J Korean Soc Radiol.  2018 Jan;78(1):13-21. 10.3348/jksr.2018.78.1.13.

Upgraded Malignancy from High-Risk and Borderline Breast Lesions: Immunohistochemical and Clinical Characteristics

• Park B
• Kang BJ
• Baek JE
• Kim SH
• Lee HS

• KMID: 2399301
• DOI: http://doi.org/10.3348/jksr.2018.78.1.13

Abstract

PURPOSE
The purpose of this study was to investigate the immune-histochemical characteristics of upgraded malignancy from high-risk and borderline breast lesions, and to correlate the upgrade rates with clinical findings.
MATERIALS AND METHODS
We scrutinized image-guided biopsy records retrospectively, and included all women afflicted with high-risk and borderline breast lesions during the period, 2011 to 2015, inclusive. A total of 340 high-risk and borderline lesions were identified by the pathologist in biopsy samples and thereafter, surgical excision and/or image follow-up for at least 24 months was performed. We compared the clinical emanating from both high-risk and borderline lesions, and with and without cancer upgrade. In the instances of lesions with cancer upgrade, histologic and immuohistochemical reviews were performed.
RESULTS
Of the 340 high-risk or borderline lesions, 18.8% (64/340) were upgraded. The upgrade rates were higher in patients of more advanced age, larger body habitus and afflicted with atypical ductal hyperplasia rather than with other pathology (p < 0.05). In the lesions with cancer upgrade (n = 64), there was no lymph node metastasis. The estrogen receptor-positive (93.8%), progesterone receptor-positive (87.5%), human epidermal growth factor receptor type 2-negative (90.6%), Ki-67-negative (82.8%), and Luminal A (76.6%) types were seen more frequently.
CONCLUSION
Most upgraded malignancies arising from high-risk and borderline breast lesions were found to be Luminal A-type with good prognostic factors, and the upgrade rates correlated with clinical characteristics.

MeSH Terms

Biopsy
Breast Neoplasms
Breast*
Estrogens
Female
Follow-Up Studies
Humans
Hyperplasia
Image-Guided Biopsy
Immunohistochemistry
Lymph Nodes
Neoplasm Metastasis
Pathology
Phenobarbital
Progesterone
Receptor, Epidermal Growth Factor
Retrospective Studies
Estrogens
Phenobarbital
Progesterone
Receptor, Epidermal Growth Factor

Figure

• 

  Fig. 1. Imaging findings of a 36-year-old woman who had a papillary neoplasm by US-guided core needle biopsy that was not surgically confirmed. A. On the US, there was a 0.6-cm-sized oval hypoechoic mass with microlobulated margins at 9 o'clock in the right breast, which was thought to be Breast Imaging Reporting and Data System category 4A (arrow). B. On the follow-up US after 5 years, the lesion had not changed (arrow). US = ultrasound

• 

  Fig. 2. Imaging findings of a 56-year-old woman who had an ADH by US-guided core needle biopsy; it was upgraded to invasive ductal carcinoma after surgical excision. The immunohistochemical characteristics of this case were Luminal A [estrogen receptor (+), progesterone receptor (+), human epidermal growth factor receptor type 2 (−), Ki-67 (low), epidermal growth factor receptor (−)]. A. Right magnification view shows two areas of grouped amorphous microcalcifications in the middle and inner upper portions of the right breast, which were thought to be Breast Imaging Reporting and Data System category 4B (arrows). B, C. By both automated (B) and hand-held ultrasound (C), there was an irregular isoechoic mass with suspicious calcifications at 12 o'clock in the right breast, which correlated with a prior mammography (arrows). Through US-guided core needle biopsy, the lesion was confirmed as ADH. D. On the maximal intensity projection image of breast magnetic resonance imaging, there was a regional nonmass enhancement 2.6 × 1.5 cm in size at 12 o'clock in the right breast. E. The patient underwent mammography-guided localization and surgical excision. The specimen contained microcalcifications approximately 4 cm in extent (arrow) and was confirmed as invasive ductal carcinoma. ADH = atypical ductal hyperplasia, US = ultrasound

Reference

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