Diagnostic challenges in clinical, radiological and histopathological tests regarding papillomatous lesions of the breast

Rasmussen, Birgitte; Balslev, Eva; Christensen, Ib Jarle; Lanng, Charlotte; Bak, Anne; Galatius, Hanne; Talman, Maj-Lis Møller; Someh, Nahid Sharghi; Vejborg, Ilse; Okholm, Mette

doi:10.1016/j.breast.2018.05.006

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…In our study, we detected an increased risk for underestimation in older populations, which is consistent with the reports by Foley et al, Rasmussen et al,and Yu et al [30,32,33]. Therefore, caution is advised when recommending conservative management to that group of patients.…”

Section: Discussionsupporting

confidence: 93%

“…We were not able to identify morphological features of the lesions on imaging which might become statistically significant predictors of benign or malignant nature of the change, which is consistent with the reports of Rasmussen et al [32].…”

Section: Discussionsupporting

confidence: 88%

“…Histopathologic examination of core needle biopsy (CNB) specimens remains the gold standard for the diagnosis of intraductal papillomas. While the diagnosis of IPs at core needle biopsy is always associated with the need for open surgical biopsy [11][12][13], this is not the case for vacuum-assisted core needle biopsy (VAB). The possibility of performing the so-called therapeutic biopsy and including the affected women in the annual ultrasound control program is increasingly recommended [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

et al. 2019

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Objectives: The aims of the study were as follows: 1) to determine the applicability of vacuum-assisted core needle biopsy in the diagnosis and management of intraductal papillomas of the breast; 2) to define factors which increase the risk for underestimation of breast cancer. Material and methods: Between 2002-2017, a total of 222 cases of intraductal papillomas were diagnosed in one center (201 using vacuum-assisted core-needle ultrasound-guided biopsy and 21 using stereotactic biopsy). All patients underwent scheduled follow-up imaging. Results: Pure papillomas were diagnosed in 158 women, whereas papillomas with atypia, in this case atypical ductal hyperplasia (ADH), were found in 29 subjects. In the latter group, 3 cases of invasive carcinoma and 5 cases of ductal carcinoma in situ (DCIS) were detected using open surgical biopsy. Breast cancer underestimation in that group of patients was 20%. Overall, ADH, whose presence increases the risk for BC by thirteen-fold as compared to other accompanying lesions, proved to be the most important predictive factor. Also, age, non-radical biopsy excision, and high BI-RADS ultrasound and mammogram scores increased the probability of malignancy. During the control follow-up, no cases of IP recurrence in the primary localization were observed in the group without open surgical biopsy. Conclusions: Vacuum-assisted core needle biopsy is an efficient tool in the diagnosis and management of intraductal papillomas of the breast. Surgical excision is not indicated in cases when a pure intraductal papilloma, and data correlation between the diagnosis and the clinical presentation were confirmed. Regardless, caution is advised if residual lesions were left and in older populations. Open surgical biopsy should remain the standard of care in cases with atypia and discordance between clinical and pathology data.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

et al. 2019

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“…A previous study indicated that the risk factors for malignant transformation of IDP were older age, larger lesion size and distance from the nipple [8]. A literature review revealed that most IDPs were less than 2 cm, the largest reported IDP was 10.5×6.0×5.0 cm on MRI, and massive size was a predisposing factor for the development of complications [9].…”

Section: Discussionmentioning

confidence: 99%

Massive Breast Intraductal Papilloma Undiagnosed After Several Core Needle Biopsies: A Case Report

