Solid Papillary Ductal Carcinoma In Situ Versus Usual Ductal Hyperplasia in the Breast: A Potentially Difficult Distinction Resolved by Cytokeratin 5/6

Context.—High–molecular weight cytokeratins, such as cytokeratin 5 (CK5), are helpful to distinguish usual ductal hyperplasia (UDH) from atypical ductal hyperplasia (ADH) or low-grade ductal carcinoma in situ (DCIS). Few studies have looked at combining CK5 with estrogen receptor (ER) to differentiate UDH from ADH. Objective.—To evaluate the expression pattern of CK5 and ER as single or combined markers to separate UDH from ADH and low-grade DCIS. Design.—A total of 23 ADH, 10 low-grade DCIS, and 32 UDH whole-tissue slides were stained for ER, CK5, progesterone receptor (PR), and Bcl-2. Nuclear staining of ER and PR was scored as diffuse (>80%), focal (10%–80%), or negative (<10%). Cytoplasmic staining of CK5 and Bcl-2 was scored as diffuse (>60%), focal (10%–60%), or negative (<10%). Differences in staining patterns were evaluated. Results.—For ER staining: 94% of ADH/DCIS cases showed a diffuse staining pattern, whereas none of the 32 UDH cases showed diffuse staining. For CK5 staining: 96% of ADH/DCIS cases were negative or focally positive, whereas all 32 UDH cases had diffuse staining. The combination of ER and CK5 increased the sensitivity (94% to 97%). For PR staining: 11 of 23 ADH cases (48%), 6 of 10 DCIS cases (60%), and 4 of 32 UDH cases (13%) showed diffuse staining. Bcl-2 staining showed no statistical significance (P = .73). Conclusions.—Although morphology remains the gold standard, ER and CK5 are useful makers to differentiate UDH from ADH. Progesterone receptor staining may have limited value, and Bcl-2 staining is not useful.

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Whole transcriptome analysis identifies upregulated genes and pathways in ductal carcinoma in situ mimicking usual ductal hyperplasia

Human Pathology Case Reports ◽

10.1016/j.hpcr.2019.200308 ◽

2019 ◽

Vol 17 ◽

pp. 200308

Author(s):

Jennifer Zeng ◽

Jonathan Serrano ◽

Matija Snuderl ◽

Farbod Darvishian

Keyword(s):

Ductal Carcinoma In Situ ◽

Transcriptome Analysis ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Usual Ductal Hyperplasia ◽

Ductal Hyperplasia ◽

Whole Transcriptome Analysis ◽

Upregulated Genes ◽

Whole Transcriptome

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Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2014-0550-oa ◽

2015 ◽

Vol 139 (9) ◽

pp. 1137-1142 ◽

Cited By ~ 21

Author(s):

Cathleen Matrai ◽

Timothy M. D'Alfonso ◽

Lindsay Pharmer ◽

Michele B. Drotman ◽

Rache M. Simmons ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Core Biopsy ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Lobular Carcinoma ◽

Radial Scar ◽

Needle Core Biopsy ◽

Ductal Hyperplasia

Context Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. Objective To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. Design Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. Results Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). Conclusions No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

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Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution

Radiologia Brasileira ◽

10.1590/0100-3984.2014.0110 ◽

2016 ◽

Vol 49 (1) ◽

pp. 6-11 ◽

Cited By ~ 9

Author(s):

Gustavo Machado Badan ◽

Decio Roveda Júnior ◽

Sebastião Piato ◽

Eduardo de Faria Castro Fleury ◽

Mário Sérgio Dantas Campos ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Surgical Excision ◽

Target Lesion ◽

Core Needle ◽

Ductal Hyperplasia ◽

Underestimation Rate

Abstract Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.

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