Papillary Breast Lesions: Association with Malignancy and Upgrade Rates on Surgical Excision

2017 ◽  
Vol 83 (11) ◽  
pp. 1294-1297 ◽  
Author(s):  
Hanh-tam Tran ◽  
Asma Mursleen ◽  
Sahar Mirpour ◽  
Omar Ghanem ◽  
Maen J. Farha
Keyword(s):  
Carcinoma In Situ ◽  
Breast Lesion ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Intraductal Papilloma ◽  
Breast Lesions ◽  
Aggressive Approach ◽  
Papillary Lesions ◽  
Benign Papilloma

Intraductal papilloma falls under the category of benign breast mass. However, recent studies show that it can harbor occult carcinoma. The management of benign intraductal papilloma remains controversial because of its nonspecific radiologic and histological findings, as well as its association with surrounding malignant pathology. The purpose of this study is to investigate upgrade rates of a benign intraductal papilloma on surgical excision and the need for surgical excision of papillary lesions diagnosed at core needle biopsy. A retrospective review of a single institution's pathology database between 2011 and 2015 identified 43 core biopsies with benign papilloma. We followed the upgrade rates of these lesions on surgical excision. There were 90 biopsies with the diagnosis of benign intraductal papilloma. The average age was 55.2 (range from 24–87 years old). Forty-three had benign intraductal papilloma; 28 of the 43 core biopsies had surgical excision. Two (7.1%) had an upgrade from benign intraductal papilloma to intraductal papilloma with atypia. One (3.6%) had an upgrade to ductal carcinoma in situ. None had invasive cancer. Surgical findings were in agreement with core biopsies in 25 (89.3%) of 28 cases (κ = 0.80, P < 0.0001). Core biopsies have a statistically significant correlation with pathologies on surgical excision in detecting atypia in breast lesion as demonstrated by κ = 0.80. However, the study shows benign intraductal papillomas on core biopsy have an upgrade rate of 10.7 per cent after undergoing surgical excision. As such, we recommend a more aggressive approach including surgical excision of all benign intraductal papillary lesions.

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

2019 ◽  
Vol 27 (7) ◽  
pp. 736-743 ◽  
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.

scholarly journals Surgical Excision of Benign Papillomas Diagnosed with Core Biopsy: A Community Hospital Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Eka Rozentsvayg ◽  
Kristen Carver ◽  
Sunita Borkar ◽  
Melvy Mathew ◽  
Sean Enis ◽  
...  
Keyword(s):  
High Risk ◽  
Core Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Surgical Excision ◽  
Surgical Pathology ◽  
Ductal Hyperplasia ◽  
Benign Papilloma

Our goal was to assess the value of surgical excision of benign papillomas of the breast diagnosed on percutaneous core biopsy by determining the frequency of upgrade to malignancies and high risk lesions on a final surgical pathology. We reviewed 67 patients who had biopsies yielding benign papilloma and underwent subsequent surgical excision. Surgical pathology of the excised lesions was compared with initial core biopsy pathology results. 54 patients had concordant benign core and excisional pathology. Cancer (ductal carcinoma in situ and invasive ductal carcinoma) was diagnosed in five (7%) patients. Surgery revealed high-risk lesions in 8 (12%) patients, including atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ. Cancer and high risk lesions accounted for 13 (19%) upstaging events from benign papilloma diagnosis. Our data suggests that surgical excision is warranted with core pathology of benign papilloma.

Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report

2021 ◽  
pp. 1-4
Author(s):  
Corrado Tagliati ◽  
Giuseppe Lanni ◽  
Federico Cerimele ◽  
Antonietta Di Martino ◽  
Valentina Calamita ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Small Region ◽  
Apparent Diffusion Coefficient Value ◽  
Apparent Diffusion

