Pathology of high-risk breast lesions and ductal carcinoma in situ

Sewell, Charles W.

doi:10.1016/j.rcl.2004.03.013

Cited by 32 publications

(17 citation statements)

References 12 publications

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“…By the way, it should be noted that within or near the third level of risk described above, we can probably include also non-inherited conditions which consist of personal history of breast cancer, lobular carcinoma in situ (recently renamed as "lobular neoplasia"), atypical ductal or lobular hyperplasia, radial sclerosing lesions, papillary lesions, or phyllodes tumor [80,81], which were used as one of the entry criteria in a retrospective study [11]. However, these conditions cannot be considered as hereditary predispositions.…”

Section: The Technical Development Of Mr Imaging Of Breast Tumorsmentioning

confidence: 99%

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

2006

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In the last few years, several papers have addressed the introduction of contrast-enhanced MR imaging for screening women at high risk for breast cancer. Taking in consideration five prospective studies, on 3,571 screened women with hereditary predisposition to the disease and 9,652 rounds, we found that 168 patients were diagnosed with breast cancer (155 screen-detected, eight interval, and five cancers excluded from analysis) with a detection rate per year of 1.7%. These cancers were small (49% equal to or less than 10 mm in diameter) but aggressive, 82% being invasive and 49% with histologic grade 3; however, only 19% of these invasive cancers were associated with nodal involvement. The pooled sensitivity was 16% for clinical breast examination, 40% for mammography, 43% for ultrasound, and 81% for MR. The positive predictive value (calculated on the basis of the number of invasive diagnostic procedures due to false positives) was 33%, 47%, 18%, and 53%, respectively. Aim of the present article is to present the historical development of MR imaging of breast tumors that made this application theoretically and technically possible, to explain what strategic problems we face in the presence of a hereditary predisposition to the disease, to review the main results of the published studies, and to outline open problems and future perspectives.

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Section: The Technical Development Of Mr Imaging Of Breast Tumorsmentioning

confidence: 99%

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

2006

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“…However, a considerable proportion of lesions diagnosed on percutaneous breast biopsies are classified as high-risk lesions [13]. The high-risk histology includes atypical ductal hyperplasia (ADH), lobular neoplasia (LN) (regrouping of the former atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS)), flat epithelial atypia (FEA), papillary lesions, radial scar/complex sclerosing lesion, phyllodes tumour, and mucocele-like lesions [14][15][16][17][18][19]. When these lesions are diagnosed at image-guided biopsy, the presence of an underlying malignancy may be underestimated, yielding a challenge in clinical management [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

et al. 2010

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Objectives To evaluate the frequency of diagnosis of highrisk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted. Methods Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared. Results Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50%

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“…Benign breast diseases comprise a large group of lesions, some of which have a known intrinsic risk of developing cancer. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Breast lesions at risk of developing cancer represent major problems in screening activities. These lesions have no pathognomonically benign imaging features, and there is no universally accepted decision-making algorithm for their diagnosis and treatment.…”

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confidence: 99%

Benign breast lesions at risk of developing cancer—A challenging problem in breast cancer screening programs

Manfrin

Mariotto

Remo

et al. 2009

Cancer

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BACKGROUND:Cytology and core‐needle biopsies are not always sufficient to exclude malignancy in benign breast lesions (BBL) that are at risk of developing cancer, and open biopsy often is mandatory. In screening programs, open biopsies performed for lesions that are at risk of developing malignancy are considered benign. The authors of this report evaluated the impact of the screen‐detected BBL at risk of developing cancer that were counted in the quota of benign breast open biopsies in the Breast Cancer Screening Program of Verona.METHODS:Benign open biopsies were subdivided into 4 groups according to their risk of developing cancer: Histo1, normal histology; Histo2, ‘pure’ BBL (fibroadenoma, fibrocystic disease, mastitis, adenosis); Histo3, BBL with a low risk of developing cancer (radial scar, papilloma, papillomatosis, phyllodes tumor, mucocele‐like lesion); and Histo4, BBL with a high risk of developing cancer (atypical columnar cell hyperplasia, atypical ductal hyperplasia, atypical lobular hyperplasia).RESULTS:Of 510 open biopsies, 83 biopsies were benign, and the ratio of benign to malignant biopsies was 1:5. Histo1 was observed in 4.8% of all benign open biopsies, Histo2 was observed in 37.4%, Histo3 was observed in 31.3%, and Histo4 was observed 26.5%.CONCLUSIONS:BBL at risk of developing cancer may be numerous in screening programs. It is inappropriate to include BBL at risk of developing cancer in the overall benign open biopsy rate. The authors propose separating pure BBL from lesions at higher risk of developing cancer. To date, there is no evidence to support the premise that detecting high‐risk proliferative lesions leads to benefits in terms of reduced mortality; however, these lesions need to be counted separately for future evaluations. Cancer 2009. © 2008 American Cancer Society.

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Pathology of high-risk breast lesions and ductal carcinoma in situ

Cited by 32 publications

References 12 publications

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

Benign breast lesions at risk of developing cancer—A challenging problem in breast cancer screening programs

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