Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy?

Jenny K. Hoang, Prue Hill and Jennifer N. Cawson
The Breast 17, Issue 3, June 2008, Pages 282-288

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In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy. Underestimates for malignancy occurred in 14 of 29 cases with granular calcification form (OR 7.9, 95% confidence interval (CI) 1.5–41) and 6 of 8 cases with segmental/linear branching distribution (OR 9.0, 95%CI 1.6–52). No malignancy was found at surgical excision in 16 cases with fine, rounded calcification.

In conclusion, detailed assessment of calcification distribution and form gave helpful predictors for malignancy. Lesions with fine rounded calcification were always benign.

Borderline breast lesions diagnosed at core needle biopsy: Can magnetic resonance mammography rule out associated malignancy? Preliminary results base

Anna Linda, Chiara Zuiani, Massimo Bazzocchi, Alessandro Furlan and Viviana Londero
The Breast 17, 2, April 2008, Pages 125-131

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The purpose of this study is to assess whether magnetic resonance mammography (MRM) can exclude associated malignancy in case of diagnosis of borderline breast lesions (B3) at core needle biopsy (CNB). Retrospective analysis of MRM findings of 79 borderline breast lesions (26 benign papillomas, 29 radial sclerosing lesions, 6 atypical ductal hyperplasias, 18 lobular neoplasias) diagnosed at CNB was performed.

Lesions were classified as “non-suspicious” or “suspicious” according to Fischer score. These findings were compared to the results of histological analysis of the excisional specimens. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of MRM in predicting the presence of malignancy were calculated. Out of 24 (30.4%) lesions classified as “suspicious”, 8 (33.3%) proved to be malignant and 16 (66.7%) benign. Among the 55 (69.6%) “non-suspicious” lesions, only 1 (1.8%) was malignant (low-grade ductal carcinoma in situ), while the remaining 54 (98.2%) proved to be benign. MRM sensitivity, specificity, PPV, and NPV were 88.9%, 77.1%, 33.3%, and 98.2%, respectively.

When a borderline lesion is diagnosed on CNB, in case of mild or no enhancement at MRM, follow-up rather than excisional biopsy might be prompted.

Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography

Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: Distribution according to patient history of breast cancer and lesion size
Anna Linda, Chiara Zuiani, Viviana Londero and Massimo Bazzocchi
The Breast Volume 17, Issue 1, February 2008, Pages 51-57

The purpose of the study was to evaluate the outcome of initially only magnetic resonance mammography (MRM)-detected breast lesions as a function of radiologic features, history of breast cancer and lesion size.
Radiologic features, history of breast cancer and large diameter are associated with high likelihood of malignancy in case of initially only MRM-detected lesions. Nevertheless, biopsy might be spared just for MRI BI-RADS 3 lesions in patients without history of breast carcinoma.