Abstract P5-02-06: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: Imaging characteristics, outcome of surgical excision or imaging follow-up

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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Benign Intraductal Papilloma Diagnosed on Imaging-Guided Breast Biopsy: Upgrade Rate to Carcinoma and to High-Risk Lesion

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.09.12590 ◽

2021 ◽

Vol 104 (9) ◽

pp. 1452-1458

Keyword(s):

High Risk ◽

Invasive Carcinoma ◽

Breast Biopsy ◽

Early Stage ◽

Surgical Excision ◽

Intraductal Papilloma ◽

Low Grade ◽

Factors Associated ◽

High Risk Lesion

Objective: To determine the upgrade rates to carcinoma and to high-risk lesion (HRL) of benign intraductal papilloma (IDP) diagnosed on core needle biopsy (CNB) at Phramongkutklao (PMK) Hospital and to identify clinical or radiologic factors associated with the upgrading. Materials and Methods: Benign IDPs diagnosed on CNB between 2012 and 2020 were retrospectively reviewed. The ones with subsequent surgical excision or with more than two years of imaging follow-up to confirm benignity were included. The upgrade rates to carcinoma and to HRL were determined. Clinical and radiologic factors associated with the upgrade were analyzed. Results: Fifty-six benign IDPs diagnosed on CNB including 41 with subsequent excision and 15 with follow-up management were included. Of the 56 lesions, four (7.14%) were upgraded to carcinoma including three DCIS and one DCIS with grade 1 invasive carcinoma. Upgrade to HRL was found in two lesions (3.57%). No factor was found to be associated with the upgrading. Conclusion: At PMK Hospital, the upgrade rates of benign IDP diagnosed on CNB to carcinoma and to HRL were 7.14% and 3.57%, respectively. No factor was found to be associated with the upgrading. All upgraded cancers were of the early stage and low grade. Case-by-case management is recommended, based on these results together with patient’s risk, patient’s concern, and follow-up compliance. Keywords: Benign intraductal papilloma; Breast carcinoma; Breast biopsy; High risk lesion; Upgrade

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High risk breast lesions identified on MRI-guided vacuum-assisted needle biopsy: outcome of surgical excision and imaging follow-up

British Journal of Radiology ◽

10.1259/bjr.20180300 ◽

2018 ◽

Vol 91 (1090) ◽

pp. 20180300 ◽

Cited By ~ 4

Author(s):

Megan E Speer ◽

Monica L Huang ◽

Basak E Dogan ◽

Beatriz E Adrada ◽

Rosalind P Candelaria ◽

...

Keyword(s):

High Risk ◽

Needle Biopsy ◽

Surgical Excision ◽

Breast Lesions ◽

Mri Guided ◽

High Risk Breast

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The Positive Outcome of MRI-Guided Vacuum Assisted Core Needle Breast Biopsies is not Influenced by a Prior Negative Targeted Second-Look Ultrasound

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2017.03.003 ◽

2017 ◽

Vol 68 (4) ◽

pp. 401-408 ◽

Cited By ~ 1

Author(s):

Romuald Ferré ◽

Shaza AlSharif ◽

Ann Aldis ◽

Benoît Mesurolle

Keyword(s):

High Risk ◽

Magnetic Resonance ◽

Breast Mri ◽

Positive Outcome ◽

Synchronous Carcinoma ◽

Second Look ◽

Guided Biopsy ◽

Imaging Characteristics ◽

Mri Features ◽

Mri Guided

Purpose The study sought to investigate the outcome of breast magnetic resonance–guided biopsies as a function of the indication for magnetic resonance imaging (MRI), the MRI features of the lesions, and the performance or not of a targeted second-look ultrasound (SLUS) prior breast MRI-guided biopsy. Methods We identified 158 women with MRI-detected breast lesions scheduled for MRI-guided biopsy (2007-2013). Patient demographics, performance of targeted SLUS, imaging characteristics, and subsequent pathology results were reviewed. Results Three biopsies were deferred, and 155 lesions were biopsied under MRI guidance (155 women; median age 55.14 years; range 27-80 years). Ninety-eight women underwent a SLUS prior to the MRI-guided biopsy (63%). Of the 155 biopsied lesions, 23 (15%) were malignant, 106 (68%) were benign, and 26 (17%) were high risk. Four of 15 surgically excised high-risk lesions were upgraded to malignancy (27%). Most of the biopsied lesions corresponded to non–mass-like enhancement (81%, 126 of 155) and most of the biopsies (52%, 81 of 155) were performed in a screening context. No demographic or MRI features were associated with malignancy. No differences were noted between the 2 subgroups (prior SLUS vs no prior SLUS) except for the presence of a synchronous carcinoma associated with a likelihood of targeted SLUS before MRI-guided biopsy ( P = .001). Conclusion A negative SLUS does not influence the pathology outcome of a suspicious lesion biopsied under MR guidance.

