Borderline Atypical Ductal Hyperplasia/Low-grade Ductal Carcinoma In Situ on Breast Needle Core Biopsy Should Be Managed Conservatively

Abstract Context.—Management of breast needle core biopsies diagnosed as atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ is controversial. Current recommendations involve excisional biopsy to rule out ductal carcinoma in situ and/or invasive carcinoma, which have been reported in more than 50% of cases in some series. Objective.—To determine how frequently these diagnoses made on needle core biopsy are ultimately found to represent in situ or invasive carcinoma based on excisional biopsy specimens, in order to identify predictive factors. Design.—One thousand eight hundred thirty-six image-guided needle core biopsies were performed between January 1, 1995 and May 1, 2001. Fifty-four (2.9%) patients diagnosed with atypical ductal hyperplasia (n = 36), atypical lobular hyperplasia (n = 12), atypical ductal hyperplasia + atypical lobular hyperplasia (n = 3), or lobular carcinoma in situ (n = 3) subsequently underwent breast excisions. Pathologic features were reviewed in each of the needle core biopsies using Page's criteria and were then correlated with excision specimens. Setting.—University medical center. Results.—Review of the needle core biopsy cases with either ductal carcinoma in situ or invasive carcinoma + ductal carcinoma in situ on final excision showed that nucleoli were evident in most of the needle core cases, with foci of nuclear pleomorphism and individual cell necrosis or apoptosis. Conclusion.—A more precise diagnosis can be made by using strict criteria for atypical ductal hyperplasia versus ductal carcinoma in situ on needle core biopsy. Cytologic atypia, even if in a small area, particularly when there is apoptosis/individual cell necrosis, correlates with the finding of a more serious lesion on excision.

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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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Ductal Carcinoma In Situ and Atypical Ductal Hyperplasia of the Breast Diagnosed at Stereotactic Core Biopsy

The Breast Journal ◽

10.1046/j.1524-4741.2001.007001014.x ◽

2001 ◽

Vol 7 (1) ◽

pp. 14-18 ◽

Cited By ~ 19

Author(s):

I. Mendez ◽

F. J. Andreu ◽

E. Saez ◽

M. Sentis ◽

I. Jurado ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Core Biopsy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Stereotactic Core Biopsy ◽

Ductal Hyperplasia ◽

Stereotactic Core

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Acidophilic Nuclear Inclusions Are Specific for Florid Ductal Hyperplasia Among Proliferative Breast Lesions

Archives of Pathology & Laboratory Medicine ◽

10.5858/2010-0377-oa.1 ◽

2011 ◽

Vol 135 (6) ◽

pp. 766-769

Author(s):

Scott Lauer ◽

Gabriela Oprea-Ilies ◽

Cynthia Cohen ◽

Volkan Adsay ◽

Amy L. Adams

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Low Grade ◽

Intranuclear Inclusions ◽

Ductal Hyperplasia ◽

Mammary Hyperplasia ◽

Insight Into

Abstract Context.—Recently we have observed distinctive acidophilic intranuclear inclusions in cases of usual intraductal hyperplasia of the breast. Similar inclusions were described almost 20 years ago in cases of mammary hyperplasia. These correlated ultrastructurally with so-called helioid inclusions. However, there since has been little discussion of these inclusions in the literature. Objective.—To examine the incidence and specificity of these inclusions in proliferative lesions of the breast. Design.—Forty cases of usual intraductal hyperplasia, 15 cases of atypical ductal hyperplasia, and 34 cases of low-grade ductal carcinoma in situ were examined for the presence of acidophilic intranuclear inclusions. Results.—Acidophilic intranuclear inclusions were present in 50% of cases of usual intraductal hyperplasia (20 of 40) but were not identified in any cases of atypical ductal hyperplasia (0 of 15) or low-grade ductal carcinoma in situ (0 of 34). Conclusions.—Acidophilic intranuclear inclusions appear to be a common, specific feature found in usual intraductal hyperplasia and may be helpful in distinguishing it from atypical ductal hyperplasia and low-grade ductal carcinoma in situ in some cases. Elucidating the nature of these inclusions may provide insight into the pathogenesis of usual intraductal hyperplasia.

