Nonsurgical Management of High-Risk Lesions Diagnosed at Core Needle Biopsy: Can Malignancy Be Ruled Out Safely With Breast MRI?

Linda, Anna; Zuiani, Chiara; Furlan, Alessandro; Lorenzon, Michele; Londero, Viviana; Girometti, Rossano; Bazzocchi, Massimo

doi:10.2214/ajr.11.7040

Cited by 74 publications

(35 citation statements)

References 32 publications

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“…The upgrade rate to malignancy was lower for papillomas and radial scars in our study (no cancers found in both entities), which is similar to the data reported in the literature [24]. Linda et al have concluded from their study that patients with papillomas or radial scars on percutaneous biopsy may not need to undergo surgical excision if MRI is negative [26]. When using MRI to predict whether surgical excision is necessary in patients with highrisk lesions classified as B3 on percutaneous biopsy, it is important to realize that MRI will probably have a higher accuracy if performed prior to biopsy as in our study rather than after percutaneous biopsy, since changes related to biopsy, which might impair the diagnostic accuracy of MRI, can be avoided by performing MRI prior to biopsy.…”

Section: Tab 3 Diagnostische Genauigkeit Der Mrt-befunde Insupporting

confidence: 90%

MRI of the Breast as Part of the Assessment in Population-Based Mammography Screening

Bick

Engelken

Diederichs

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate the indications and impact of MRI of the breast as an assessment modality in population-based mammography screening. Materials and Methods: 135 consecutive contrast-enhanced MRI exams of the breast, which were performed between April 2007 and October 2012 as part of the assessment at one mammography screening unit before issuance of a final management recommendation (e.?g. definitely benign or malignant), were retrospectively reviewed. Overall, the cases with an MRI exam of the breast during assessment represent less than 2?% of all assessment cases at this screening unit. All MRI exams were performed as part of the routine clinical care on a 1.5?T or 3?T whole-body magnet using a standard dynamic breast MRI protocol. Results: In the 135 study patients, a total of 30?malignancies in 28 patients were found, including two bilateral cancers. One patient was diagnosed with a non-Hodgkin lymphoma, and of the remaining 29 malignant lesions, 3 (10?%) were in-situ cancers (DCIS) and 26 (90?%) were invasive breast cancers including 3 multifocal or multicentric cancers. All 26 detected invasive cancers were lymph-node negative and 25/29 (86?%) of the detected breast cancer were early stage cancers (stage 0 or 1). 53 of the 135 MRI exams (39.3?%) were suspicious for malignancy (BIRADS 4 or 5) with no cancer missed by MRI. The sensitivity, specificity, positive predictive value, and negative predictive value of the MRI on a per patient basis were 100?%, 77?%, 0.53, and 1, respectively. Conclusion: MRI is a useful problem-solving tool in mammography screening assessment with a high sensitivity and an acceptable positive predictive value. Citation Format:

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Section: Tab 3 Diagnostische Genauigkeit Der Mrt-befunde Insupporting

confidence: 90%

MRI of the Breast as Part of the Assessment in Population-Based Mammography Screening

Bick

Engelken

Diederichs

et al. 2013

Fortschr Röntgenstr

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“…In most studies, the rate of upgrade, or underestimation of malignancy, of surgically excised radial scars has been variable, but most reported rates are in the range of 0% to 10%. 3,[5][6][7][8][9][10][11][12][13][14] However, most radiologists are not comfortable recommending clinical follow-up over surgical excision of radial scars because studies have not consistently demonstrated an upgrade rate of less than 2%, the cutoff for categorizing a lesion as ''probably benign'' according to the BI-RADS (Breast Imaging Reporting and Data System) system (BI-RADS 3). 15 The variability in reported upgrade rates may be due to several factors including variability in study design, small sample sizes, and inconsistent radiologic-pathologic concordance.…”

Section: Commentmentioning

confidence: 99%

“…3,6,7,16 It is also worthy to note that even the high-risk lesions (LCIS, ADH, ALH) considered as pathologic upgrades could, themselves, be considered incidental microscopic findings, as they would have remained clinically occult had an excisional biopsy not been performed in these cases.…”

Section: Commentmentioning

confidence: 99%

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Matrai¹,

D’Alfonso²,

Drotman³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. Objective To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. Design Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. Results Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). Conclusions No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

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“…However, data on high-risk lesions from MRI-guided biopsies, including ADH, ALH, flat epithelial atypia (FEA), and LCIS are limited. [6][7][8][9][10] The purpose of our study was to determine the frequency of high-risk histopathologic features resulting from MRI-guided core needle biopsy, the subsequent upstage rates to malignancy, and whether the imaging characteristics could help predict upstage rates.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging-Guided Core Needle Breast Biopsies Resulting in High-Risk Histopathologic Findings: Upstage Frequency and Lesion Characteristics

Weinfurtner

Patel

Laronga

et al. 2015

Clinical Breast Cancer

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Nonsurgical Management of High-Risk Lesions Diagnosed at Core Needle Biopsy: Can Malignancy Be Ruled Out Safely With Breast MRI?

Cited by 74 publications

References 32 publications

MRI of the Breast as Part of the Assessment in Population-Based Mammography Screening

MRI of the Breast as Part of the Assessment in Population-Based Mammography Screening

Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases

Magnetic Resonance Imaging-Guided Core Needle Breast Biopsies Resulting in High-Risk Histopathologic Findings: Upstage Frequency and Lesion Characteristics

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