Histology after lumpectomy in women with epithelial atypia on stereotactic vacuum-assisted breast biopsy

Graesslin, O.; Antoine, M.; Chopier, J.; Seror, J.Y.; Flahault, A.; Callard, P.; Daraï, E.; Uzan, S.

doi:10.1016/j.ejso.2009.09.002

« Previous Next »European Journal of Surgical Oncology
Volume 36, Issue 2 , Pages 170-175, February 2010

Histology after lumpectomy in women with epithelial atypia on stereotactic vacuum-assisted breast biopsy

O. Graesslin
- Centre Hospitalier Universitaire, Institut Mère Enfant Alix de Champagne, Service de Gynécologie, F-51092 Reims, France
- UPRES EA 2396 UFR Saint-Antoine, Université Pierre et Marie Curie, Paris VI, F-75006 Paris, France
- Corresponding author at: Service de Gynécologie-Obstétrique, Institut Mère Enfant Alix de Champagne, 45 rue Cognacq-Jay, 51092 Reims Cedex, France. Tel.: +33 3 26 78 3517; fax: +33 3 26 78 38 39.
M. Antoine
- Service d'Anatomie Pathologique, Hôpital Tenon, AP-HP, F-75020 Paris, France
J. Chopier
- Service de Radiologie, Hôpital Tenon, AP-HP, F-75020 Paris, France
J.Y. Seror
- Service de Radiologie, Hôpital Tenon, AP-HP, F-75020 Paris, France
- Centre de radiologie Duroc, Boulevard Montparnasse, F-75014 Paris, France
A. Flahault
- Département de biostatistiques, Hôpital Tenon, AP-HP, F-75020 Paris, France
P. Callard
- Service d'Anatomie Pathologique, Hôpital Tenon, AP-HP, F-75020 Paris, France
E. Daraï
- UPRES EA 2396 UFR Saint-Antoine, Université Pierre et Marie Curie, Paris VI, F-75006 Paris, France
- Service de Gynécologie, Hôpital Tenon, AP-HP, F-75020 Paris, France
S. Uzan
- UPRES EA 2396 UFR Saint-Antoine, Université Pierre et Marie Curie, Paris VI, F-75006 Paris, France
- Service de Gynécologie, Hôpital Tenon, AP-HP, F-75020 Paris, France

Accepted 10 September 2009.

Abstract

Background

Large-core needle biopsy of the breast (LCNB) and vacuum-assisted breast biopsy (VABB) are widely used as alternatives to open surgical biopsy (OSB) for initial diagnosis of mammographic abnormalities. Between 18% and 80% of cases in which such specimens show atypical lobular hyperplasia (ALH) or atypical ductal hyperplasia (ADH) are found to be malignant at surgery.

Design

From 1999 to 2005, 68 women with mammographic abnormalities were sampled by stereotactic VABB and presented atypical epithelial hyperplasia. Immunohistochemical staining with anti-cytokeratin 5/6 and anti-E-cadherin antibodies was performed. All women underwent a lumpectomy. Clinical, radiological or histological factors predictive of the risk of finding malignancy at surgery were sought.

Results

VABB initially showed 28 cases of ADH, 32 cases of ALH, one case of flat epithelial atypia, five cases of mixed atypia, and two cases of Lobular Carcinoma In Situ (LCIS). After slide review with immunohistochemical staining, two cases of ADH were reclassified as simple hyperplasia and two cases of ALH were reclassified as mixed atypia. Seven lesions (10.3%) that appeared to be benign on VABB were found to be malignant on OSB (Ductal Carcinoma In Situ (DCIS) in six cases and invasive ductal carcinoma in one case). ADH was the only predictive factor of malignancy on OSB (p=0.04 versus ALH).

Conclusion

ADH diagnosed by vacuum-assisted breast biopsy frequently corresponds to cancer on open surgical biopsy. Surgical excision of all breast lesions containing atypical hyperplasia on percutaneous biopsy can be recommended.

Keywords: Vacuum-assisted breast biopsy, Atypical eptithelial hyperplasia, Atypical ductal hyperplasia, Atypical lobular hyperplasia, Breast cancer, Immunohistochemistry