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Variation in Pathological Appearance Across Repeated Sampling from Probably Benign Breast Lesions

Year: 2025
Type: article
Abstract: Background The diagnostic process of probable benign breast lesions involves a 1–40% upgrade rate to malignancy comparing biopsy (cytology and/or histology) to surgery. Within a previous performed clinical randomized trial, we aimed to examine the diagnostic discrepancies between prior biopsy results and subsequent vacuum-assisted excision (VAE). Materials and methods This study is a post hoc analysis of the Swedish VAE randomized trial. Patients were enrolled between November 2019 and August 2022. All patients who underwent a biopsy before VAE were included in this study. Pathology reports from initial biopsy, from VAE, from surgical excision and from recurrence were collected. In addition, we conducted clinical follow-up, including imaging, for at least 2 years. Results The study population included 169 patients with 169 lesions, of which 71 had a fine-needle aspiration cytology (FNA) and 126 had a core-needle biopsy (CNB) before VAE. The diagnostic discrepancy between FNA and VAE was 38% (27/71). The discrepancy between CNB and VAE was 29% (37/126). The upgrade rate to cancer was 7% (5/71) for FNA and 5% (6/126) for CNB. In the CNB group, the highest upgrade rate to cancer occurred in patients with prior atypical ductal hyperplasia (ADH) on CNB (3/12, 25%). Conclusions The upgrade rate in histopathological diagnosis between prior CNB and VAE was high (15%), and even higher when comparing FNA with VAE (24%). Our findings support avoiding FNA for B3 lesions and suggest that multi-round VAE may be a safe and effective alternative to surgery for selected cases, particularly those with ADH on CNB.
Source: Biomedicines
DOI: 10.3390/biomedicines13122897
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W4416765530
FWCI:
Cites: 31
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