Surgical outcomes of borderline breast lesions detected by needle biopsy in a breast screening program

Abstract

BackgroundThe Australian Capital Territory and South East New South Wales branch of BreastScreen Australia (BreastScreen ACT&SENSW) performs over 20,000 screening mammograms annually. This study describes the outcome of surgical biopsies of the breast performed as a result of a borderline lesion being identified after screening mammography and subsequent workup.A secondary aim was to identify any parameters, such as a family history of breast cancer, or radiological findings that may indicate which borderline lesions are likely to be upgraded to malignancy after surgery.MethodsFrom a period of just over eight years, all patients of BreastScreen ACT&SENSW who were diagnosed with a borderline breast lesion were identified. These women had undergone needle biopsy in Breastscreen ACT&SENSW and either atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), atypical lobular hyperplasia (ALH), radial scar/complex sclerosing lesion, papillary lesion, mucocoele-like lesion (MLL) or lobular carcinoma in situ (LCIS) was found. Final outcomes for each type of borderline lesion after referral for surgical biopsy were recorded and analysed. Results of the surgical biopsy were compared to the type of needle biopsy and its result, radiological findings and family history status.ResultsOf the 94 surgical biopsies performed due to the presence of a borderline breast lesion, 20% showed benign pathology, 55% remained as borderline lesions, 17% showed non-invasive malignancy and 7% showed invasive malignancy. VALCS biopsy was the most common needle biopsy method used to identify the lesions in this study (76%). Malignant outcomes resulted from 24% of the surgical biopsies, with the most common malignant lesion being non-comedo ductal carcinoma in situ (DCIS). The most common borderline lesion for which women underwent surgical biopsy was ADH (38%). Of these women, 22% were confirmed as ADH on surgical biopsy and 47% with a malignancy.ConclusionsFurther research is required to determine whether characteristics of the mammographic lesion (particularly calcification patterns), the area targeted for biopsy and number of core samples retrieved, can indicate a closer correlation with eventual pathology. This study identified no findings in the diagnostic assessment that could exclude women with borderline lesions from surgical biopsy.

Outcome of pure mucocele‐like lesions diagnosed on breast core biopsy

“…Subsequent studies showed that MLL could be associated with atypical ductal hyperplasia (ADH), DCIS or mucinous carcinoma . The frequency of malignancy after a diagnosis of MLL without atypia on core biopsy reported in the literature shows a wide range, due mainly to the small number of patients, with only one series having more than 10 patients …”

“…[2][3][4][5][6][7][8][9][10][11] The frequency of malignancy after a diagnosis of MLL without atypia on core biopsy reported in the literature shows a wide range, due mainly to the small number of patients, with only one series having more than 10 patients. [9][10][11][12][13][14][15][16][17] Although the UK national guidelines recommend categorizing MLL diagnosed on core biopsy of the breast as lesions of uncertain malignant potential (B3), 18,19 the outcome of pure MLL and its positive predictive value for malignancy remains uncertain. In the current study, we aimed to assess the outcome of a large series of pure MLL diagnosed on core biopsy and to review the literature, to provide evidence that can guide further management.…”

Lobular carcinoma in situ of the breast – correlation between minimally invasive biopsy and final pathology

“…Scoggins and colleagues found that 90% of lesions yielding LCIS had mammographic abnormalities, most frequently (80%) grouped amorphous calcifications [17]. Other investigators reported similar association between LCIS and the presence of microcalcifications, which were observed in 75–82% of cases [10, 11, 18]. …”

Brustbildgebung / Mammografie – Bildgebung und Vorgehen bei präinvasiven Läsionen der Mamma

“…Wegen des resultierenden Risikos eines synchronen Malignoms wird deshalb die FEA in der MIB der pathologischen Kategorie B3 (malignes unklares Potenzial) zugeordnet. Die limitierten Daten zeigen zwar in etwa einem Drittel der folgenden Exzision eine zusätzliche Läsion des Low-Grade-Pathways [18,19,25]. Die Interpretation dieser Studien ist allerdings eingeschränkt, da eine individuelle radiologisch-pathologische Korrelation oft nicht gegeben war und damit die Indikationen zur offenen Biopsie uneinheitlich waren.…”