Diagnostic Management of the Atypical Hyperplasias: Core Biopsy Alone Versus Excisional Biopsy

2018 ◽  
pp. 79-88
Author(s):  
Emily Siegel ◽  
Alice Chung
Keyword(s):  
Core Biopsy ◽  
Excisional Biopsy ◽  
Diagnostic Management

Do Breast Columnar Cell Lesions with Atypia Need to be Excised?

2007 ◽  
Vol 73 (10) ◽  
pp. 984-986
Author(s):  
Nicole Datrice ◽  
Navneet Narula ◽  
Melinda Maggard ◽  
John Butler ◽  
David Hsiang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Excisional Biopsy ◽  
Columnar Cell ◽  
Columnar Cell Lesion ◽  
Simple Mastectomy ◽  
Abnormal Pathology

Columnar cell lesion with atypia (CCLA) is a newly recognized pathologic entity seen in breast specimens. The breast cancer risk associated with this finding is unclear, although CCLA had been found adjacent to both in situ and invasive carcinomas, but the incidence is unknown. Breast specimens from patients with a columnar cell lesion were reviewed by a pathologist for atypia. Twenty-one specimens with CCLA were identified [core biopsy (8), excisional biopsy (11), and simple mastectomy (2)]. Six of eight specimens with CCLA on core had adjacent abnormal pathology: infiltrating ductal carcinoma (IDC)/lobular carcinoma in situ (LCIS) (1), ductal carcinoma in situ (DCIS)/LCIS (1), DCIS (1), LCIS (1), and papillomatosis (2). Five of 11 specimens with CCLA on excisional biopsy had adjacent abnormal pathology: IDC (3), DCIS/LCIS (1), and atypical ductal hyperplasia/papilloma (1). Two of two simple mastectomy specimens had CCLA associated with IDC (1) and DCIS (1). Overall, abnormal pathology was found adjacent to CCLA in 62 per cent of specimens (13/21). Breast pathologic specimens containing a columnar cell lesion should be carefully examined for atypia. Surgical excision is warranted for CCLA found on core biopsy. The future risk of breast cancer based on the finding of CCLA alone requires further investigation.

SP3, a reliable alternative to HercepTest in determining HER-2/neu status in breast cancer patients

2013 ◽  
Vol 66 (5) ◽  
pp. 409-414 ◽  
Author(s):  
Timothy Michael D'Alfonso ◽  
Yi-Fang Liu ◽  
Zhengming Chen ◽  
Ying-Bei Chen ◽  
Ashley Cimino-Mathews ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Core Biopsy ◽  
In Situ Hybridisation ◽  
Excisional Biopsy ◽  
Needle Core Biopsy ◽  
Breast Cancer Patients ◽  
Biopsy Specimens ◽  
Her 2

Accurate assessment of HER-2/neu gene status in breast cancer patients has important prognostic and therapeutic implications. Overexpression/gene amplification of HER-2 is associated with a more aggressive clinical course and eligibility for targeted therapy with trastuzumab. A variety of immunohistochemical (IHC) antibodies and in situ hybridisation (ISH) methods have been employed to assess HER-2 status. SP3 is a rabbit monoclonal antibody that has been shown to have a high level of agreement with other anti-HER-2 antibodies and ISH methods. We assessed HER-2 status by SP3 and HercepTest IHC stains and by fluorescence in situ hybridisation (FISH) on invasive breast carcinomas from paired needle core biopsy and excisional biopsy specimens from 100 patients. We compared the two antibodies with respect to concordance rates with FISH, concordance rates between samples of the same tumour, and sensitivity and specificity using FISH as the reference test. Concordance between SP3 and FISH in needle core biopsy and excisional biopsy specimens was 96% (95% CI 91.9% to 99.7%) (κ=0.89 (95% CI 0.73 to 1.00)) and 97% (95% CI 90.3% to 99.3%) (κ=0.84 (95% CI 0.66 to 1.00)), respectively. Sensitivity and specificity of SP3 for detecting HER-2 overexpression/gene amplification were 78.3% and 100%, respectively, in needle core biopsy and excisional biopsy specimens. Concordance between SP3 results assessed on the needle core biopsy and excisional biopsy was 89% (95% CI 81.2% to 94.4%) (κ=0.62 (95% CI 0.42 to 0.82)). Concordance between SP3 and HercepTest antibodies, after excluding 2+ cases, was 97.6% (95% CI 94.0% to 99.3%) (κ=0.88 (95% CI 0.77 to 1.00)). SP3 is a reliable alternative to HercepTest in evaluating HER-2 status in breast cancer patients. Like other anti-HER-2 antibodies, SP3 may serve as a diagnostic tool in breast pathology and has potential utility as an IHC biomarker in non-mammary malignancies.

