breast biopsy
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Pathology
- risk of breast cancer after benign histology on breast biopsy is relative to specific histologic pattern.
- in order of increasing 15 year risk* by histology
- non-proliferative pattern# RR: 1.3
- proliferative pattern without atypia RR: 1.9
- atypical hyperplasia RR: 4.2
- risk for breast cancer ~30% over 25 years
- found in ~10% of biopsies with benign findings
- atypical ductal hyperplasia & atypical lobular hyperplasia occur with equal frequency & confer similar increased risks of later breast cancer[2]
* risk relative to reference population
# if no family history of breast cancer, no increased risk in this group
Indications
- evaluation of breast lump
- diagnosis of breast cancer
Procedure
- complications similar for stopping or continuing antiplatelet agents with core needle biopsy[5]
Notes
- pathologists disagree in on diagnosis 25% of time
- concordance by diagnosis[3][4]
- 96-97% for invasive cancer
- 70-84% for ductal carcinoma in situ (DCIS)
- 40-48% for atypical hyperplasia (atypia)
- 87-97% for benign lesions without atypia
- concordance by diagnosis[3][4]
More general terms
References
- ↑ Hartmann LC et al Benign breast disease and the risk of breast cancer. N Engl J Med. 2005 Jul 21;353(3):229-37. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16034008
- ↑ 2.0 2.1 Hartmann LC et al Atypical Hyperplasia of the Breast - Risk Assessment and Management Options. N Engl J Med 2015; 372:78-89. January 1, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25551530 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMsr1407164
- ↑ 3.0 3.1 Elmore JG et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA 2015 Mar 17; 313:1122. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25781441 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2203798
Davidson NE and Rimm DL. Expertise vs evidence in assessment of breast biopsies: An atypical science. JAMA 2015 Mar 17; 313:1109 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25781438 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2203783 - ↑ 4.0 4.1 Elmore JG et al Variability in Pathologists' Interpretations of Individual Breast Biopsy Slides: A Population Perspective. Annals of Internal Medicine. March 22, 2016 http://annals.org/article.aspx?articleid=2505396
Borowsky A, Esserman L When the Gold Standard Loses Its Luster, Perhaps It Is Time to Change Nomenclature. Annals of Internal Medicine. March 22, 2016 http://annals.org/article.aspx?articleid=2504523 - ↑ 5.0 5.1 Reichman MB, McMahon P, Dwyer M et al. Bleeding events after image-guided breast biopsies: Comparison of patients temporarily discontinuing versus maintaining antithrombotic therapy during biopsy. AJR Am J Roentgenol 2023 Oct; 221:438. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37162038
- ↑ Medline Plus: Breast biopsy http://www.nlm.nih.gov/medlineplus/ency/article/003920.htm
- ↑ Mayo Clinic: Breast biopsy http://www.mayoclinic.com/health/breast-biopsy/MY00301