Mucocele-like Lesion of the Breast Diagnosed on Core Biopsy: Histologic and Clinical Analysis of 78 Cases With Focus on Features Associated With Upgrade

Context.— Mucocele-like lesion of the breast (MLL) is an uncommon entity, and recent studies show low rates of upgrade from core needle biopsy (CNB) to excision. Objective.— To evaluate features associated with upgrade of MLLs diagnosed on CNB. Design.— Seventy-eight MLLs diagnosed on CNB from 1998–2019 and subsequent excisions were reviewed. Histologic parameters evaluated included the presence of atypia, presence and morphology of calcifications, and morphologic variant (classic [C-MLL], duct ectasia–like [DEL-MLL], or cystic mastopathy–like [CML-MLL]). Results.— Overall, 45 MLLs lacked atypia and 33 were associated with atypia (atypical ductal hyperplasia, 32; atypical lobular hyperplasia, 1). Most were C-MLLs (61) with fewer DEL-MLLs (14) and CML-MLLs (3). Half showed both coarse and fine calcifications, with fewer showing only coarse or fine calcifications, and some showing none. Subsequent excision or clinical follow-up was available for 25 MLLs without atypia—of which 2 (8.0%) were upgraded to ductal carcinoma in situ (DCIS)—and 23 with atypia, of which 4 (17.4%) were upgraded to DCIS. No cases were upgraded to invasive carcinoma. All upgraded cases showed coarse calcifications on CNB, and all upgraded cases were associated with residual calcifications on post-CNB imaging. Conclusions.— Most MLLs present as calcifications and nearly half are associated with atypia. Upgrade to DCIS is twice as frequent in MLLs with atypia versus those without. A predominance of coarse calcifications and the presence of residual targeted calcifications following core biopsy may be associated with higher upgrade rates.

SURGICAL REMOVAL OF COMPLEX FIBROADENOMAS AND THE INCIDENCE OF UPGRADE, RETROSPECTIVE ANALYSIS IN A CANCER CENTRE.

Breast cancer (BC) is the foremost cause of mortality associated to female cancer among the world. Fibroadenomas are one of the most common benign breast diseases, Radiologically, broadenomas appear as a slightly homogenous, lobulated, isoechoic or hypoechoic solid mass. The objective of the study is to present the broadenoma characteristics observed at Mediclinic city hospital, Dubai, UAE. Therefore, we conducted a retrospective observational cross-sectional study to identify the characteristics of broadenoma with total of 116 patients from 2014 to 2019. All 116 cases were females, and diagnosed with broadenoma between the ages of 15 to 60 with a Bi-RADS score of 3 to 5. Patients were followed up till 6 months. 28 (20.74 %) of the broadenomas were stable sized, size growth observed in 2 (1.48 %), size growth stabilised after 6 months in 2 (1.48 %), 74 (54.81 %) broadenomas were surgically excised. Our study reported Complex broadenoma and Complex broadenoma patients with complex features like atypical hyperplasia, Atypical lobular hyperplasia enhances the risk of causing breast cancer. Additionally, study has demonstrated that, surgical removal of complex broadenomas and broadenomas with complex features is the best way to reduce the risk of carcinoma

Triaging Atypical Lobular Hyperplasia and Lobular Carcinoma In Situ on Percutaneous Core Biopsy to Surgery or Observation: Assiduous Radiologic-Pathologic Correlation Works, Quantitating Extent of Disease Does Not

Context.— The management of lobular neoplasia (LN) found on core biopsy is controversial and ranges from obligatory surgical excision to clinical/imaging observation. Objective.— To determine if in cases of core needle biopsy yielding LN, quantification of normal and diseased terminal ductal lobular units (TDLUs) can predict which cases require surgical excision and which can be safely followed. A secondary goal is to assess whether the concordance or discordance of core biopsy results, determined by rigorous radiologic-pathologic correlation, can predict for upgrade to malignancy at excision. Design.— In this retrospective study, 79 specimens from 78 women who underwent image-guided core needle biopsies between 2005 and 2012 yielding LN were evaluated for total number of TDLUs and total number and percentage of TDLUs involved by LN. Additionally, radiologic-pathologic correlation was performed to assess concordance or discordance. All were correlated with the results of surgical excisional biopsy or imaging/clinical follow-up. Results.— There were 5 upgrades to malignancy. There was no association between upgrade to malignancy and any of the 3 TDLU variables evaluated, including total TDLUs in the specimen (P = .42), total abnormal TDLUs (P = .56), and percent of TDLUs that are abnormal (P = .07). Kendall rank correlation demonstrated a correlation between discordance and upgrade to cancer at surgery that was statistically significant (τb = −0.394, P < .001). Conclusions.— Quantifying total TDLU and those involved by LN on core biopsy will not aid in triaging patients to surgery or observation. Assiduous radiologic-pathologic correlation to determine lesion concordance/discordance can predict those patients who would benefit from surgical excision.

Isolated Atypical Lobular Hyperplasia Diagnosed on Breast Biopsy: Low Upgrade Rate on Subsequent Excision With Long-Term Follow-up

Context.— The upgrade rate to carcinoma on excision for atypical lobular hyperplasia diagnosed on breast biopsy is controversial. Objective.— To review cases with isolated atypical lobular hyperplasia on biopsy to establish the rate of upgrade on excision and correlate with long-term follow-up. Design.— A database search was performed for 191 months to identify breast core biopsies with isolated atypical lobular hyperplasia. Cases with other atypical lesions in the biopsy or discordant radiologic-pathologic findings were excluded. Invasive carcinoma and ductal carcinoma in situ were considered upgraded pathology on excision. Patients without and with a history of, or concurrent diagnosis of, breast carcinoma were compared. Results.— Eighty-seven cases of isolated atypical lobular hyperplasia on biopsy underwent subsequent excision, which resulted in 3 upgraded cases (3.4%). All 3 cases with immediate upgrades revealed ductal carcinoma in situ. Upgrade was higher in patients with a concurrent diagnosis of breast carcinoma (2 of 26 and 1 of 61; 7.7% versus 1.6%, respectively). Follow-up information was available for 63 patients (57.8 ± 43.9 months; range, 6–183 months). Overall, 13% of patients without a history of breast carcinoma had a future breast cancer event, with the majority (83%) presenting in the contralateral breast. Conclusions.— With careful radiologic-pathologic correlation, the upgrade rate for isolated atypical lobular hyperplasia on biopsy is low, and a more conservative approach may be appropriate.