Vacuum assisted breast biopsy (VAB) excision of subcentimeter microcalcifications as an alternative to open biopsy for atypical ductal hyperplasia

Schiaffino, Simone; Massone, Elena; Gristina, Licia; Fregatti, Piero; Rescinito, Giuseppe; Villa, Alessandro; Friedman, Daniele; Calabrese, Massimo

doi:10.1259/bjr.20180003

Cited by 26 publications

(31 citation statements)

References 45 publications

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“…The incidence of pure FEA is approximately 1–2% of benign breast biopsies [ 20 ]. It is frequently discovered secondary to suspicious microcalcifications [ 60 ]. In addition, FEA is often found in association with other high-risk lesions of the breast, such as ALH, ADH, or LN, although currently it is increasingly referred to as a precursor of the latter alteration [ 61 ] and also considered, together with ADH and DCIS, as a non-obligatory precursor of invasive carcinoma [ 62 , 63 ].…”

Section: Flat Atypical Epitheliamentioning

confidence: 99%

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

et al. 2021

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Breast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favored to reduce overtreatment and spare patients from unnecessary anxiety or high healthcare costs associated with surgical excision. The purpose of this work is to provide the reader with an accurate overview focused on the main high-risk lesions of the breast: atypical intraductal epithelial proliferation (atypical ductal hyperplasia), lobular neoplasia (including the subcategories lobular carcinoma in situ and atypical lobular hyperplasia), flat epithelial atypia, radial scar and papillary lesions, and phyllodes tumor. Beyond merely presenting the radiological aspects of these lesions and the recent literature, information about their potential upgrade rates is discussed in order to provide a useful guide for appropriate clinical management while avoiding the risks of unnecessary surgical intervention (overtreatment).

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Section: Flat Atypical Epitheliamentioning

confidence: 99%

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

et al. 2021

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“…A review of the available literature shows that ADH is often associated with a significantly higher risk of concomitant DCIS and/or invasive carcinoma (IC) diagnosed by subsequent surgical excisions [ 5 , 6 , 7 , 8 , 9 ]. Although debate on this subject still exists, the diagnosis of ADH is an indication for surgery [ 3 , 6 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

et al. 2021

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(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients’ characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.

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“…In the residual cases, multidisciplinary discussion is indicated and further information not included in our algorithm could be considered (presence of several associated high-risk lesions at histology, family history, and other risk factors, including eventual associated imaging findings, i.e., MRI findings [2,13]). In lesions with a low risk of malignancy according to the proposed algorithm and no other risk factors, follow-up or larger excision with VABB might be considered as valuable alternatives [14].…”

Section: Discussionmentioning

confidence: 99%

A risk stratification algorithm for lesions of uncertain malignant potential diagnosed by vacuum-assisted breast biopsy (VABB) of mammographic microcalcifications

Clauser¹,

Kapetas²,

Stöttinger³

et al. 2021

European Journal of Radiology

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Vacuum assisted breast biopsy (VAB) excision of subcentimeter microcalcifications as an alternative to open biopsy for atypical ductal hyperplasia

Cited by 26 publications

References 45 publications

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

A risk stratification algorithm for lesions of uncertain malignant potential diagnosed by vacuum-assisted breast biopsy (VABB) of mammographic microcalcifications

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