Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study
Year: 2023
Type: article
Study design: Observational Study
Abstract: PURPOSE: The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS: This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS: The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION: ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.
Authors: Ayşenur Oktay, Özge Aslan, Füsun Taşkın, Nermin Tunçbilek, Selma Gül Esen İçten, Pınar Balcı, Mustafa Erkin Arıbal, Levent Çelik, İhsan Şebnem Örgüç, Figen Başaran Demirkazık, Serap Gültekin, Ayşe Murat Aydın, Emel Durmaz, Sibel Kul, Figen Binokay, Meltem Çetin, Ganime Dilek Emlik, Meltem Gülsün Akpınar, Sadiye Nuray Kadıoğlu Voyvoda, Ahmet Veysel Polat, Işıl Başara Akın, Şeyma Yıldız, Necdet Poyraz, Arzu Özsoy, Pelin Seher Öztekin, Eda Elverici, İlkay Koray Bayrak, Türkan İkizceli, Funda Dinç, Gülten Sezgin, Gökçe Gülşen, Işıl Tunçbilek, Sabiha Rabia Yalçın, Gül Çolakoğlu, Serpil Ağlamış, Ravza Yılmaz, Günay Rona, Gamze Durhan, Davut Can Güner, Fatma Çelik Yabul, Leman Günbey Karabekmez, Burçin Tutar, Muhammet Göktaş, Onur Buğdaycı, Aslı Suner, Necmettin Özdemir
Institutions: Ege University, Acıbadem University, Acıbadem University Atakent Hospital, Trakya University, Dokuz Eylül University, Maltepe University, Manisa Celal Bayar University, Hacettepe University, Gazi University, Fırat University, Akdeniz University, Karadeniz Technical University, Cukurova University, Süleyman Demirel Üniversitesi, Necmettin Erbakan University, Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, Sağlık Bilimleri Üniversitesi, Ondokuz Mayıs University, Bezmiâlem Vakıf Üniversitesi, Ankara Eğitim ve Araştırma Hastanesi, Haseki Eğitim ve Araştırma Hastanesi, Muğla University, Izmir Kâtip Çelebi University, Izmir Tepecik Eğitim ve Araştırma Hastanesi, Istanbul University, Ankara Yıldırım Beyazıt University, Ministry of Health, Marmara University
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4316037176