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Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases

International Journal of Surgical Pathology ◽

10.1177/10668969211010954 ◽

2021 ◽

pp. 106689692110109

Author(s):

Cunxian Zhang ◽

Edmond Y. Wang ◽

Fang Liu ◽

M. Ruhul Quddus ◽

C. James Sung

Keyword(s):

Breast Carcinoma ◽

Invasive Ductal Carcinoma ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Low Grade ◽

Type B ◽

Ductal Hyperplasia

The literature shows a wide range in the frequencies of finding breast carcinoma in the excised specimens following a biopsy diagnosis of atypical ductal hyperplasia (ADH), likely due to a poor diagnostic reproducibility among different pathologists as well as an inherent heterogeneity in ADH. We evaluated whether histologic subtyping of ADH would help predict the risk of breast carcinoma. Our study consisted of 143 cases of ADH diagnosed by core needle biopsy and followed by excision. Of these, 54 cases (37.8%) showed carcinoma in the excised specimens (47 cases of ductal carcinoma in situ alone, 3 cases of invasive ductal carcinoma alone, and 4 cases of mixed invasive ductal carcinoma and ductal carcinoma in situ). We arbitrarily divided ADH into two subtypes: type A was considered when one or more ducts were completely replaced by low-grade ductal carcinoma in situ type cells but the lesion was <2 mm and type B was considered when one or more ducts were partially involved by low-grade ductal carcinoma in situ type cells regardless of lesion size. Type A was associated with a significantly higher frequency of breast carcinoma (63.6%) than type B (30.0%). ADH containing punctate necrosis showed a higher association of carcinoma (66.7%) compared to those without necrosis (35.1%). Within type B ADH, involvement of 3 or more foci had a higher frequency of carcinoma (50.0%) than involvement of fewer foci (26.6%). These histologic features of ADH may prove useful in predicting the likelihood of breast carcinoma and provide helpful information for patient's management.

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Reflex Estrogen Receptor (ER) and Progesterone Receptor (PR) Analysis of Ductal Carcinoma In Situ (DCIS) in Breast Needle Core Biopsy Specimens

The American Journal of Surgical Pathology ◽

10.1097/pas.0000000000000674 ◽

2016 ◽

Vol 40 (8) ◽

pp. 1090-1099 ◽

Cited By ~ 4

Author(s):

Christopher J. VandenBussche ◽

Ashley Cimino-Mathews ◽

Ben Ho Park ◽

Leisha A. Emens ◽

Theodore N. Tsangaris ◽

...

Keyword(s):

Estrogen Receptor ◽

Progesterone Receptor ◽

Ductal Carcinoma In Situ ◽

Core Biopsy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Needle Core Biopsy ◽

Biopsy Specimens

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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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Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ as Revealed by Large-Core Needle Breast Biopsy

American Journal of Roentgenology ◽

10.2214/ajr.175.5.1751341 ◽

2000 ◽

Vol 175 (5) ◽

pp. 1341-1346 ◽

Cited By ~ 219

Author(s):

Marla L. Rosenfield Darling ◽

Darrell N. Smith ◽

Susan C. Lester ◽

Carolyn Kaelin ◽

Donna-Lee G. Selland ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Large Core ◽

Core Needle ◽

Ductal Hyperplasia

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Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability

International Journal of Surgical Pathology ◽

10.1177/1066896919854543 ◽

2019 ◽

Vol 27 (7) ◽

pp. 736-743 ◽

Cited By ~ 1

Author(s):

Lianqun Qiu ◽

Daniel D. Mais ◽

Marlo Nicolas ◽

Jennifer Nanyes ◽

Kenneth Kist ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Imaging ◽

Interobserver Variability ◽

Ductal Carcinoma ◽

Atypical Ductal Hyperplasia ◽

Breast Lesions ◽

Ductal Hyperplasia ◽

Papillary Lesions

The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the “substantial” agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). “Substantial” and “fair” κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into “excellent” range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.

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