Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

Nicosia, Luca; Latronico, Antuono; Addante, Francesca; Santis, Rossella De; Bozzini, Anna Carla; Montesano, Marta; Frassoni, Samuele; Bagnardi, Vincenzo; Mazzarol, Giovanni; Pala, Oriana; Lazzeroni, Matteo; Lissidini, Germana; Mastropasqua, Mauro G.; Cassano, Enrico

doi:10.3390/diagnostics11061120

Cited by 15 publications

(17 citation statements)

References 41 publications

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“…In our study, we propose a predictive model in order to minimize the risk of diagnostic underestimation in a smaller group of patients. Nomograms are predictive tools that allow, considering the multiples features, an assessment of the risk of underestimation [ 27 ]. With our nomogram, you are able to evaluate if a patient has a predicted probability of diagnostic underestimation below 2%.…”

Section: Discussionmentioning

confidence: 99%

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

Nicosia

Bozzini

Penco

et al. 2022

Cancers

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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: A total of 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 and multivariate analysis. Finally, we developed a nomogram for predicting the upstage at surgery, according to the multivariate logistic regression model. Results: The overall upgrade rate to invasive carcinoma was 10.8%. At univariate analysis, the risk of upgrade was significantly lower in patients with greater age (p = 0.018), without post-biopsy residual lesion (p < 0.001), with a smaller post-biopsy residual lesion size (p < 0.001), and in the presence of low-grade DCIS only in specimens with microcalcifications (p = 0.002). According to the final multivariable model, the predicted probability of upstage at surgery was lower than 2% in 58 patients; among these 58 patients, only one (1.7%) upstage was observed, showing a good calibration of the model. Conclusions: An easy-to-use nomogram for predicting the upstage at surgery based on radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

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Section: Discussionmentioning

confidence: 99%

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

Nicosia

Bozzini

Penco

et al. 2022

Cancers

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“…Als Grund wird angeführt, dass in der Regel an der Nadelbiopsie die endgültige Ausdehnung der atypischen intraduktalen Epithelproliferation nicht festgelegt werden kann und somit keine sichere Grenzziehung zwischen ADH und low-grade duktalem Carcinoma in situ (DCIS) möglich ist [ 4 , 16 , 47 , 55 ]. Zahlreiche Studien haben versucht morphologische Kriterien an den präoperativen Biopsien zu identifizieren, die voraussagen können, welche ADH-Fälle im nachfolgenden chirurgischen Präparat höhergradige Läsionen (wie DCIS, invasives Karzinom) oder andere B3-Läsionen wie klassische lobuläre Neoplasie (LN) oder flache epitheliale Atypie (FEA) enthalten [ 34 , 38 , 41 ]. Diese Kriterien (unter anderem die Assoziation zu Verkalkungen, die Zahl der betroffenen Gangstrukturen oder der Nachweis von assoziierten intraläsionalen Nekrosen) können zwar in Einzelfällen prädiktiv sein, eine signifikante Assoziation zwischen diesen Faktoren an der Stanzbiopsie und den Diagnosen im Operationspräparat konnte aber bisher nicht etabliert werden [ 34 , 38 , 41 ].…”

Section: Atypische Duktale Hyperplasieunclassified

“…Zahlreiche Studien haben versucht morphologische Kriterien an den präoperativen Biopsien zu identifizieren, die voraussagen können, welche ADH-Fälle im nachfolgenden chirurgischen Präparat höhergradige Läsionen (wie DCIS, invasives Karzinom) oder andere B3-Läsionen wie klassische lobuläre Neoplasie (LN) oder flache epitheliale Atypie (FEA) enthalten [ 34 , 38 , 41 ]. Diese Kriterien (unter anderem die Assoziation zu Verkalkungen, die Zahl der betroffenen Gangstrukturen oder der Nachweis von assoziierten intraläsionalen Nekrosen) können zwar in Einzelfällen prädiktiv sein, eine signifikante Assoziation zwischen diesen Faktoren an der Stanzbiopsie und den Diagnosen im Operationspräparat konnte aber bisher nicht etabliert werden [ 34 , 38 , 41 ]. Es gibt keine radiologischen Merkmale, die helfen, mit ADH assoziierte Verkalkungen von denen anderer Läsionen zu unterscheiden, wie z.…”

Section: Atypische Duktale Hyperplasieunclassified

“…In Zusammenschau der Literaturdaten der letzten Jahre ist das Unterschätzungsrisiko bei einer ADH immer noch hoch und je nach Studie liegt die Upgraderate bei 10–50 % im nachfolgenden Exzisat [ 3 , 11 , 15 , 17 , 29 , 35 , 37 , 41 , 52 ]. Risikofaktoren sind dabei die fehlende Korrelation zwischen bildgebendem Befund und Pathologie, grössere/ausgedehntere bildgebende Befunde oder Herdbefunde und die Art der Biopsie (Diagnose der ADH an Stanz- oder Vakuumbiopsie) [ 4 , 34 , 38 , 41 ].…”

