Pathologic review of atypical hyperplasia identified by image-guided needle core breast biopsy: Correlation with excision specimen

I. T. Yeh, D. A. Dimitrov, P. M. Otto, M. S. Kahlenberg, A. B. Cruz, A. R. Miller

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS) are pathologic entities closely related to malignancy whose management is currently controversial. Current recommendations involve excisional biopsy of these lesions to rule out the possibility of associated ductal carcinoma in situ (DCIS) or invasive carcinoma (IDCA), which has been reported in more than 50% of cases in some series. We wished to determine how frequently these diagnoses are ultimately found to represent in situ or invasive carcinoma based on excisional biopsy specimens in order to identify predictive factors in the core biopsy that might indicate clinically aggressive pathology. Design: 1832 image-guided needle core (NC) biopsies were performed between 1/1/95. and 5/1/01. Fifty-four (2.9%) patients diagnosed with ADH (36), ALH (12), ADH+ALH (3) or LCIS (3) subsequently underwent breast excisions. Pathologic features were reviewed in each of the needle core biopsies using Page's criteria and correlated with excision specimens. Results: Upon review, three of the ADH needle core biopsies were upgraded to DCIS. Excision in all three patients demonstrated DCIS. One of these excision specimens also contained IDCA. Examination of the excisions of the remaining 33 NC ADH cases revealed 2 DCIS, 1 IDCA+DCIS, 18 residual ADH, 1 LCIS, and 11 usual ductal hyperplasia (UDH). No cases of invasive carcinoma were identified in the excision specimens of the 12 ALH cases: however, 4 LCIS, 1 DCIS were observed. The 3 NC cases that had combined features of ADH and ALH had final review diagnoses of LCIS in 2 and UDH in 1. The 3 NC LCIS cases had LCIS in 2 and ALH in 1 final excision specimen. Review of the NC cases with either DCIS or IDCA+DCIS on final excision showed that nucleoli were evident in most of the NC cases, with foci of nuclear pleomorphism and individual cell necrosis or apoptosis. Conclusion: A more precise diagnosis can be made by using strict criteria for ADH vs. DCIS on needle core biopsy. Cytologic atypia, even if in a small area, particularly when there is apoptosis/individual cell necrosis, correlates with the finding of a more serious lesion on excision.

Original languageEnglish (US)
Pages (from-to)277
Number of pages1
JournalBreast Cancer Research and Treatment
Volume69
Issue number3
StatePublished - 2001

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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