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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2019

01-10-2019 | Breast Oncology

Clinical Management of Mucocele-Like Lesions of the Breast with Limited or no Epithelial Atypia on Core Biopsy: Experience from Two Institutions

Authors: Tanya W. Moseley, MD, Sejal S. Shah, MD, Christopher V. Nguyen, MD, Juliana Rosenblat, MD, Erika Resetkova, MD, PhD, Nour Sneige, MD, Kathy R. Brandt, MD, Lei Huo, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2019

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Abstract

Purpose

Mucocele-like lesions of the breast identified on core biopsy are rare high-risk lesions associated with variable upgrade rates to carcinoma on excision. We aimed to identify the clinicoradiopathological features that can help optimize management of this lesion.

Methods

We evaluated 50 mucocele-like lesions identified on core biopsies from two institutions, including 36 with no atypia and 14 with limited atypia. Outcome data from excision or clinicoradiological follow-up were reviewed with core biopsy results.

Results

Radiological targets were calcifications in 74% of cases, calcifications with associated mass or density in 16%, and mass in 10%. One of the 16 excised lesions without atypia on core biopsy, which was a mass lesion, was upgraded to mucinous carcinoma on excision. Of the 12 excised lesions with limited atypia, none were upgraded on excision. Among the lesions not excised, 20 without atypia had a median follow-up of 61 months, and 2 with limited atypia had follow-up of 97 and 109 months. None of these 22 patients had new development of their lesions on follow-up. The upgrade rate was 2% in our entire cohort, 3% for lesions without atypia, and 0% for lesions with limited atypia.

Conclusions

Clinicoradiological surveillance can be appropriate when a mucocele-like lesion without atypia is identified on core biopsy for a non-mass lesion with pathological-radiological concordance. For mucocele-like lesions with limited atypia, a nonsurgical approach could be considered if the atypia by itself does not warrant excision. The latter recommendation requires careful clinicopathological correlation and support from additional studies.
Literature
1.
2.
Komaki K, Sakamoto G, Sugano H, Morimoto T, Monden Y (1988) Mucinous carcinoma of the breast in Japan. A prognostic analysis based on morphologic features. Cancer. 61:989–96.CrossRefPubMed
3.
Ha D, Dialani V, Mehta TS, Keefe W, Iuanow E, Slanetz PJ. Mucocele-like lesions in the breast diagnosed with percutaneous biopsy: is surgical excision necessary? AJR Am J Roentgenol. 2015;204(1):204–10.CrossRefPubMed
4.
Diorio C, Provencher L, Morin J, et al. Is there an upgrading to malignancy at surgery of mucocele-like lesions diagnosed on percutaneous breast biopsy? Breast J. 2016;22(2):173–79.CrossRefPubMed
5.
Dash I, Dessauvagie B, Hardie M, Saunders C, Wylie E. Mucocoele-like lesions: is surgical excision still necessary? Clin Radiol. 2017;72(11):992.e1–992.e6.CrossRef
6.
Ely KA, Carter BA, Jensen RA, Simpson JF, Page DL. Core biopsy of the breast with atypical ductal hyperplasia: a probabilistic approach to reporting. Am J Surg Pathol. 2001;25(8):1017–21.CrossRefPubMed
7.
Sneige N, Lim SC, Whitman GJ, Krishnamurthy S, Sahin AA, Smith TL, Stelling CB (2003) Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcifications. Considerations for surgical excision. Am J Clin Pathol. 119(2):248–53.CrossRefPubMed
8.
Forgeard C, Benchaib M, Guerin N, et al. Is surgical biopsy mandatory in case of atypical ductal hyperplasia on 11-gauge core needle biopsy? A retrospective study of 300 patients. Am J Surg. 2008;196(3):339–45.CrossRefPubMed
9.
Wagoner MJ, Laronga C, Acs G. Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol. 2009;131(1):112–21.CrossRefPubMed
10.
Nguyen CV, Albarracin CT, Whitman GJ, Lopez A, Sneige N. Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision. Ann Surg Oncol. 2011;18(3):752–61.CrossRefPubMed
11.
Peña A, Shah SS, Fazzio RT, et al. Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat. 2017;164(2):295–304.CrossRefPubMed
12.
Jaffer S, Bleiweiss IJ, Nagi CS. Benign mucocele-like lesions of the breast: revisited. Mod Pathol. 2011;24(5):683–7.CrossRefPubMed
13.
Sutton B, Davion S, Feldman M, Siziopikou K, Mendelson E, Sullivan M. Mucocele-like lesions diagnosed on breast core biopsy: assessment of upgrade rate and need for surgical excision. Am J Clin Pathol. 2012;138(6):783–8.CrossRefPubMed
14.
Rakha EA, Shaaban AM, Haider SA, et al. Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology. 2013;62(6):894–8.CrossRefPubMed
15.
Park YJ, Kim EK. A pure mucocele-like lesion of the breast diagnosed on ultrasonography-guided core-needle biopsy: is imaging follow-up sufficient? Ultrasonography. 2015;34(2):133–8.CrossRefPubMed
16.
Begum SM, Jara-Lazaro AR, Thike AA, Tse GM, Wong JS, Ho JT, Tan PH. Mucin extravasation in breast core biopsies–clinical significance and outcome correlation. Histopathology. 2009;55(5):609–17.CrossRefPubMed
17.
Edelweiss M, Corben AD, Liberman L, Kaplan J, Nehhozina T, Catalano JP, Brogi E. Focal extravasated mucin in breast core needle biopsies: is surgical excision always necessary? Breast J. 2013;19(3):302–9.CrossRefPubMed
18.
Gibreel WO, Boughey JC. Mucocele-like lesions of the breast: rate of upstaging and cancer development. Ann Surg Oncol. 2016;23(12):3838–42.CrossRefPubMed
19.
Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology. 2002;224(2):548–54.CrossRefPubMed
20.
Darling ML, Smith DN, Lester SC, et al. Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol. 2000;175(5):1341–6.CrossRefPubMed
21.
Kohr JR, Eby PR, Allison KH, DeMartini WB, Gutierrez RL, Peacock S, Lehman CD. Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology. 2010;255(3):723–30.CrossRefPubMed
22.
Khoury T, Chen X, Wang D, Kumar P, Qin M, Liu S, Turner B. Nomogram to predict the likelihood of upgrade of atypical ductal hyperplasia diagnosed on a core needle biopsy in mammographically detected lesions. Histopathology. 2015;67(1):106–20.CrossRefPubMed
23.
Meares AL, Frank RD, Degnim AC, et al. Mucocele-like lesions of the breast: a clinical outcome and histologic analysis of 102 cases. Hum Pathol. 2016;49:33–8.CrossRefPubMed
24.
Menen RS, Ganesan N, Bevers T, et al. Long-term safety of observation in selected women following core biopsy diagnosis of atypical ductal hyperplasia. Ann Surg Oncol. 2017;24(1):70–6.CrossRefPubMed
25.
Rageth CJ, O’Flynn EA, Comstock C, et al. First international consensus conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2016;159(2):203–13.CrossRefPubMedPubMedCentral
Metadata
Title
Clinical Management of Mucocele-Like Lesions of the Breast with Limited or no Epithelial Atypia on Core Biopsy: Experience from Two Institutions
Authors
Tanya W. Moseley, MD
Sejal S. Shah, MD
Christopher V. Nguyen, MD
Juliana Rosenblat, MD
Erika Resetkova, MD, PhD
Nour Sneige, MD
Kathy R. Brandt, MD
Lei Huo, MD, PhD
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07377-w

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