JIAPAER¹,

Mengting²,

Xiaofei³

et al. 2021

COS

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Background: Patients with breast Intraductal Papilloma (IDP) and atypical ductal hyperplasia have an increased risk for breast cancer. Core Needle Biopsy (CNB) plays a significant role in inchoate diagnosis of atypical IDP. However, the standard procedure of CNB may be unable to provide definite diagnosis of a complicated large mass. This is the first report of the largest case of peripheral atypical IDP with ductal epithelial atypical hyperplasia and hemorrhage necrosis. The mass grew larger, without a clear diagnosis. Herein, we documented our recommendations for the treatment of a large breast mass. 1.2. Case Summary: A 74-year-old Chinese female had a palpable left breast mass for two years, which was enlarging in the past one month. The patient had periodic breast check-ups in a reputed hospital. However, the ultrasound examination and four CNBs of the breast mass did not provide a clear diagnosis, besides non-lactating mastitis. However the mass was finally diagnosed as an atypical IDP after intraoperative pathology. The patient recovered well after the lumpectomy. Conclusion: When obtaining the sample from cystic tissue during CNB, the needle should take the core of the mass as well as the surrounding wall of the cyst. Clear diagnosis is important for further treatment. Large breast IDP in elderly may develop into breast cancer, so we recommend that lumpectomy is necessary rather than periodic check-ups for these patient.

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“…It is well known that although BI-RADS scoring is an established method to inform the surgeon about high-risk consideration-required breast tumors, the number of discrepant BI-RADS scoring with pathological evaluation is still high. 1,2,5,9 This discrepancy may be due to several parameters, such as nondiagnostic or inadequate sampling in heterogeneous lesions, 2,11 underestimating high-risk or borderline lesions in BI-RADS scoring (such as preneoplastic ductal/ lobular lesions atypical ductal hyperplasia/atypical lobular hyperplasia [ADH 12 /ALH 2 ], papillary lesions of the breast, [39][40][41] flat epithelial atypia (FEA), 13 columnar cell hyperpalsia, 42 phyllodes tumors, 43 complex fibroadenoma, 38 etc. ), 1 or diagnosis with unexperienced radiologists.…”

Section: Discussionmentioning

confidence: 99%

Intraradiological pathology‐calibrated electrical impedance spectroscopy in the evaluation of excision‐required breast lesions

et al. 2022

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Evaluating a real-time complementary bioelectrical diagnostic device based on electrical impedance spectroscopy (EIS) for improving breast imagingreporting and data system (BI-RADS) scoring accuracy, especially in high-risk or borderline breast diseases. The primary purpose is to characterize breast tumors based on their dielectric properties. Early detection of high-risk lesions and increasing the accuracy of tumor sampling and pathological diagnosis are secondary objectives of the study. Methods: The tumor detection probe (TDP) was first applied to the mouse model for electrical safety evaluations by electrical current measurement. Then it was utilized for characterization of 138 human palpable breast lesions that were to undergo core needle biopsy (CNB), vacuum-assisted biopsy (VAB), or fine needle aspiration (FNA) on the surgeon's requests. Impedance phase slope (IPS) in frequency ranges of 100-500 kHz and impedance magnitude in f = 1 kHz were extracted as the classification parameters. Consistency of radiological and pathological declarations for the excisional recommendation was then compared with the IPS values. Results: Considering pathological results as the gold standard, meaningful correlations between IPS and pathophysiological status of lesions recommended for excision (such as atypical ductal hyperplasia, papillary lesions, complex sclerosing adenosis, and fibroadenoma) were observed (p < 0.0001). These pathophysiological properties may include cell size, membrane permeability, packing density, adenosis, cytoplasm structure, etc. Benign breast lesions showed IPS values greater than 0, while high-risk proliferative, precancerous, or cancerous lesions had negative IPS values.Statistical analysis showed 95% sensitivity with area under the curve (AUC) equal to 0.92. Conclusion: Borderline breast diseases and high-risk lesions that should be excised according to standard guidelines can be diagnosed with TDP before any sampling process. It is an important outcome for high-risk lesions that are radiologically underestimated to BI-RADS3, specifically in younger patients with dense breast masses that present challenges in mammographic and sonographic evaluations. Also, the lowest IPS value detects the most pathologic portions of the tumor for increasing sampling accuracy in large tumors.

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Diagnostic challenges in clinical, radiological and histopathological tests regarding papillomatous lesions of the breast

Cited by 6 publications

References 13 publications

Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy

Massive Breast Intraductal Papilloma Undiagnosed After Several Core Needle Biopsies: A Case Report

Intraradiological pathology‐calibrated electrical impedance spectroscopy in the evaluation of excision‐required breast lesions

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