title: Magnetic resonance imaging-guided core needle breast biopsies resulting in high-risk histopathologic findings: upstage frequency and lesion characteristics.
abstract: Analysis of magnetic resonance imaging-guided breast biopsies yielding high-risk histopathologic features at a single institution found an overall upstage rate to malignancy of 14% at surgical excision. All upstaged lesions were associated with atypical ductal hyperplasia. Flat epithelial atypia and atypical lobular hyperplasia alone or with lobular carcinoma in situ were not associated with an upstage to malignancy.
  
  
  BACKGROUND
  The purpose of the present study w as to determine the malignancy upstage rates and imaging features of high-risk histopathologic findings resulting from magnetic resonance imaging (MRI)-guided core needle breast biopsies. These features include atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), flat epithelial atypia (FEA), and lobular carcinoma in situ (LCIS).
  
  
  METHODS
  A retrospective medical record review was performed on all MRI-guided core needle breast biopsies at a single institution from June 1, 2007 to December 1, 2013 to select biopsies yielding high-risk histopathologic findings. The patient demographics, MRI lesion characteristics, and histopathologic features at biopsy and surgical excision were analyzed.
  
  
  RESULTS
  A total of 257 MRI-guided biopsies had been performed, and 50 yielded high-risk histopathologic features (19%). Biopsy site and surgical excision site correlation was confirmed in 29 of 50 cases. Four of 29 lesions (14%) were upstaged: 1 case to invasive ductal carcinoma and 3 cases to ductal carcinoma in situ. ADH alone had an overall upstage rate of 7% (1 of 14), mixed ADH/ALH a rate of 75% (3 of 4), ALH alone or with LCIS a rate of 0% (0 of 7), and FEA a rate of 0% (0 of 4). Only mixed ADH/ALH had a statistically significant upstage rate to malignancy compared with the other high-risk histopathologic subtypes combined. No specific imaging characteristics on MRI were associated with an upstage to malignancy on the statistical analysis.
  
  
  CONCLUSIONS
  MRI-guided breast biopsies yielding high-risk histopathologic features were associated with an overall upstage to malignancy rate of 14% at surgical excision. All upstaged lesions were associated with ADH. FEA and ALH alone or with LCIS were not associated with an upstage to malignancy.
authors.affiliation: Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL. Electronic address: robert.weinfurtner@moffitt.org.
authors.forename: R Jared
authors.initials: RJ
authors.lastname: Weinfurtner
authors.affiliation: Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL.
authors.forename: Bhavika
authors.initials: B
authors.lastname: Patel
authors.affiliation: Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
authors.affiliation: Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Falcon
authors.affiliation: Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL.
authors.forename: Blaise P
authors.initials: BP
authors.lastname: Mooney
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center, Tampa, FL.
authors.forename: Binglin
authors.initials: B
authors.lastname: Yue
authors.affiliation: Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Drukteinis
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology*; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies
keywords: Atypia; Atypical ductal hyperplasia; Atypical lobular hyperplasia; Flat epithelial atypia; Lobular carcinoma in situ; MRI-guided breast biopsy