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Pilomatrixoma, a Rare Mimicker of Male Breast Cancer

Journal of Clinical Imaging Science ◽

10.25259/jcis_64_2019 ◽

2019 ◽

Vol 9 ◽

pp. 46

Author(s):

Aurela Clark ◽

Rebecca Leddy ◽

Laura Spruill ◽

Abbie Cluver

Keyword(s):

Benign Lesion ◽

Surgical Excision ◽

Male Breast ◽

Skin Tumor ◽

Imaging Features ◽

Histologic Diagnosis ◽

Outer Quadrant ◽

Imaging Characteristics ◽

Suspicious Feature

Pilomatrixoma or calcifying epithelioma of Malherbe is a benign skin tumor arising from the hair follicle; breast occurrence is considered a rarity. Clinically presenting as a palpable abnormality and with both benign and malignant mammographic and sonographic features, it can be easily misdiagnosed as a breast neoplasm. We report a very rare case of pilomatrixoma of the male breast in a 36-year-old male presenting with a firm, superficial nodule in the upper outer quadrant. Though the sonographic trifecta of imaging features (shape- margins-orientation/oval, circumscribed mass, parallel to the skin) is consistent with a benign lesion, a histologic diagnosis was warranted based on its most suspicious feature of internal pleomorphic calcifications. Pathologic diagnosis revealed the uncommon benign entity of pilomatrixoma in the male breast. Our patient was recommended for surgical excision based on current literature recommendations for management in most reports of pilomatrixoma. One alternative recommendation presented in a single report of pilomatrixoma in the breast supported follow-up imaging based on benign imaging characteristics.

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High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management

American Journal of Roentgenology ◽

10.2214/ajr.20.23040 ◽

2021 ◽

Vol 216 (3) ◽

pp. 622-632

Author(s):

Aya Y. Michaels ◽

Paula S. Ginter ◽

Katerina Dodelzon ◽

Matthew R. Naunheim ◽

Genevieve N. Abbey

Keyword(s):

High Risk ◽

Core Biopsy ◽

Surgical Excision ◽

Mri Guided

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The accuracy of ultrasound guided 14–gauge core needle breast biopsy: Correlation with surgical excision or long term follow–up

Asian Pacific Journal of Tropical Disease ◽

10.1016/s2222-1808(11)60033-9 ◽

2011 ◽

Vol 1 (3) ◽

pp. 222-226 ◽

Cited By ~ 2

Author(s):

Sumaporn Makkun ◽

Jenjeera Prueksadee ◽

Jatuporn Chayakulkheeree ◽

Darunee Boonjunwetwat

Keyword(s):

Breast Biopsy ◽

Surgical Excision ◽

Ultrasound Guided ◽

Core Needle ◽

Long Term Follow Up

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Abstract P2-02-02: Cancer detection rate in high-risk patients on short-term, and long-term follow-up MRI after a benign concordant MRI-guided breast biopsy

10.1158/0008-5472.sabcs13-p2-02-02 ◽

2013 ◽

Author(s):

EI Den ◽

BA Laguna ◽

SP Weinstein ◽

SG Roth

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

Breast Biopsy ◽

Cancer Detection Rate ◽

Short Term ◽

Long Term Follow Up ◽

Risk Patients ◽

Mri Guided

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Compliance with Short-Interval Follow-up MRI after Benign Concordant MRI-guided Breast Biopsy

Journal of Breast Imaging ◽

10.1093/jbi/wbaa089 ◽

2020 ◽

Author(s):

Shruthi Ram ◽

Helaina Regen-Tuero ◽

Grayson L Baird ◽

Ana P Lourenco

Keyword(s):

Breast Biopsy ◽

Short Interval ◽

False Negative ◽

False Negative Rate ◽

Negative Rate ◽

Guided Biopsy ◽

Institutional Review ◽

Biopsy Report ◽

Mri Guided

Abstract Objective To evaluate compliance with short-interval follow-up MRI after benign concordant MRI-guided breast biopsy. Methods This institutional review board-approved retrospective study included all benign concordant MRI-guided biopsies performed between January 1, 2010, and May 1, 2018. The following was collected from the electronic medical record: patient and lesion characteristics, short-interval follow-up MRI recommendation, communication to referring physician, follow-up imaging, repeat biopsies, biopsy outcome, and patient insurance status. Compliance with recommendations was defined as follow-up MRI within 9 months of biopsy. Results Among 98 patients, there were 107 lesions with benign concordant MRI-guided biopsy results that met study criteria. After excluding 7 patients who underwent subsequent mastectomy, 50/91 (54.9%) patients were recommended short-interval follow-up MRI. Of these, 33/50 (66.0%) had a short-interval follow-up MRI. Direct communication of the short-interval follow-up recommendation was documented in the biopsy report for 4/50 (8%) patients. Subsequent MRI was available for 77/107 (72%) lesions at a median of 29 months following MRI-guided biopsy (range, 3–96 months). Subsequent mammography was available for 21/30 (70%) remaining lesions at a median of 47 months following MRI-guided biopsy (range, 23–88 months). There were two repeat biopsies, with one subsequent malignancy, resulting in a false-negative rate of 0.9% (1/107). Conclusions When short-interval follow-up MRI was recommended following benign concordant MRI-guided breast biopsy, compliance was 66.0%. Lack of communication of the recommendation may at least partially explain the low compliance. The low false-negative rate (0.9%) suggests routine short-interval follow-up MRI may be unnecessary following benign concordant MRI-guided biopsy.

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