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

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

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

Breast Cancer ◽  
2019 ◽  
Vol 27 (3) ◽  
pp. 405-414
Author(s):  
Satoko Okamoto ◽  
Shu-Tian Chen ◽  
James D. Covelli ◽  
Wendy B. DeMartini ◽  
Bruce L. Daniel ◽  
...  
Keyword(s):  
High Risk ◽  
Breast Biopsy ◽  
Surgical Excision ◽  
Imaging Characteristics ◽  
Mri Guided

scholarly journals A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-grade Ductal Carcinoma In Situ of the Breast

2021 ◽  
Author(s):  
Luca Nicosia ◽  
Anna Carla Bozzini ◽  
Silvia Penco ◽  
Chiara Trentin ◽  
Maria Pizzamiglio ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Surgical Excision ◽  
Low Grade ◽  
Multivariable Model

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: 3100 VABBs were retrospectively reviewed among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients’ features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate analysis. Finally, we developed a predictive multivariable model based on the features which were significantly associated with the univariate analysis outcome. Results: the upgrade rate to invasive carcinoma was 10.8 %. At univariate analysis, the risk of upgrade was significantly lower in the absence of post- biopsy residual lesion (p<0.001), age > 50 (p=0.029), and in presence of low-grade DCIS only in specimens with microcalcifications (p=0.002). According to the final multivariable model, the predicted probability of diagnostic underestimation for a patient with all the three favourable features selected at univariate analysis was 1% (95% CI: 0.3%-4%). Conclusions: An easy to use predictive model of radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

scholarly journals Upgrade Rate of Flat Epithelial Atypia Diagnosed at Stereotactic Core Needle Biopsy of Microcalcifications: Is Excisional Biopsy Indicated?

2020 ◽  
Vol 2 (4) ◽  
pp. 336-342
Author(s):  
Paula B Gordon ◽  
Emma Branch
Keyword(s):  
Family History ◽  
High Risk ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Flat Epithelial Atypia ◽  
High Risk Lesion ◽  
History Of ◽  
Epithelial Atypia

Abstract Objective Whether the optimal management of pure flat epithelial atypia (FEA) found on core needle biopsy (CNB) specimens is surgical excision or imaging follow-up remains controversial. This study aimed to determine the upgrade rate to ductal carcinoma in situ (DCIS), invasive carcinoma or a high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ), and it explored the relationship between a family history of breast cancer and the risk of upgrade. Methods Cases with pure FEA found on stereotactic CNB of microcalcifications between March 2011 to December 2017 were followed by excisional biopsy or periodic imaging. The proportion of cases upgraded to a high-risk lesion and the odds of upgrade as related to a family history of breast cancer were determined with 95% confidence intervals (CIs). Results We identified 622 cases of pure FEA; 101 (16.2%) underwent surgical excision and 269 (43.2%) had imaging follow-up of ≥ 24 months. There were no upgrades to DCIS or invasive cancer in any of these 370 individuals (0%), and 4.6% (17/370; 95% CI: 2.9%–7.2%) were upgraded to a high-risk lesion. There was a nonstatistically significant trend between family history and upgrade to high-risk lesion (odds ratio 1.72 [95% CI: 0.65%–4.57%]). Conclusion In our study, the upgrade rate of pure FEA to malignancy was 0%. We suggest that regular imaging follow-up is an appropriate alternative to surgery. Because of potential differences in biopsy techniques and pathologist interpretation of the primary biopsy, individual institutions should audit their own results prior to altering their management of FEA.

scholarly journals Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 364-368 ◽  
Author(s):  
Doris Leithner ◽  
Benjamin Kaltenbach ◽  
Petra Hödl ◽  
Volker Möbus ◽  
Volker Brandenbusch ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Statistical Tests ◽  
Menopausal Status ◽  
Surgical Excision ◽  
Lesion Size ◽  
Intraductal Papilloma ◽  
Image Guided ◽  
Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

scholarly journals Can we eradicate gastric MALT-lymphoma?