We present a case of ductal carcinoma in situ within a fibroadenoma. Breast cancer arising within fibroadenoma incidence ranges from 0.125% to 0.02%, and ductal carcinoma in situ is not the most frequent malignancy that can be found within a fibroadenoma. Dynamic contrast-enhanced magnetic resonance imaging showed an oval mass with circumscribed margins and dark internal septations, suspicious for fibroadenoma. According to European Society of Breast Radiology diffusion-weighted imaging consensus, mean apparent diffusion coefficient value obtained by drawing a small region of interest on the lesion apparent diffusion coefficient map showed a low diffusion level. Therefore, ductal carcinoma in situ within a fibroadenoma was diagnosed at final pathology after surgical excision.

scholarly journals High-grade ductal carcinoma in-situ detected by microcalcification within borderline phyllodes tumour: A report of a case and literature review

2021 ◽  
Author(s):  
Wing Nam Yuen ◽  
Joshua Jing Xi Li ◽  
Man Yi Chan ◽  
Gary M Tse
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Management Plan ◽  
High Grade ◽  
Total Mastectomy ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Abstract BackgroundPhyllodes tumour is a rare biphasic neoplasm of the breast that mostly affects middle aged women. Ductal carcinoma in-situ and microcalcifications occurring within phyllodes tumours are documented but are rare findings. Primary surgical excision with adjuvant therapies remains the mainstay of treatment.Case presentationWe report a case of a 42-year-old woman with high-grade ductal carcinoma in-situ within a borderline phyllodes tumour. Radiologically, clumps of microcalcification were detected within the lesion. Local excision followed by total mastectomy with axillary dissection was then performed. No tumour recurrence was detected up to a period of 8 years.ConclusionPresence of microcalcifications within a phyllodes tumour should alert clinicians and pathologists of possible coexisting carcinoma components. Stromal and epithelial components of these lesions should be evaluated separately when formulating a management plan.

scholarly journals 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

2016 ◽  
Vol 49 (1) ◽  
pp. 6-11 ◽  
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.

Evaluation of CD56 and CD57 immunostainings for discrimination between endocrine ductal carcinoma in situ and intraductal papilloma

2010 ◽  
Vol 60 (6) ◽  
pp. 459-465 ◽  
Author(s):  
Shinya Tajima ◽  
Ichiro Maeda ◽  
Yoshihide Kanemaki ◽  
Yasuo Nakajima ◽  
Shinobu Tatsunami ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Intraductal Papilloma

Predictors of microinvasion and its prognostic role in ductal carcinoma in situ.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 188-188
Author(s):  
Gloria Sue ◽  
Donald R. Lannin ◽  
Brigid K. Killelea ◽  
Nina Ruth Horowitz ◽  
Anees B. Chagpar
Keyword(s):  
Black Women ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
White Women ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Bivariate Analysis ◽  
Prognostic Role ◽  
Increase Risk

188 Background: Predictors of microinvasion in ductal carcinoma in situ (DCIS) are not well understood. We sought to determine factors predicting microinvasion and the prognostic role this plays in patients with DCIS. Methods: A retrospective cohort study of 205 consecutive patients presenting to the Yale Breast Center with DCIS from 2000 through 2003 was performed. A chart review was conducted and bivariate and multivariate analyses comparing patients with and without possible microinvasion were performed. Statistical analyses were done using SPSS software version 19. Results: Of the 205 patients who presented with DCIS and were treated with surgical excision, 51 (24.9%) had evidence of possible microinvasion on final pathology. The median age of all patients was 53.0 years (range 35.8 to 88.9). On bivariate analysis, patients with microinvasion had larger areas of DCIS, and were more likely to have high grade DCIS, of solid type, associated with necrosis and microcalcifications (see table). There was a trend towards white women having a higher rate of microinvasion than black women (26.9% vs. 8.7%, p=0.061). On multivariate analysis, none of these factors were independent predictors of microinvasion. With a median follow-up of 8.5 years, there was no difference in the likelihood of recurrence in the microinvasion vs. no microinvasion groups (6.0% vs. 7.2%, p=1.000). 5-year actuarial overall survival was also not different between the two groups (96% vs. 94%, p=0.202, respectively). Conclusions: Patients with larger DCIS size, higher grade, solid histology, necrosis, and microcalcifications have a higher likelihood of microinvasion. However, the presence of possible microinvasion does not significantly increase risk of recurrence or decrease survival. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document