The effect of delay of excisional biopsy on upstage rate for atypical ductal hyperplasia, flat epithelial atypia, intraductal papilloma, and radial scar

Breast Cancer Res Treat. 2022 Dec;196(3):527-534. doi: 10.1007/s10549-022-06745-7. Epub 2022 Oct 1.

Abstract

Purpose: When Core Needle Biopsy (CNB) demonstrates Atypical Ductal Hyperplasia (ADH), Flat Epithelial Atypia (FEA), Intraductal Papilloma (IDP), or Radial Scar/Complex Sclerosing Lesion (RS), excisional biopsy (EB) is often performed to rule out underlying malignancy with upstage rates (UR) ranging between 1 and 20%. The COVID-19 pandemic led to delayed EB for many patients. We sought to evaluate whether this delay was associated with higher UR.

Methods: We performed a retrospective analysis of women who underwent CNB and then EB for ADH, FEA, IDP, or RS between 2017 and 2021 using an IRB-approved repository. UR was evaluated by days between CNB and EB.

Results: 473 patients met inclusion. 55 were upstaged to cancer (11.6%). 178 patients had pure ADH on CNB and 37 were upstaged (20.8%). 50 patients had pure FEA and 3 were upstaged (6%). 132 had pure IDP and 7 were upstaged (5.3%). 98 had pure RS and 1 was upstaged (1%). 7/15 (46.7%) had a combination of diagnoses or diagnosis with palpable mass and were upstaged. Days between CNB and EB were < 60 for 275 patients (58.1%), 60-90 for 108 (22.8%), 91-120 for 43 (9.1%), and > 120 for 47 (9.9%). There was no significant difference in UR (10.9% for < 60, 14.8% for 60-90, 7% for 90-120, and 12.8% for > 120, p = 0.54). UR for ADH was clinically increased after 60 days (27.8 vs. 17.5%), but this did not reach statistical significance (p = 0.1).

Conclusion: Surgical delay was not associated with an increased UR.

Keywords: Atypia; Breast; Excisional biopsy; Papilloma; Upstage.

MeSH terms

  • Biopsy, Large-Core Needle
  • Breast / pathology
  • Breast Neoplasms* / pathology
  • Carcinoma in Situ* / pathology
  • Carcinoma, Intraductal, Noninfiltrating* / diagnosis
  • Carcinoma, Intraductal, Noninfiltrating* / pathology
  • Carcinoma, Intraductal, Noninfiltrating* / surgery
  • Cicatrix / etiology
  • Cicatrix / pathology
  • Female
  • Fibrocystic Breast Disease* / pathology
  • Humans
  • Hyperplasia / pathology
  • Pandemics
  • Papilloma, Intraductal* / diagnosis
  • Papilloma, Intraductal* / pathology
  • Papilloma, Intraductal* / surgery
  • Retrospective Studies