2013 ◽  
pp. 154-158
Author(s):  
Angelo Zullo ◽  
Cesare Hassan ◽  
Francesca Cristofari ◽  
Claudia Iegri ◽  
Nicoletta Villiva ◽  
...  
Keyword(s):  
Malt Lymphoma ◽  
Early Stage ◽  
Gastric Lymphoma ◽  
Survival Rates ◽  
Antibody Therapy ◽  
Gastric Malt Lymphoma ◽  
Low Grade ◽  
Success Rates ◽  
H Pylori

The incidence of primary gastric lymphoma in Italy is considerably higher than that observed in the rest of Europe. It is widely accepted that gastric B-cell, low-grade mucosalassociated lymphoid tissue (MALT) lymphoma is caused by specific host-bacterial interactions that occur during Helicobacter pylori infection. This review examines recent findings on the origins, diagnosis, treatment, and follow-up of gastric MALT lymphomas. Clinical and endoscopic findings at diagnosis vary widely. In a substantial number of cases, the patient presents only vague dyspeptic symptoms or poorly defined abdominal pain with no macroscopic lesions on the gastric mucosa. Review of data from 32 trials in which a total of 1,387 MALT-lymphoma patients of the stomach were treated solely with H. pylori eradication revealed high remission rates when the disease is treated early (stage I-II1). Neoplasia confined to the submucosa, antral localization of tumors, and negativity for the API2-MALT1 translocation were associated with a high probability of remission following H. pylori eradication. When the latter approach is not sufficient, radiotherapy, chemotherapy and, in selected cases, surgery are associated with high success rates; data on the efficacy of monoclonal antibody therapy (rituximab) are still limited. Five-year survival rates are higher than 90%. Patients whose tumors have been eliminated require close, long-term endoscopic follow-up since recurrence has been reported in some cases. Broader clinical follow-up is also advisable because the incidence of other solid tumors and of cardiovascular events is reportedly increased in these patients.

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

2011 ◽  
Vol 1 (3) ◽  
pp. 222-226 ◽  
Author(s):  
Sumaporn Makkun ◽  
Jenjeera Prueksadee ◽  
Jatuporn Chayakulkheeree ◽  
Darunee Boonjunwetwat
Keyword(s):  
Breast Biopsy ◽  
Surgical Excision ◽  
Ultrasound Guided ◽  
Core Needle ◽  
Long Term Follow Up

scholarly journals A Rare Malignant Disease, Dermatofibrosarcoma Protuberans of the Breast: A Retrospective Analysis and Review of Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Yihua Wang ◽  
Yu Wang ◽  
Rui Chen ◽  
Zhenrong Tang ◽  
Shengchun Liu
Keyword(s):  
Retrospective Analysis ◽  
Smooth Muscle Actin ◽  
Clinical Information ◽  
Dermatofibrosarcoma Protuberans ◽  
Surgical Excision ◽  
Low Grade ◽  
Pubmed Database ◽  
Storiform Pattern ◽  
Rare Malignancy

Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade fibroblastic mesenchymal tumor derived from the dermis. The aim of this retrospective analysis was to summarize the clinicopathological data from our cases and published cases to offer more evidence for the recognition of dermatofibrosarcoma protuberans (DFSP). A total of 6 breast DFSP patients who had received treatment in our hospital were retrospectively enrolled, and detailed clinicopathological data were gathered for analysis. The median age was 29.5 years (ranging from 17 to 42 years). Most cases presented a red or brown-red, mobile, well-circumscribed, protruding, breast mass (ranging from 1 to 3 cm). For histopathology, all cases (6/6) showed a storiform pattern of spindle cells that were positive for CD34 (6/6) and Vimentin (5/6) and negative for smooth muscle actin (0/6) and S-100 protein (0/6). The majority of patients (5/6) underwent wide local excision, with 2 cases treated with radiotherapy. With a median follow-up of 36 months, all 6 patients survived without recurrence or metastasis. The PubMed database was used to search for similar cases. Eventually, 36 cases were included in this review, while cases without detailed clinical information or not reported in English were excluded from the analysis. To summarize, DFSP of the breast is an extremely rare malignancy characterized by spindle tumor cells arranged in a storiform pattern and positivity for CD34. The core needle biopsy is one of the crucial methods for its preoperative diagnosis. Management of DFSP is mainly based on surgical excision. It is prone to local recurrence, so long-term follow-up is required.