Histologic Correlation of Breast Biopsies Presenting as Non-Mass Enhancing Lesions on Magnetic Resonance Imaging: A Contemporary Single Institutional Series

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S155-S155
Author(s):  
J Gruenberg ◽  
A Ravindran ◽  
D Visscher ◽  
E Valencia ◽  
M Wickre
Keyword(s):  
High Risk ◽  
Core Biopsy ◽  
Ductal Carcinoma ◽  
Excisional Biopsy ◽  
Primary Diagnosis ◽  
High Rate ◽  
Radial Scar ◽  
Apocrine Metaplasia ◽  
Ductal Hyperplasia ◽  
Benign Mass

Abstract Introduction/Objective Non-mass enhancement (NME) in breast tissue is an area of enhancement on MRI that appears distinct from background breast parenchyma, but lacks definitive features of a mass. NME is characterized by its internal enhancement pattern and distribution, and can represent benign, high risk, or malignant pathology. Given this considerable overlap, a core biopsy is often necessary for diagnosis and management. We aimed to elucidate the most frequent histologic findings found on breast biopsies for MRI NME. Methods Using our institutional database we identified 70 female patients with high risk status for breast cancer with MRI screen detected NME (BIRADS-4-suspicious for malignancy) that underwent subsequent biopsy procedure during the period of 01/2016-12/2017. Primary pathologic diagnoses were subcategorized as follows: malignant, atypical, benign mass-like lesions, fibrocystic changes (proliferative, nonproliferative), or “other” primary diagnoses. Results The median age of patients was 48 years (range: 22-76 years). Of the 70 patients, 66 underwent MRI-guided core biopsy, 3 underwent ultrasound-guided core biopsy and 1 underwent excisional biopsy. The primary diagnosis was analyzed. Of these 70 cases, 8 (11.4%) were malignant (7 with ductal carcinoma in situ and 1 with invasive ductal carcinoma), 1 (1.4%) had atypical lobular hyperplasia, and the remaining 61 (87.1%) showed benign findings (36 with fibrocystic changes (FCC), 22 benign mass-like lesions, 3 with other non-specific findings). The FCC were subcategorized as proliferative (usual ductal hyperplasia, columnar cell change, incidental radial scar, incidental intraductal papilloma, sclerosing adenosis, focal pseudoangiomatous stromal hyperplasia (PASH)) or nonprolifeative (stromal fibrosis, duct ectasia, apocrine metaplasia). Majority (61.1%) of FCC were both proliferative and nonproliferative, 22.2% proliferative only and 16.7% nonproliferative only. Benign mass-like lesions included PASH (45.4%), fibroadenomatoid nodule (22.7%), fat necrosis (18.2 %) and remaining had the diagnosis of clustered apocrine cysts, papillomatosis, and radial sclerosing lesion. Conclusion Less than a third of cases showed malignant findings and more than two-third of cases showed benign findings with a high rate of detection of proliferative lesions and PASH.

Is Excisional Biopsy and Chemoprevention Warranted in Patients with Atypical Lobular Hyperplasia on Core Biopsy?

2015 ◽  
Vol 81 (9) ◽  
pp. 876-878 ◽  
Author(s):  
Shelby Allen ◽  
Edward A. Levine ◽  
Nadja Lesko ◽  
Marissa Howard-Mcnatt
Keyword(s):  
Breast Cancer ◽  
Core Biopsy ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Patient Characteristics ◽  
Current Treatment ◽  
Final Pathology ◽  
Atypical Lobular Hyperplasia

The management of atypical lobular hyperplasia (ALH) on core biopsy remains controversial. The upstaging rates after surgical excision vary. We reviewed our upgrade rates and use of chemoprevention for ALH. Patients were identified through our pathology database for ALH from 2006 to 2013. Patients were included in the study that had a diagnosis only of ALH on core needle biopsy. Tumor and patient characteristics and final pathology were analyzed. ALH was identified in 56 patients since 2006. Sixteen patients met the inclusion criteria. All the patients underwent surgical excision. Final pathology of the excised specimens confirmed ALH in 62 per cent (n = 11). Two cases contained lobular carcinoma in situ. The upgrade rate on excisional biopsy was 18.75 per cent (n = 3) to invasive cancer. Chemopreventative treatment was taken by 44 per cent of the patients. After a mean follow-up of three years, none of the patients who received chemoprevention developed breast cancer. One patient who refused tamoxifen developed breast cancer. This is one of the few studies to examine the current treatment of ALH. We noted a significant upstaging rate after excision. We recommend women to undergo surgical excision. Patients should also consider chemoprevention to reduce their risk for developing breast cancer.

