Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium

Abstract

Background Upgrade rates of high-risk breast lesions after screening mammography were examined. Study design The Breast Cancer Surveillance Consortium registry was used to identify all BI-RADS 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women. Results High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (N=685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia and 2% in papillary). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, those associated with lobular neoplasia were mostly (56%) invasive. During further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery. Conclusion Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on BI-RADS 4 mammograms among asymptomatic women do not justify surgical excision.

CXCL1 Derived from Mammary Fibroblasts Promotes Progression of Mammary Lesions to Invasive Carcinoma through CXCR2 Dependent Mechanisms

“…Improved imaging approaches combined with core needle biopsies have led to earlier detection of abnormal breast lesions in women over time, with most lesions diagnosed as non-cancerous [1–3]. Non-cancerous breast lesions are highly variable, and include non-proliferative diseases such as breast cysts, and proliferative diseases such as hyperplasia and intraductal papilloma [4, 5].…”

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

“…A number of studies have documented upstaging to malignancy for high-risk lesions detected by stereotactic and ultrasound-guided biopsies. Menes et al 5 analyzed the Breast Cancer Consortium data, in which atypical ductal hyperplasia (ADH) had an upstage rate of 18% and lobular neoplasia (atypical lobular hyperplasia [ALH] and lobular carcinoma in situ [LCIS]) had an overall upstage rate of 10%. However, data on high-risk lesions from MRI-guided biopsies, including ADH, ALH, flat epithelial atypia (FEA), and LCIS are limited.…”

Upgraded Malignancy from High-Risk and Borderline Breast Lesions: Immunohistochemical and Clinical Characteristics

“…There are many papers that distinguish prognosis or analysis of DCIS, an early cancer without invasion, from invasive ductal carcinoma (IDC) (3,15,16). In this study, we also analyzed the cases that were upgraded to DCIS and IDC.…”

“…Evaluation of breast lesions with percutaneous needle biopsy, including ultrasound (US)-guided and stereotactic biopsy, is an established practice at general medical centers (1)(2)(3). Percutaneous needle biopsies of complex histologic lesions with a spectrum of benign, atypical and malignant changes can result in upgrade or underestimation of the histopathologic findings at post-procedural surgical excision.…”