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Management of high-risk breast lesions diagnosed on core biopsies and experiences from prospective high-risk breast lesion conferences at an academic institution

  • Preclinical study
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Abstract

Background

The management of high-risk breast lesions diagnosed on image-guided core biopsy remains controversial. We implemented a high-risk breast conference attended by breast pathologists, imagers, and surgeons to prospectively review all contemporary cases in order to provide a consensus recommendation to either surgically excise or follow on imaging at 6-month intervals for a minimum of 2 years.

Methods

Between May, 2015 and June, 2019, 127 high-risk lesions were discussed. Of these 127 cases, 116 had concordant radiology–pathology (rad–path) findings. The remaining 11 patients had discordant rad–path findings. Of the 116 concordant cases, 6 were excluded due to lack of the first imaging follow-up until analysis. Of the remaining 110 patients, 43 had atypical ductal hyperplasia (ADH), 12 had lobular carcinoma in situ (LCIS), 19 had atypical lobular hyperplasia (ALH), 33 had radial scar (RS), 2 had flat epithelial atypia (FEA), and 1 had mucocele-like lesion (ML). We recommended excision for ADH if there were > 2 ADH foci or < 90% of the associated calcifications were removed. For patients with LCIS or ALH, we recommended excision if the LCIS or ALH was associated with microcalcifications or the LCIS was extensive. We recommended excision of RS when < 1/2 of the lesion was biopsied. We recommended all patients with FEA and ML for 6-month follow-up.

Results

Following conference-derived consensus for excision, of the 27 ADH excised, 9 were upgraded to invasive carcinoma or ductal carcinoma in situ. Of the six LCIS cases recommended for excision, none were upgraded. Nine excised radial scars revealed no upgrades. Additionally, 3 patients with ADH, 2 with ALH, 1 with LCIS, and 2 with RS underwent voluntary excision, and none were upgraded. All other patients (13 with ADH, 5 LCIS, 17 ALH, 22 RS, 2 FEA and 1 ML) were followed with imaging, and none revealed evidence of disease progression during follow-up (187–1389 days). All 11 rad–path discordant cases were excised with 2 upgraded to carcinoma.

Conclusions

The results of this prospective study indicate that high-risk breast lesions can be successfully triaged to surgery versus observation following establishment of predefined firm guidelines and performance of rigorous rad–path correlation.

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Funding

Zhongliang Ma is supported by the Science and Technology Project for Colleges of Shandong Province (No. J18KB111).

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Author notes

  1. Xiaoxian Li and Zhongliang Ma contributed equally to this work.

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA

    Xiaoxian Li

  2. Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China

    Zhongliang Ma & Haibo Wang

  3. Department of Surgery, Emory University, Atlanta, GA, USA

    Toncred M. Styblo & Cletus A. Arciero

  4. Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA

    Michael A. Cohen

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  1. Xiaoxian Li
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  5. Haibo Wang
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Contributions

Conception and design: XL, ZM, TMS, CAA, HW, MAC. Analysis and interpretation of data: XL, ZM, TMS, CAA, HW, MAC. Manuscript drafting and reviewing: XL, ZM, TMS, CAA, HW, MAC. XL is responsible for the overall content.

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Correspondence to Xiaoxian Li or Michael A. Cohen.

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Li, X., Ma, Z., Styblo, T.M. et al. Management of high-risk breast lesions diagnosed on core biopsies and experiences from prospective high-risk breast lesion conferences at an academic institution. Breast Cancer Res Treat 185, 573–581 (2021). https://doi.org/10.1007/s10549-020-05977-9

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  • DOI: https://doi.org/10.1007/s10549-020-05977-9

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