Variation in Pathological Appearance Across Repeated Sampling from Probably Benign Breast Lesions

Area of Science:

• Breast oncology
• Diagnostic pathology
• Minimally invasive procedures

Background:

• Benign breast lesions can have a 1-40% upgrade rate to malignancy when comparing biopsy to surgical excision.
• Previous research has explored diagnostic discrepancies between biopsy and surgical outcomes.
• Vacuum-assisted excision (VAE) is a minimally invasive technique for breast lesion diagnosis and treatment.

Purpose of the Study:

• To analyze diagnostic discrepancies between initial breast biopsies (cytology and histology) and subsequent vacuum-assisted excision (VAE).
• To determine the upgrade rate to malignancy based on different biopsy methods prior to VAE.
• To evaluate the effectiveness of VAE as an alternative to surgical excision for specific breast lesions.

Main Methods:

• Post hoc analysis of a Swedish randomized trial involving patients undergoing VAE between November 2019 and August 2022.
• Inclusion of patients with initial biopsy (fine-needle aspiration cytology [FNA] or core-needle biopsy [CNB]) preceding VAE.
• Collection and comparison of pathology reports from biopsy, VAE, surgical excision, and recurrence, with at least 2 years of clinical and imaging follow-up.

Main Results:

• Diagnostic discrepancy between FNA and VAE was 38% (27/71), and between CNB and VAE was 29% (37/126).
• Upgrade rate to cancer was 7% (5/71) for FNA and 5% (6/126) for CNB.
• The highest upgrade rate to cancer in the CNB group was 25% (3/12) for lesions with prior atypical ductal hyperplasia (ADH).

Conclusions:

• High upgrade rates were observed between prior CNB (15%) and FNA (24%) and VAE, indicating significant diagnostic discrepancies.
• Findings suggest avoiding FNA for BI-RADS 3 and 4a breast lesions.
• Multi-round VAE may serve as a safe and effective alternative to surgery for selected cases, particularly those with ADH on CNB.