title: Incidental Findings in Reduction Mammoplasty Specimens in Patients with No Prior History of Breast Cancer. An Analysis of 783 Specimens.
abstract: Breast reduction surgery is a common procedure and the rate of incidental findings in the removed specimens varies between 0% and 4.6%. There are no guidelines about pathological evaluation of breast reduction surgery. We reviewed all pathology reports of patients undergoing breast reduction surgery in a single tertiary institution in Brazil from January 2008 to August 2014. Exclusion criteria were a personal history of breast cancer, unclear reason for mastectomy and incomplete data on the pathology report. We considered "relevant findings" flat epithelial atypia, atypical hyperplasia, carcinomas in situ and invasive carcinoma. Of 1672 specimens from breast reduction surgery, 783 met inclusion criteria. Median patient age was 40 (8-77), 91% underwent bilateral mastectomy and 57% of the specimens weighted less than 200 g. In 55% of cases, 4 or more paraffin blocks were sampled. There were 40 (5.1%) relevant findings and the most common was atypical lobular hyperplasia (16-2%). There were 3 invasive carcinomas (0.38%). In multivariate analysis, the only variables associated with a higher odds of relevant pathological findings were patient age ≥ 40 (OR 4.73 CI95% 1.98-11.3 p < 0.001) and sampling of ≥4 paraffin blocks from each specimen (OR 6.69 95% CI 2.25-19.9 p < 0.001). The incidence of pre-malignant and malignant lesions in specimens from breast reduction surgery is around 5%, but this risk is significantly higher for patients older than 40 years-old. Sampling at least 4 paraffin blocks from each specimen significantly increases detection rates.
authors.affiliation: Oncology Department, Hospital Israelita Albert Einstein, 627/701 Av. Albert Einstein, Sao Paulo, CEP 05651-901, Brazil. pedroluiz_uson@hotmail.com.
authors.forename: Pedro Luiz Serrano
authors.initials: PLS
authors.lastname: Usón Junior
authors.affiliation: Oncology Department, Hospital Israelita Albert Einstein, 627/701 Av. Albert Einstein, Sao Paulo, CEP 05651-901, Brazil.
authors.forename: Donato
authors.initials: D
authors.lastname: Callegaro Filho
authors.affiliation: Oncology Department, Hospital Israelita Albert Einstein, 627/701 Av. Albert Einstein, Sao Paulo, CEP 05651-901, Brazil.
authors.forename: Diogo Diniz Gomes
authors.initials: DDG
authors.lastname: Bugano
authors.affiliation: Pathology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Felipe Correa
authors.initials: FC
authors.lastname: Geyer
authors.affiliation: Pathology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marcus Vinicius
authors.initials: MV
authors.lastname: de Nigro Corpa
authors.affiliation: Epidemiology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Paulo David Scatena
authors.initials: PDS
authors.lastname: Gonçalves
authors.affiliation: Oncology Department, Hospital Israelita Albert Einstein, 627/701 Av. Albert Einstein, Sao Paulo, CEP 05651-901, Brazil.
authors.forename: Sergio Daniel
authors.initials: SD
authors.lastname: Simon
authors.affiliation: Oncology Department, Hospital Israelita Albert Einstein, 627/701 Av. Albert Einstein, Sao Paulo, CEP 05651-901, Brazil.
authors.forename: Rafael Aliosha
authors.initials: RA
authors.lastname: Kaliks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D055815:Young Adult
keywords: Breast cancer; Breast reduction surgery; Incidental findings; Mammoplasty