remain controversial for each histological type. In this review, the principal factors that could impact surgical decision and long-term follow-up are discussed with areas of controversy highlighted.
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