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Observational Study
. 2018 May;91(1085):20180003.
doi: 10.1259/bjr.20180003. Epub 2018 Feb 23.

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

Simone Schiaffino  1 , Elena Massone  1 , Licia Gristina  1 , Piero Fregatti  2 , Giuseppe Rescinito  3 , Alessandro Villa  4 , Daniele Friedman  2 , Massimo Calabrese  1   3
Affiliations
Observational Study

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

Simone Schiaffino et al. Br J Radiol. 2018 May.

Abstract

Objective: Atypical ductal hyperplasia (ADH) is a proliferative lesion associated with a variable increased risk of breast malignancy, but the management of the patients is still not completely defined, with mandatory surgical excision in most cases. To report the results of the conservative management with mammographic checks of patients with ADH diagnosed by vacuum assisted breast biopsy (VAB), without residual calcifications.

Methods: The authors accessed the institutional database of radiological, surgical and pathological anatomy. Inclusion criteria were: ADH diagnosed by VAB on a single group of microcalcifications, without residual post-procedure; follow-up at least of 12 months. Exclusion criteria were the presence of personal history of breast cancer or other high-risk lesions; association with other synchronous lesions, both more and less advanced proliferative lesions.

Results: The 65 included patients were all females, with age range of 40-79 years (mean 54 years). The maximum diameter range of the groups of microcalcifications was 4-11 mm (mean 6.2 mm), all classified as BI-RADS 4b (Breast Imaging Reporting and Data System 4b) and defined as fine pleomorphic in 29 cases (45%) or amorphous in 36 cases (55%). The range of follow-up length was 12-156 months (mean 67 months). Only one patients developed new microcalcifications, in the same breast, 48 months after and 15 mm from the first VAB, interpreted as low-grade ductal carcinoma in situ (DCIS) at surgical excision.

Conclusion: These results could justify the conservative management, in a selected group of patients, being the malignancy rate lower than 2%, considered in the literature as the "probably benign" definition. Advances in knowledge: Increasing the length of follow-up of selected patients conservatively managed can improve the management of ADH cases.

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Figures

Figure 1.
Figure 1.
Direct magnification mammography: suspicious group of fine pleomorphic microcalcifications of about 5 mm of extension, classified as BI-RADS 4b. BI-RADS, Breast Imaging Reporting and Data System.
Figure 2.
Figure 2.
Magnification radiograph of VAB specimens, checking the presence of microcalcifications in the specimens. VAB, vacuum assisted breast biopsy.
See this image and copyright information in PMC

References

    1. Hartmann LC, Radisky DC, Frost MH, Santen RJ, Vierkant RA, Benetti LL, et al. . Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res 2014; 7: 211–7. doi: 10.1158/1940-6207.CAPR-13-0222 - DOI - PMC - PubMed
    1. Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology 2002; 224: 548–54. doi: 10.1148/radiol.2242011528 - DOI - PubMed
    1. Plantade R, Hammou JC, Fighiera M, Aubanel D, Scotto A, Gueret S. Underestimation of breast carcinoma with 11-gauge stereotactically guided directional vacuum-assisted biopsy. J Radiol 2004; 85: 391–401. - PubMed
    1. Travade A, Isnard A, Bouchet F, Bagard C. Non-palpable breast lesions and core needle biopsy with mammotome 11G: is surgery required in patients with atypical ductal hyperplasia? J Radiol 2006; 87: 307–10. - PubMed
    1. Forgeard C, Benchaib M, Guerin N, Thiesse P, Mignotte H, Faure C, et al. . Is surgical biopsy mandatory in case of atypical ductal hyperplasia on 11-gauge core needle biopsy? A retrospective study of 300 patients. Am J Surg 2008; 196: 339–45. doi: 10.1016/j.amjsurg.2007.07.038 - DOI - PubMed

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