70 Malignancy Upgrade Rates of Discordant Breast Lesions

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 54

70 Malignancy Upgrade Rates of Discordant Breast Lesions

70 Malignancy Upgrade Rates of Discordant Breast Lesions

Background/Significance

When a breast lesion with imaging characteristics suspicious for malignancy is benign on needle core biopsy (NCB), it is radiographically/pathologically discordant. Surgical excision of discordant breast lesions (DBLs) is recommended to rule out malignancy. Our objective was to evaluate the malignancy upgrade rate of DBLs and predictors of upgrade, and to identify a subset of patients who might be offered active surveillance.

Materials and Methods

Patients diagnosed with DBLs who underwent excision between 2016 and 2023 were identified in an institutional breast surgery database. The upgrade rates to malignancy (ductal carcinoma in situ [DCIS], invasive ductal carcinoma [IDC], invasive lobular carcinoma [ILC]) and benign high-risk lesions (HRLs; atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and/or lobular carcinoma in situ [LCIS]) were assessed. T-tests and χ2 tests were performed. A multivariable logistic regression model was used to identify predictors of malignancy upgrade.

Results

There were 119 patients with DBLs. Median age was 50 years (IQR, 44-60). All DBLs were breast imaging reporting and data system score 4. Ipsilateral concurrent breast cancer (CBC) was present in 13%. Most (77%) DBLs were screen detected, and 24% presented with symptoms (mass or nipple discharge). On imaging, 22% had calcifications on mammography, 67% had a mass (median, 11.5 mm; IQR, 8-19), and 4% had lesions visible on MRI only. Excision revealed purely benign (no HRL) lesions in 76.5%, HRLs in 11.7%, 6.7% in DCIS, and 5.0% in IDC/ILC. The rate of upgrade to malignancy was higher among patients with an HRL on NCB vs a benign (non-HRL) NCB (42.9% [n = 3/7] vs 9.8% [n = 11/112]; P = .009). The rate of malignancy was higher among patients with CBC (37.5% [n = 6/16] vs 7.8% [8/103], P = .001). In patients with no CBC and a purely benign (no HRL) NCB (n = 86), upgrade to DCIS was 2.3% (n = 2) and to IDC/ILC in 2.3% (n = 2). Factors significantly associated with malignancy upgrade included older age ≥ 50 (OR, 5.8; 95% CI 1.0-30.0, P = .03), ipsilateral CBC (OR, 41; 95% CI, 6-299; P = .01), and HRL on NCB (OR, 17; 95% Cl, 2-162; P = .01).

Conclusion

Overall, the majority of DBLs are found to be benign (88.3%). In women without CBC and a purely benign (non-HRL) on NCB, malignancy upgrade rates are low: 2.3% DCIS, 2.3% IDC/ILC. This is similar to malignancy upgrade rates of ALH/LCIS on NCB of 3% to 6%, for which active surveillance is offered. Active surveillance could perhaps be considered as an option to select low-risk patients.

Articles in this issue

70 Malignancy Upgrade Rates of Discordant Breast Lesions
70 Malignancy Upgrade Rates of Discordant Breast Lesions
71 Beyond the Surface: Suspicious Nipple Lesions
71 Beyond the Surface: Suspicious Nipple Lesions
72 Breast Cancer After Breast Augmentation: A Multicenter Collaborative Study Of Patient Management and Outcomes
72 Breast Cancer After Breast Augmentation: A Multicenter Collaborative Study Of Patient Management and Outcomes
73 Short- and Long-Term Outcomes in Use of Titanium-Coated Polypropylene Meshes in Immediate Breast Reconstruction: A Cost-Effective and Safe Option?
73 Short- and Long-Term Outcomes in Use of Titanium-Coated Polypropylene Meshes in Immediate Breast Reconstruction: A Cost-Effective and Safe Option?
74 Lessons Learned From a Breast Surgery ERAS Program in an Oncologic Ambulatory Center
74 Lessons Learned From a Breast Surgery ERAS Program in an Oncologic Ambulatory Center
75 Comparing 21-Gene Assay Recurrence Scores Before and After Preoperative Radiation Boost in Patients Enrolled in a Phase 2 Prospective Clinical Trial
75 Comparing 21-Gene Assay Recurrence Scores Before and After Preoperative Radiation Boost in Patients Enrolled in a Phase 2 Prospective Clinical Trial
76 Electromagnetic Chip Bracketed vs Wire Bracketed Localization in Breast Conserving Surgery
76 Electromagnetic Chip Bracketed vs Wire Bracketed Localization in Breast Conserving Surgery
77 A Radio Opaque Suture May Improve Radiation Target Delineation in Post Lumpectomy Patients With Breast Cancer: A Retrospective Analysis
77 A Radio Opaque Suture May Improve Radiation Target Delineation in Post Lumpectomy Patients With Breast Cancer: A Retrospective Analysis
78 Comparison of Positive Margin Rate of Breast Cancer in Higher BMI Patients
78 Comparison of Positive Margin Rate of Breast Cancer in Higher BMI Patients
79 Case Series of Pathologic Upgrade After Reconstructive Breast Surgery
79 Case Series of Pathologic Upgrade After Reconstructive Breast Surgery
81 Assessing Recurrence Likelihood in Hormone Receptor–Positive/HER2-Negative Breast Cancer Patients Directly From MRI Using Imaging AI
81 Assessing Recurrence Likelihood in Hormone Receptor–Positive/HER2-Negative Breast Cancer Patients Directly From MRI Using Imaging AI
82 Efficacy, Safety, and Biomarker Analysis of ICARUS-BREAST01: A Phase 2 Study of Patritumab Deruxtecan (HER3-DXd) in Patients With HR+/HER2– Advanced Breast Cancer
82 Efficacy, Safety, and Biomarker Analysis of ICARUS-BREAST01: A Phase 2 Study of Patritumab Deruxtecan (HER3-DXd) in Patients With HR+/HER2– Advanced Breast Cancer
TPS 83 ELAINE 3: Open-Label, Randomized, Multicenter, Phase 3 Study of the Efficacy and Safety of Lasofoxifene Plus Abemaciclib for Treating Locally Advanced or Metastatic, ER+/HER2–, Breast Cancer With an ESR1 Mutation
TPS 83 ELAINE 3: Open-Label, Randomized, Multicenter, Phase 3 Study of the Efficacy and Safety of Lasofoxifene Plus Abemaciclib for Treating Locally Advanced or Metastatic, ER+/HER2–, Breast Cancer With an ESR1 Mutation
84 EQUALS: Vaginal/Sexual Health in Patients With Estrogen Receptor–Positive/HER2- Metastatic Breast Cancer
84 EQUALS: Vaginal/Sexual Health in Patients With Estrogen Receptor–Positive/HER2- Metastatic Breast Cancer
86 Elacestrant Combinations in Patients With Estrogen Receptor-Positive, HER2-Negative Locally Advanced or Metastatic Breast Cancer: Update From ELEVATE, a Phase 1b/2, Open-Label, Umbrella Study
86 Elacestrant Combinations in Patients With Estrogen Receptor-Positive, HER2-Negative Locally Advanced or Metastatic Breast Cancer: Update From ELEVATE, a Phase 1b/2, Open-Label, Umbrella Study

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