scholarly journals Unique Molecular Features in High-Risk Histology Endometrial Cancers

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1665 ◽  
Author(s):  
Pooja Pandita ◽  
Xiyin Wang ◽  
Devin E. Jones ◽  
Kaitlyn Collins ◽  
Shannon M. Hawkins
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Early Stage ◽  
Standard Of Care ◽  
The United States ◽  
Model Systems ◽  
Low Grade ◽  
Cell Of Origin ◽  
Molecular Features ◽  
The Impact

Endometrial cancer is the most common gynecologic malignancy in the United States and the sixth most common cancer in women worldwide. Fortunately, most women who develop endometrial cancer have low-grade early-stage endometrioid carcinomas, and simple hysterectomy is curative. Unfortunately, 15% of women with endometrial cancer will develop high-risk histologic tumors including uterine carcinosarcoma or high-grade endometrioid, clear cell, or serous carcinomas. These high-risk histologic tumors account for more than 50% of deaths from this disease. In this review, we will highlight the biologic differences between low- and high-risk carcinomas with a focus on the cell of origin, early precursor lesions including atrophic and proliferative endometrium, and the potential role of stem cells. We will discuss treatment, including standard of care therapy, hormonal therapy, and precision medicine-based or targeted molecular therapies. We will also discuss the impact and need for model systems. The molecular underpinnings behind this high death to incidence ratio are important to understand and improve outcomes.

Long-term follow-up of women enrolled in a randomized trial of adjuvant chemotherapy for early stage ovarian cancer (ICON1)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5509-5509 ◽  
Author(s):  
A. C. Swart
Keyword(s):  
Ovarian Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Risk Groups ◽  
P Value ◽  
Long Term Follow Up

5509 Background: ICON1 and a meta-analysis of all relevant trials demonstrated an improvement in 5 year recurrence-free and overall survival (RFS and OS) for women with early-stage epithelial ovarian cancer (ES EOC) treated with adjuvant chemotherapy compared to no adjuvant chemotherapy. We aimed to determine if this initial benefit is maintained long-term and whether benefit is different with different risk groups of patients defined by stage, grade and histology. Method: 477 women with ES EOC were recruited from centres in Italy (271 women) UK (195) Switzerland (11) between August 1991 and January 2000. 5-year results were presented at ASCO 2001. Systematic long-term follow up was planned and completed in May 2006. Results: With a median follow-up of 9.2 years, 168 women have developed recurrent disease or died and 144 women have died. The Hazard Ratio (HR) for RFS of 0.70 in favour of adjuvant chemotherapy (95% CI 0.52–0.95 p= 0.023) translated into an improvement of 10-year absolute RFS of 10% from 57 to 67%. For OS, HR was 0.74 (95% CI 0.53–1.02 p= 0.066), a corresponding improvement in 10-year absolute OS of 8% from 64% to 72%. 26% of patients died from causes other than ovarian cancer. Stage I patients were grouped as low (Ia, grade 1), medium (Ia grade 2, Ib or Ic grade 1) and high risk (Ia, grade 3, Ib or IC grade 2 or 3, any clear cell). The test of interaction between risk groups and adjuvant treatment for RFS and OS was 0.055 and 0.13, respectively. The HR, 95%CI and p value are summarised in the table . Conclusions The long-term benefit of adjuvant treatment on RFS is confirmed. There is clear evidence that adjuvant chemotherapy reduces the risk of recurrence/death or death alone in high-risk patients but not in the low-risk group. [Table: see text] [Table: see text]

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