Section: Atypische Duktale Hyperplasieunclassified

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B3-Läsionen der Mamma: Histologische, klinische und epidemiologische Aspekte

2023

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ZusammenfassungB3-Läsionen der Mamma stellen eine heterogene Gruppe von Läsionen mit unsicherem Malignitätspotenzial dar, welche histologisch klar definierte Diagnosen beinhalten und welche in diagnostischem und therapeutischem Kontext unterschiedlich gewichtet und behandelt werden. Vor allem die Entscheidung über die Schritte nach der Diagnose einer B3-Läsion an Stanzbiopsie oder Vakuumbiopsie können eine Herausforderung darstellen. B3-Läsionen werden oft wegen bildgebenden Kalzifikationen oder Herdbefunden entdeckt und biopsiert. Histologisch können die Veränderungen einer Reihe von häufigen Diagnosen (wie die atypische duktale Hyperplasie, die klassische lobuläre Neoplasie, flache Epithelatypien, intraduktale Papillome, radiäre Narben oder fibroepitheliale Tumoren vom Typ eines Phylloidestumors) oder seltenen Diagnosen (wie Mukozelen-ähnliche Läsion, atypische apokrine Läsionen und seltene stromale Proliferate) zugeordnet werden. Immunhistochemie ist hilfreich in der Differenzierung und einer korrekten nomenklatorischen Zuordnung dieser Läsionen (vor allem Östrogenrezeptoren, basale Zytokeratine, Myoepithelmarker oder stromale Markerpanel). Im klinischen Kontext bleibt die Korrelation der bildgebenden und histologischen Befunde der wichtigste Faktor in der Entscheidung der nächsten diagnostischen/therapeutischen Schritte.

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“…Recent studies have demonstrated that VAB is a reliable and effective alternative to OE of B3 lesions without atypia, such as papillomas and radial scars (RSs) [6,[12][13][14][15][16][17]. This has led to an increasing use of VAB and subsequent observation in nonsurgically managed B3 lesions in some countries [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Follow-Up of High-Risk Breast Lesions at Vacuum-Assisted Biopsy without Subsequent Surgical Resection

Elfgen,

Varga,

Breitling

et al. 2023

Breast Care

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Introduction: B3-lesions of the breast are a heterogeneous group of neoplasms, associated with a higher risk of breast cancer. Recent studies show a low upgrade rate into malignancy after subsequent open surgical excision (OE) of most B3-lesions when proven by vacuum-assisted biopsy (VAB). However, there is a lack of long-term follow-up data after VAB of high-risk lesions. The primary aim of this study was to demonstrate whether follow-up of B3 lesions is a beneficial and reliable alternative to OE in terms of long-term outcome. The secondary aim was to identify patient and lesion characteristics of B3 lesions for which OE is still necessary. Methods: This retrospective multicenter study was conducted at 8 Swiss breast centers between 2010 and 2019. A total of 278 women (mean age: 53.5 ± 10.7 years) with 286 B3-lesions who had observation only and who had at least 24 months of follow-up were included. Any event during follow-up (ductal carcinoma in situ [DCIS], invasive cancer, new B3-lesion) was systematically recorded. Data from women who had an event during follow-up were compared with those who did not. The results for the different B3 lesions were analyzed using the t test and Fisher’s exact test. A p value of <0.05 was considered statistically significant. Results: The median follow-up interval was 59 months (range: 24–143 months) with 52% (148/286) having a follow-up of more than 5 years. During follow-up, in 42 women, 44 suspicious lesions occurred, with 36.4% (16/44) being invasive cancer and 6.8% (3/44) being DCIS. Thus, 6.6% (19/286) of all women developed malignancy during follow-up after a median follow-up interval of 6.5 years (range: 31–119 months). The initial histology of the B3 lesion influenced the subsequent occurrence of a malignant lesion during follow-up (p < 0.038). The highest malignancy-developing rate was observed in atypical ductal hyperplasia (ADH) (24%, 19/79), while all other B3-lesions had malignant findings ipsi- and contralateral between 0% and 6%. The results were not influenced by the VAB method (Mx-, US-, magnetic resonance imaging-guided), the radiological characteristics of the lesion, or the age or menopausal status of the patient (p > 0.12). Conclusion: With a low risk of <6% of developing malignancy, VAB followed by long-term follow-up is a safe alternative to OE for most B3-lesions. A higher malignancy rate only occurred in ADH (24%). Based on our results, radiological follow-up should be bilateral, preferable using the technique of initial diagnosis. As we observed a late peak (6–7 years) of breast malignancies after B3-lesions, follow-up should be continued for a longer period (>10 years). Knowledge of these long-term outcome results will be helpful in making treatment decisions and determining the optimal radiological follow-up interval.

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Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

Cited by 15 publications

References 41 publications

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

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

B3-Läsionen der Mamma: Histologische, klinische und epidemiologische Aspekte

Long-Term Follow-Up of High-Risk Breast Lesions at Vacuum-Assisted Biopsy without Subsequent Surgical Resection

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