Breast cancer risk associated with atypical hyperplasia and lobular carcinoma in situ initially diagnosed on core‐needle biopsy

Donaldson, Alana R.; McCarthy, Caitlin; Goraya, Shazia Tanvir; Pederson, Holly J.; Sturgis, Charles D.; Grobmyer, Stephen R.; Calhoun, Benjamin C.

doi:10.1002/cncr.31061

Cited by 34 publications

(19 citation statements)

References 39 publications

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“…Carcinoma of the breast can arise from either the lobular or the ductal epithelium. Lobular carcinomas are less prevalent than ductal, accounting for 4–10% of diagnoses from breast biopsies [1]. Before BCa reaches the invasive stage at which point it can spread to the rest of the body, it is referred to as a pre-invasive lesion (Figure 1).…”

Section: Lesions Of the Breastmentioning

confidence: 99%

The Immune Microenvironment of Breast Cancer Progression

Tower

Ruppert

Britt

2019

Cancers

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Inflammation is now recognized as a hallmark of cancer. Genetic changes in the cancer cell are accepted as the match that lights the fire, whilst inflammation is seen as the fuel that feeds the fire. Once inside the tumour, the immune cells secrete cytokines that kick-start angiogenesis to ferry in much-needed oxygen and nutrients that encourage the growth of tumours. There is now irrefutable data demonstrating that the immune contexture of breast tumours can influence growth and metastasis. A higher immune cell count in invasive breast cancer predicts prognosis and response to chemotherapy. We are beginning now to define the specific innate and adaptive immune cells present in breast cancer and their role not just in the progression of invasive disease, but also in the development of pre-invasive lesions and their transition to malignant tumours. This review article focusses on the immune cells present in early stage breast cancer and their relationship with the immunoediting process involved in tumour advancement.

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Section: Lesions Of the Breastmentioning

confidence: 99%

The Immune Microenvironment of Breast Cancer Progression

Tower

Ruppert

Britt

2019

Cancers

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“…Our study showed that 18.36% of intraductal papillomas coexist with malignancy, and 37.33% coexist with ADH, ALH or LCIS. The rate of coexistence with AH or LCIS is obviously higher than the rate previously indicated in Table 2 Evidence supporting the excision of papilloma with AH is certainly incontrovertible [21,22] . The treatment of intraductal papilloma without atypia is controversial and presents the notion, to observe or to excise?…”

Section: Discussionmentioning

confidence: 70%

A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real-world experience.

Mao

Sun

Fan

et al. 2018

JCO

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Background: Breast intraductal papilloma are a heterogeneous group. The aim of this study is to investigate the intraductal breast papilloma and its coexisting lesions retrospectively in real-world practice. Methods: We retrospectively identified 4450 intraductal breast papilloma and its coexisting lesions. Results: 18.36% coexisted with malignant lesions of the breast, 37.33% coexisted with atypia hyperplasia, 25.24% coexisted with benign lesions and only 19.10% coexisted without concomitant lesions. In addition, 36.80% of intraductal breast papilloma had nipple discharge, 51.46% had a palpable breast mass and 16.45% had both nipple discharge and a palpable breast mass. 28.18% experienced discomfort or were asymptomatic. Furthermore, 98.99% had ultrasound abnormalities, 53.06% had intraductal hypoechoic upon ultrasound. 31.89% had mammographic distortion, 14.45% had microcalcification upon mammography. Intraductal breast papilloma with malignancy had significant correlations with clinical manifestations. Conclusion: Coexisting malignancy was also related to ultrasound abnormality (BIRADS 4C and 5), mammographic distortion and microcalcification upon mammography but was not related to the intraductal hypoechoic upon ultrasound. Coexisting atypical hyperplasia correlated with nipple discharge but not palpable mass, mammographic distortion or intraductal hypoechoic upon ultrasound. The coexisting atypia hyperplasia was also related to abnormality upon ultrasound or microcalcification compared with the benign lesions. The intraductal papilloma coexists with malignancy or atypia hyperplasia accounted for more than 50%, the clinical information on papilloma and its coexisting lesions is nonspecific. We recommended surgical treatment for benign intraductal papillary lesions. Impact: The current study provides insight into the real-world pattern of intraductal papillomas and their coexisting lesions in a population of Chinese women.

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“…After an average follow-up of 38 months, we found that 3 in 5 patients presented no lesions, and no enlargement process was found in the other 2 patients' lesions. Donaldson et al [21] found that the 7-year cumulative breast cancer incidence rate was only 10% in patients who had an initial diagnosis of AHP on CNB, so they believed that close imaging follow-up was applicable to these patients. Furthermore, breast papillary carcinoma is rare, representing only 1-2% of all breast malignancies [22].…”

Section: Discussionmentioning

confidence: 99%

Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

Gao

et al. 2020

BMC Surg

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Background The management of papillary lesions of the breast remains controversial, and thus, we assessed the value of vacuum-assisted excision (VAE)-guided ultrasound in the diagnosis and treatment of breast papillary lesions. Methods We retrospectively reviewed the data of 108 patients with papillary lesions diagnosed using VAE between August 2014 and January 2019. Cases without postoperative breast imaging in the follow-up were excluded, and 85 cases were eligible for the study. The follow-up period ranged from 6 to 53 months, with 38 months on average. All the papillary lesions were located away from the skin or nipple with a size less than or equal to 30 mm, and the lesions categorized as C2-4b were completely excised using VAE. All VAEs were performed using an 8-gauge vacuum-assisted biopsy needle under the guidance of ultrasound using a 10 MHz linear probe. Results Most patients with breast papillary lesions were asymptomatic (56.5%), and when the size of the breast papillary lesion was more than 20 mm on ultrasound imaging, atypical hyperplasia may have been concomitant. Breast lesions might have been pathologically diagnosed as papilloma after biopsy when they were categorized as BI-RADS 4a on ultrasound images. The rate of underestimation was 7.7% in papillary lesions diagnosed with VAE, and the recurrence rate of papilloma after VAE was low. Conclusions Breast papilloma was a common lesion on ultrasonographic screening, and VAE was applicable for completely excising small papillomas, even papillomas with atypical hyperplasia, to obtain an accurate diagnosis with a low rate of underestimation and recurrence. We believe that papilloma diagnosed by VAE might not require immediate excision, and imaging follow-up may be safe for at least 3 years.

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Breast cancer risk associated with atypical hyperplasia and lobular carcinoma in situ initially diagnosed on core‐needle biopsy

Cited by 34 publications

References 39 publications

The Immune Microenvironment of Breast Cancer Progression

The Immune Microenvironment of Breast Cancer Progression

A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real-world experience.

Breast papillary lesions diagnosed and treated using ultrasound-guided vacuum-assisted excision

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