Breast Density Lacks Influence on Upgrade Rates to High Risk Lesions and Cancer Among Proliferative Breast Lesion Excisions

Am Surg. 2022 Sep;88(9):2119-2123. doi: 10.1177/00031348221091949. Epub 2022 Apr 27.


Introduction: Breast density is an independent risk factor for the development of breast cancer. We assessed if upgrade rates to high-risk lesions and cancer were influenced by density when evaluating proliferative complex sclerosing lesions and intraductal papillomas.

Methods: This is a retrospective single institution study. We evaluated 168 women aged 18-86 who received a core needle biopsy revealing a breast proliferative lesion of complex sclerosing lesion (CSL) or intraductal papilloma. We analyzed the upgrade rate to high-risk atypia (HRL) and cancer. Subgroup analysis based on age and breast density was performed.

Results: The patient collective was well balanced-51% had dense breasts and 42% were under 50 years old. Half were diagnosed with papilloma based on CNB and the other half with CSL. For those proliferative lesions without atypia, the upgrade rate to cancer was 1.6%. CNB showed concomitant HRL in 23% of patients with non-dense breasts and in 22% with dense tissue. In 24 cases, the pathology was considered an upgrade by showing either a not prior noted HRL or carcinoma. Most patients with upgrade following surgical excision were over 50 years old. Dense breasts did not show a higher risk of upgrade following surgical excision (P = .975).

Conclusion: Our data did not reveal a difference between upgrade rates of proliferative lesions excised in dense and non-dense breasts. Further evaluation is warranted to establish whether density should be considered as a meaningful factor in excision vs observation of CSL and papillomas.

Keywords: breast; surgical oncology.

MeSH terms

  • Biopsy, Large-Core Needle
  • Breast Density
  • Breast Neoplasms* / pathology
  • Carcinoma, Intraductal, Noninfiltrating* / pathology
  • Carcinoma, Intraductal, Noninfiltrating* / surgery
  • Cicatrix / pathology
  • Female
  • Humans
  • Middle Aged
  • Papilloma* / diagnosis
  • Papilloma* / pathology
  • Papilloma* / surgery
  • Papilloma, Intraductal* / pathology
  • Retrospective Studies