Analysis of 612 Benign Papillomas Diagnosed At Core Biopsy: Rate of Upgrade to Malignancy, Factors Associated with Upgrade, and A Proposal For Selective Surgical Excision

Objective The probability of malignancy in women who are diagnosed with a Breast Imaging Reporting and Data System (BI-RADS) 4A score is low. Application of a second opinion ultrasound (SOUS), which is low in cost and minimally invasive, may lower the biopsy rate for patients who fall into this category. This study aimed to apply SOUS to patients with a BI-RADS score of 4A and predict the pathological results of a biopsy. Methods One hundred seventy-eight patients were analyzed. Univariate and multivariate analyses were performed to screen for predictive factors that are associated with malignancy. Categorical alteration of downgraded, unchanged, or upgraded was made after SOUS results. Changes in category were compared with biopsies to determine their predictive value of benignancy or malignancy. Results Independent factors associated with malignancy were age (>50 years), tumor size (≥20 mm), margin (not circumscribed), orientation (not parallel), and peripheral location, and an upgraded categorical alteration from SOUS. Downgraded categorical alterations were associated with benignancy. Conclusions In BI-RADS 4A cases, a biopsy is recommended when independent factors are associated with malignancy. A downgraded result from an SOUS examination is a protective factor, supporting the likelihood of benignancy in these patients.

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PO3 Borderline lesions diagnosed on breast core biopsy: Frequency of atypia and carcinoma on surgical excision – Local clinical experience

The Breast ◽

10.1016/j.breast.2018.02.014 ◽

2018 ◽

Vol 38 ◽

pp. 193-194

Author(s):

H. Bevis ◽

V. Atienza-Hipolito ◽

M. Ong

Keyword(s):

Clinical Experience ◽

Core Biopsy ◽

Surgical Excision

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Surgical excision of intraductal breast papilloma diagnosed on core biopsy

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2011.05969.x ◽

2012 ◽

Vol 82 (3) ◽

pp. 168-172 ◽

Cited By ~ 13

Author(s):

Qinghui Lu ◽

Ern Yu Tan ◽

Bernard Ho ◽

Juliana J. C. Chen ◽

Patrick M. Y. Chan

Keyword(s):

Core Biopsy ◽

Surgical Excision

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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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Will the spectrum of lesions prompting a "B3" breast core biopsy increase the benign biopsy rate?

Journal of Clinical Pathology ◽

10.1136/jcp.56.2.133 ◽

2003 ◽

Vol 56 (2) ◽

pp. 133-138 ◽

Cited By ~ 22

Author(s):

P J Carder

Keyword(s):

Core Biopsy ◽

Benign Biopsy ◽

Biopsy Rate

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A multivariate model to predict cancer upgrade from atypical ductal hyperplasia by core needle biopsy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.3 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 3-3 ◽

Cited By ~ 2

Author(s):

Alvaro Pena ◽

Robert T. Fazzio ◽

Sejal Shah ◽

Tanya L. Hoskin ◽

Rushin D Brahmbhatt ◽

...

Keyword(s):

Needle Biopsy ◽

Core Biopsy ◽

Atypical Ductal Hyperplasia ◽

Individual Cell ◽

Surgical Excision ◽

Multivariate Model ◽

Low Risk ◽

Cell Necrosis ◽

Core Needle ◽

Ductal Hyperplasia

3 Background: Atypical ductal hyperplasia (ADH) is a high-risk breast lesion usually diagnosed with core needle biopsy. Although upgraded to cancer at surgical excision in ~15 to 25% of cases, routine excision is questioned due to cost and overtreatment. We evaluated clinical, imaging, and histologic features associated with cancer upgrade and developed a multivariate model to predict risk of upgrade. Methods: With IRB approval a single institution retrospective review was performed of patients who underwent surgical excision of ADH diagnosed by core biopsy from 06/2005 to 06/2013. Review was performed of electronic records, breast imagin,g and biopsy slides. Multiple imputations were used for missing data. Association of cancer upgrade with various features was assessed with logistic regression. Results: 409 biopsies with ADH on core biopsy, with later surgical excision, were included. The overall upgrade rate was (16.1%, 95% CI:12.9-20.0%); 10 patients had invasive cancer at excision and 56 DCIS only. Features on core biopsy most strongly associated with upgrade were imaging estimated percent of lesion removed (upgrade 9% for 90% removed, 14% for 50 to 75%, and 27% for < 50% removed), individual cell necrosis (upgrade 34% with necrosis vs. 9.5% without), and # foci of ADH (22% for >1 focus vs 8% for 1 focus). A multivariate predictive model (see Table) showed an average C-statistic of 0.77. Women with no necrosis and either 1 focus with ≥ 50% removal or >1 focus with 90% removal (36% of the sample) have low risk of upgrade (5.0%, 95% CI:1.3-8.7%). Conclusions: ADH on core biopsy with low risk of upgrade to cancer is defined by percent of imaging lesion removed, # of foci of ADH, and lack of individual cell necrosis. If findings are validated, women whose biopsies meet low-risk criteria might be considered for chemoprevention and surveillance rather than surgical excision.[Table: see text]

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