Incidental Findings in Reduction Mammoplasty Specimens in Patients with No Prior History of Breast Cancer. An Analysis of 783 Specimens

Abstract

Breast reduction surgery is a common procedure and the rate of incidental findings in the removed specimens varies between 0% and 4.6%. There are no guidelines about pathological evaluation of breast reduction surgery. We reviewed all pathology reports of patients undergoing breast reduction surgery in a single tertiary institution in Brazil from January 2008 to August 2014. Exclusion criteria were a personal history of breast cancer, unclear reason for mastectomy and incomplete data on the pathology report. We considered "relevant findings" flat epithelial atypia, atypical hyperplasia, carcinomas in situ and invasive carcinoma. Of 1672 specimens from breast reduction surgery, 783 met inclusion criteria. Median patient age was 40 (8-77), 91% underwent bilateral mastectomy and 57% of the specimens weighted less than 200 g. In 55% of cases, 4 or more paraffin blocks were sampled. There were 40 (5.1%) relevant findings and the most common was atypical lobular hyperplasia (16-2%). There were 3 invasive carcinomas (0.38%). In multivariate analysis, the only variables associated with a higher odds of relevant pathological findings were patient age ≥ 40 (OR 4.73 CI95% 1.98-11.3 p < 0.001) and sampling of ≥4 paraffin blocks from each specimen (OR 6.69 95% CI 2.25-19.9 p < 0.001). The incidence of pre-malignant and malignant lesions in specimens from breast reduction surgery is around 5%, but this risk is significantly higher for patients older than 40 years-old. Sampling at least 4 paraffin blocks from each specimen significantly increases detection rates.

The rate of incidental atypical and malignant breast lesions in reduction mammoplasty specimens

“…The cancer rate in patients with no history of breast cancer in previous studies ranged from 0 to 1% 12–26 . Similar to those studies, the cancer rate in our study was 0.36%.…”

“…In our study, the rate of AMBL in patients with no history of breast cancer was 3.3%. The previous studies that included only patients with no history of breast cancer reported the rate of AMBL to be between 1.5 and 14% 5,7–26 . The wide range of reported rates of AMBL in different studies can be attributed to different pathological assessment methods of RM specimens between institutions.…”

“…and Desouki et al . reported a significantly higher AMBL rate as a result of the increased number of submitted tissue blocks 17,22 . However, they did not mention whether each block had the same number of tissue sections, preventing an accurate assessment of the results.…”

“…In this context, previous studies that analysed RM specimens showed a higher rate of incidental breast cancer in patients with a history of breast cancer compared to patients with no history of breast cancer 5–11 . The rate of incidental atypical and malignant breast lesions (AMBL) in patients with no history of breast cancer ranged from 1.5 to 14% 5,7–26 . One of the most common findings in all these studies was the older age of patients with AMBL compared to patients with no AMBL.…”

Significant Family History of Breast Cancer may Further Increase Risk of Pre-malignant and Malignant Lesions in Specimens from Breast Reduction Surgery

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Dear Editor, I wish to congratulate Usón Junior and colleagues for their article [1] in which they reviewed all pathology reports of 783 patients undergoing breast reduction surgery. Exclusion criteria were a personal history of breast cancer, unclear reason for mastectomy and incomplete data on the pathology report.

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