All pure flat atypical atypia lesions of the breast diagnosed using percutaneous vacuum-assisted breast biopsy do not need surgical excision

Ouldamer, Lobna; Poisson, E.; Arbion, Flavie; Bonneau, Carole; Vildé, A.; Body, G.; Michenet, Patrick

doi:10.1016/j.breast.2018.03.012

Cited by 16 publications

(5 citation statements)

References 36 publications

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“…15 Considerable variation in the upgrading of flat epithelial atypia, atypical ductal hyperplasia, LCIS/atypical lobular hyperplasia and radial scar to malignancy has been reported (flat epithelial atypia: 0-15%, atypical ductal hyperplasia: 22%-32%, LCIS/atypical lobular hyperplasia: 2%-29%, radial scar: 0%-23%), resulting in mixed recommendations that range from radiologic surveillance to diagnostic surgical excision of every high-risk lesion. [16][17][18][19][20][21][22][23][24][25][26] In our series, 29% of excised high-risk lesions proved to be malignant; 20.7% DCIS and 8.3% invasive breast cancer, respectively. Other studies report a somewhat lower likelihood of upgrading to malignancy of 20%-22%.…”

Section: Discussionmentioning

confidence: 46%

“…Several studies advocate radiologic imaging follow‐up for nonatypical papillomas as the malignancy rate of these lesions may be less than 2.5%, whereas others have found that up to 33% of these lesions may prove malignant and therefore recommend complete surgical excision . Considerable variation in the upgrading of flat epithelial atypia, atypical ductal hyperplasia, LCIS/atypical lobular hyperplasia and radial scar to malignancy has been reported (flat epithelial atypia: 0–15%, atypical ductal hyperplasia: 22%–32%, LCIS/atypical lobular hyperplasia: 2%–29%, radial scar: 0%–23%), resulting in mixed recommendations that range from radiologic surveillance to diagnostic surgical excision of every high‐risk lesion . In our series, 29% of excised high‐risk lesions proved to be malignant; 20.7% DCIS and 8.3% invasive breast cancer, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Luiten

Korte

Voogd

et al. 2019

Intl Journal of Cancer

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Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high‐risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6‐year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high‐risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high‐risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high‐risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high‐risk lesions at CNB tripled in a 6‐year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Luiten

Korte

Voogd

et al. 2019

Intl Journal of Cancer

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“…Indeed, calcifications spanning more than 10 mm were found to be significantly associated with malignancy in one series. 21 However, in our data set, the carcinomas themselves did not contain calcifications and were present on tissue sections not containing the CNB site. Our findings suggest that when the biopsy target is a lesion that is >10-15 mm and is not entirely removed at CNB, surgical excision may be considered.…”

Section: Discussionmentioning

confidence: 63%

Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance

Grabenstetter¹,

Brennan²,

Salagean³

et al. 2019

American Journal of Surgical Pathology

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Flat epithelial atypia (FEA) is an alteration of terminal duct-lobular units by a proliferation of ductal epithelium with low grade atypia. No consensus exists on whether the diagnosis of FEA in core needle biopsy (CNB) requires excision (EXC). We retrospectively identified all in-house CNBs obtained between 1/2012-7/2018 with FEA. We reviewed all CNB slides and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma (IC) and/or ductal carcinoma in situ in the EXC. The EXC slides of all upgraded cases were re-reviewed. Out of ~15,700 consecutive CNBs in the study period, 106 CNBs from 106 patients yielded FEA alone or with classic lobular neoplasia (LN). We excluded 52 CNBs (40 patients with prior/concurrent carcinoma and 12 without EXC). After re-review, we reclassified 14 cases (2 marked nuclear atypia, 10 focal ADH, 2 benign). The final FEA study cohort consisted of 40 CNBs from 40 women. The CNB targeted mammographic calcifications in 36 (90%) cases, MRI non-mass enhancement in 3 (8%), and 1 (2%) sonographic mass. All CNBs were deemed radiologicpathologic concordant. FEA was present alone in 34 CNBs and with LN in 6. EXC yielded 2 low grade IC, each spanning less than 2 mm, identified in tissue sections without biopsy site changes. The remaining 38 cases had no upgrade. Classic LN did not affect the upgrade. The upgrade rate of FEA was 5%; both minute, low-grade "incidental" IC. We conclude that non-surgical management may be considered in patients without prior/concurrent carcinoma and radiologicpathologic concordant CNB diagnosis of FEA.

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“…Multiple studies have shown that there would be no benefit of follow-up within a year after benign ultrasonic, radiographic and MRI-guided breast biopsies [10,16,17,19,20,28]. Present analysis is focused solely on VASB breast calcifications.…”

Section: Discussionmentioning

confidence: 99%

Ten years follow-up of histologically benign calcifications in the breast after vacuum-assisted stereotactic biopsy (VASB): Is additional mammographic follow-up warranted?

Bekkum

Dams

Westenend³

et al. 2021

The Breast

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Objective: This study assessed the short-term and the long-term breast cancer rate in patients with benign histopathologic results after a vacuum-assisted stereotactic biopsy (VASB) for calcifications. Methods: In a retrospective cohort study, all consecutive patients who had a benign diagnosis after VASB to analyze breast calcifications. Data of breast cancer development at short-term (four years) and longterm follow-up was gathered. Breast cancer rates in our cohort were compared to the breast cancer incidence in the general population. Results: Of 1376 patients who underwent VASB to analyze breast calcifications, 823 had a benign histopathologic diagnosis. During short-term follow-up, eight patients developed breast cancer. During the mean long-term follow-up period of 9.3 ± 3.1 years, 22 patients were diagnosed with ipsilateral breast cancer. The incidence rate of breast cancer after benign biopsy was comparable to the rate in the general population. Conclusion:In patients with VASB-confirmed benign calcifications of the breast, we found no excess incidence of ipsilateral breast cancer during ten years follow-up. Therefore, in patients with an increased risk of breast cancer (due to a history of breast cancer or familial risk) annual mammography should be sufficient. Patients with a population-based risk may be monitored via biennial mammography by the national screening program. More frequent screening would provide no benefit.

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All pure flat atypical atypia lesions of the breast diagnosed using percutaneous vacuum-assisted breast biopsy do not need surgical excision

Cited by 16 publications

References 36 publications

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Flat Epithelial Atypia in Breast Core Needle Biopsies With Radiologic-Pathologic Concordance

Ten years follow-up of histologically benign calcifications in the breast after vacuum-assisted stereotactic biopsy (VASB): Is additional mammographic follow-up warranted?

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