Lobular neoplasia on core biopsy: Is excision always indicated?

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 75-75
Author(s):  
C. A. Makarewich ◽  
K. M. Rosenkranz
Keyword(s):  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Incidental Finding ◽  
Lobular Carcinoma ◽  
Excisional Biopsy ◽  
Invasive Disease ◽  
Lobular Neoplasia ◽  
Occult Malignancy

75 Background: Lobular neoplasia (LN) is a continuum of rare, noninvasive lesions of the breast including lobular carcinoma in situ and atypical lobular hyperplasia. Current management is controversial and often includes excisional biopsy in women diagnosed with LN on percutaneous core biopsy (PCB) to exclude an occult malignancy. This strategy is based on retrospective data in women undergoing selective excisions. We performed routine excision of all lesions diagnosed as LN in our institution in order to ascertain a more accurate assessment of pathologic upgrade. Methods: Retrospective review of all prospectively collected cases of LN treated in a single institution from 2007-2010. Excisional biopsies were performed in all cases of LN excepting one (patient declined). Histologic findings of excisional biopsies were reviewed to assess the rate of pathologic upgrade. Results: Of the 2,289 PCBs performed during the study period, LN was found in 23 cases (1.0%). Twenty two (0.96%) cases proceeded to excisional biopsy. On final pathology, malignancy was found in 4 patients (18%). Two of 22 (9%) women were upgraded to ductal carcinoma in situ (DCIS) (both intermediate grade with foci of <1mm and 4mm) and 2/22 (9%) women were diagnosed with invasive lobular carcinoma. Conclusions: While 18% of women in our series had upgraded pathology at the time of excisional biopsy, we support selective rather than routine excisional biopsy. One of the invasive diagnoses was an incidental finding unrelated to the microcalcifications for which biopsy was initially performed. In the second case of invasive disease, the upgraded lesion was a mass identified on MRI performed for surgical planning in a woman already diagnosed with breast cancer. In both cases of DCIS, the area of malignancy was small (<1mm and 4mm) and of uncertain clinical significance. Based on these findings, we do not recommend routine excision of all LN identified on PCB. Cases in which the lesion is associated with a radiographic mass and/or is identified in a breast with a synchronous malignancy do warrant excisional biopsy. Patients without these high risk features can be counseled on the risks of malignancy and given the option of observation with close follow up.

Upgrade rate of core biopsy-determined atypical ductal hyperplasia by open excisional biopsy

2001 ◽  
Vol 182 (4) ◽  
pp. 355-358 ◽  
Author(s):  
Robert O Maganini ◽  
David A Klem ◽  
Bernard J Huston ◽  
Elizabeth S Bruner ◽  
H.Kurt Jacobs
Keyword(s):  
Core Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Excisional Biopsy ◽  
Ductal Hyperplasia

scholarly journals Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

Breast Care ◽  
2014 ◽  
Vol 10 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Aykut Soyder ◽  
Füsun Taşkın ◽  
Serdar Ozbas
Keyword(s):  
Core Biopsy ◽  
Breast Biopsy ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Breast Lesions ◽  
Core Needle ◽  
Ductal Carcinomas ◽  
Histological Results

Background: The objectives of this study were to determine the frequency of imaging-histological discordance and to compare the frequency of carcinoma between discordant lesions at ultrasound (US)-guided core needle biopsy. Materials and Methods: From November 2009 to June 2012, we performed US-guided 14-gauge core needle biopsies on 989 breast lesions in 961 women. We reviewed 58 (5.8%) cases that had imaging-histological discordance after percutaneous breast biopsy and underwent subsequent excisional biopsy. The clinical, radiological, and histological findings were reviewed for those 58 cases. Results: Among the 58 cases, subsequent excisions revealed 16 (27.5%) malignancies, which were categorized as 9 (15.5%) invasive ductal carcinomas, 4 (6.9%) malignant phyllodes tumors, and 3 (5.1%) ductal carcinomas in situ. Conclusion: The malignancy rate of 27.5% suggests that surgical excision should be performed in those cases presenting with imaging-histological discordance after US-guided core biopsy. Careful correlation of clinical, radiological, and histological results as well as appropriate follow-up are essential.

Atypical Ductal Hyperplasia on Core Biopsy: An Automatic Trigger for Excisional Biopsy?

2012 ◽  
Vol 19 (10) ◽  
pp. 3264-3269 ◽  
Author(s):  
Lee J. McGhan ◽  
Barbara A. Pockaj ◽  
Nabil Wasif ◽  
Marina E. Giurescu ◽  
Ann E. McCullough ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Excisional Biopsy ◽  
Ductal Hyperplasia ◽  
Automatic Trigger
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