scholarly journals Atypical Ductal Lesions of the Breast: Criteria, Significance, and Laboratory Updates

2018 ◽  
Vol 142 (10) ◽  
pp. 1182-1185 ◽  
Author(s):  
Ellen G. East ◽  
Cody S. Carter ◽  
Celina G. Kleer
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Significance ◽  
Atypical Ductal Hyperplasia ◽  
Data Sources ◽  
Molecular Signature ◽  
Breast Lesions ◽  
Architectural Features ◽  
Increased Risk ◽  
Ductal Hyperplasia ◽  
Benign Breast Lesions

Context.— Atypical ductal hyperplasia (ADH) is a challenging diagnosis defined by cytologic and architectural features that carries an increased risk of subsequent carcinoma when diagnosed in isolation. In addition, ADH may secondarily involve benign breast lesions, wherein it carries variable clinical significance. Objectives.— To review the diagnostic criteria and clinical significance of ADH in isolation and as it involves benign breast lesions, and to review the evolving literature on its molecular signature. Data Sources.— Recently published studies that collectively examine ADH were reviewed. Conclusions.— Atypical ductal hyperplasia carries an increased risk of subsequent carcinoma in isolation and when it involves most benign breast lesions. Identifying which cases of ADH will be upgraded to carcinoma has been challenging, and new laboratory developments, such as EZH2 overexpression, may have a future role.

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 Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy.

1995 ◽  
Vol 164 (5) ◽  
pp. 1111-1113 ◽  
Author(s):  
L Liberman ◽  
M A Cohen ◽  
D D Dershaw ◽  
A F Abramson ◽  
L E Hann ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Atypical Ductal Hyperplasia ◽  
Breast Lesions ◽  
Surgical Biopsy ◽  
Ductal Hyperplasia

High-Risk Benign Breast Lesions: Current Strategies in Management

2007 ◽  
Vol 14 (4) ◽  
pp. 321-329 ◽  
Author(s):  
John V. Kiluk ◽  
Geza Acs ◽  
Susan J. Hoover
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Chemoprevention ◽  
Breast Lesions ◽  
Management Guidelines ◽  
Increased Risk ◽  
Breast Cancer Chemoprevention ◽  
Benign Breast Lesions ◽  
Screening And Prevention ◽  
High Risk Breast

Background High-risk benign breast lesions can create confusion for both the patient and the clinician. This paper reviews the characteristics of these lesions to help direct appropriate management. Methods The authors reviewed the literature regarding high-risk breast lesions and include management guidelines that we employ at our institute. Results High-risk breast lesions offer varying degrees of increased risk for the future development of breast cancer. Chemoprevention may be used to help decrease the risks from some lesions. Conclusions The management of high-risk benign breast lesions can be confusing. Clinicians should assess the risk of future breast cancer and develop a proper screening and prevention strategy for each individual patient.

201Tl Scintigraphy in the Evaluation of Palpable and Nonpalpable Breast Lesions: Correlation with Mammography and Ultrasonography

1997 ◽  
Vol 36 (08) ◽  
pp. 282-288 ◽  
Author(s):  
T. Atasever ◽  
A. Özdemir ◽  
I. Öznur ◽  
N. I. Karabacak ◽  
N. Gökçora ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
Lower Sensitivity ◽  
Breast Lesions ◽  
Breast Cancers ◽  
Combined Use ◽  
Malignant Breast ◽  
Malignant Lesions ◽  
Benign Breast Lesions ◽  
Palpable Breast ◽  
Metastatic Sites

Summary Aim: Our goal was to determine the clinical usefulness of TI-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. Methods: TI-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of TI-201. Visual and semiquantitative interpretation was performed. Results: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. TI-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by TI-201 scintigraphy. The smallest mass lesion detected by TI-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. TI-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed TI-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated TI-201. TI-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by TI-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 ± 0.38 (mean ± SD) and 1.48 ± 0.32 (p >0.05), 1.87 ± 0.65 and 1.34 ± 0.20 (p<0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). Conclusion: Overall, TI-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of TI-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

The Effects of Smoking Cessation on Diabetes Mellitus Patients

2020 ◽  
Vol 16 (2) ◽  
pp. 137-142
Author(s):  
Ali Alshahrani
Keyword(s):  
Smoking Cessation ◽  
The Other ◽  
Data Sources ◽  
Controlled Trials ◽  
Effective Management ◽  
Tailored Intervention ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Diabetes Progression

Background: Smoking is an established predictor of type 2 diabetes. However, the link between smoking cessation and diabetes progression remains a subject of scholarly investigation. Objective: The objective of this systematic review is to establish the link between smoking cessation and diabetes. Data Sources: The study utilized conference abstracts and peer-reviewed journals that reported randomized controlled trials smoking cessation interventions for diabetes patients. Results: Results from the review were inconclusive on the link between smoking cessation and diabetes. On one hand, several researchers have confirmed a positive correlation between smoking cessation and decreased risk of diabetes. On the other hand, some researchers have demonstrated that immediate withdrawal of nicotine resulted in increased risk of diabetes; however, this risk reduces with time. Conclusion: The result of this review did not estblish a clear relationship between smoking cessation and diabates. Limitations: Compared to other studies examining the implication of smoking on chronic diseases, this study identified a very small number of trials evaluating the effect of smoking cessation on diabetes. The small number of studies implies that the results may not be suitable for generalization. Implication: Results from the review can help in the development of a tailored intervention for effective management of diabetes in smoking patients.

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