Our Summary

This research paper discusses how certain non-cancerous (benign) and unusual (atypical) conditions found in breast tissue samples can potentially lead to breast cancer. These conditions are often found when a small sample of breast tissue is taken with a needle biopsy. It is common for these conditions to progress (or “upgrade”) to cancer, but the rate at which this happens varies greatly according to different studies. This could be due to factors like a lack of coordination between the biopsy results and radiology images, inconsistent rules for when to do a surgical biopsy, and a lack of follow-up with patients who don’t get surgery. This paper emphasizes the need for clear diagnostic criteria and outcome data to make better decisions about how to treat these conditions. The conditions discussed include atypical ductal hyperplasia, atypical lobular hyperplasia, flat epithelial atypia, lobular carcinoma in situ, lobular neoplasia, papilloma, and radial scar.

FAQs

  1. What are some nonmalignant lesions of the breast that can be diagnosed on a core needle biopsy (CNB)?
  2. What is the rate of “upgrade” to carcinoma in excision specimens for benign and atypical lesions associated with breast cancer risk?
  3. What are some limitations of CNB studies in diagnosing nonmalignant lesions of the breast?

Doctor’s Tip

One helpful tip a doctor might give a patient about breast biopsy is to discuss the potential risks and benefits of the procedure before moving forward. It’s important for the patient to understand why the biopsy is being recommended and what the potential outcomes could be. Additionally, the doctor may advise the patient to follow up with their healthcare provider for further testing or treatment based on the results of the biopsy.

Suitable For

Patients who are typically recommended for breast biopsy include those with suspicious findings on imaging studies such as mammograms or ultrasounds, as well as those with palpable lumps or changes in the breast tissue. Additionally, patients with a personal or family history of breast cancer, or those with a genetic predisposition to the disease, may also be recommended for a breast biopsy. Patients with atypical or suspicious lesions found on previous biopsies may also be candidates for further evaluation through a breast biopsy.

Timeline

Before breast biopsy:

  1. Patient undergoes routine breast imaging (mammogram or ultrasound) which shows suspicious findings.
  2. Patient and healthcare provider discuss the need for a biopsy to further evaluate the abnormalities.
  3. Patient may undergo additional imaging or tests to guide the biopsy procedure.
  4. Consent is obtained from the patient for the biopsy procedure.

During breast biopsy:

  1. Patient is prepared for the procedure and given local anesthesia.
  2. A needle or surgical instrument is used to extract tissue samples from the breast.
  3. Samples are sent to a pathologist for analysis.
  4. Patient may experience mild discomfort or pain during the procedure.

After breast biopsy:

  1. Patient receives instructions on post-procedure care and any necessary follow-up appointments.
  2. Pathology results are communicated to the patient by their healthcare provider.
  3. Depending on the results, further diagnostic tests or procedures may be recommended.
  4. Treatment options are discussed with the patient, which may include surgery, radiation therapy, or hormone therapy.
  5. Patients with benign or atypical lesions may be advised to undergo regular monitoring and surveillance to detect any changes in the breast tissue.

What to Ask Your Doctor

  1. What is the reason for recommending a breast biopsy?
  2. What type of biopsy will be performed (core needle biopsy, fine needle aspiration, surgical biopsy)?
  3. How will the biopsy be performed and what can I expect during the procedure?
  4. What are the potential risks or complications associated with the biopsy?
  5. How long will it take to receive the biopsy results?
  6. What will the biopsy results indicate and how will they be communicated to me?
  7. If the biopsy results show atypical or abnormal cells, what are the next steps?
  8. What is the likelihood of the biopsy results being upgraded to carcinoma in the excision specimen?
  9. What are the treatment options if the biopsy results indicate breast cancer?
  10. What are the long-term implications or risks associated with the biopsy results?

Reference

Authors: Calhoun BC. Journal: Surg Pathol Clin. 2018 Mar;11(1):1-16. doi: 10.1016/j.path.2017.09.001. Epub 2017 Dec 6. PMID: 29413652