Increased risk of upstage when combinations of breast lesions of uncertain malignant potential are found on core needle biopsy: The need for surgical excision

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Background: Management of breast lesions of uncertain malignant potential diagnosed at core needle biopsy (CNB) is controversial due to variable upstage rate (UR) with surgical excision (SE).

Methods: We performed an IRB-approved retrospective analysis of adult women who underwent CNB demonstrating atypical ductal hyperplasia (ADH), flat epithelial atypia, radial scar, or intraductal papilloma then SE between 2010 and 2022. We evaluated CNB pathology for combination diagnoses (CD), defined as multiple primary lesions or primary with lobular neoplasia (LN), and surgical pathology for upstage.

Results: 719 patients were included. UR was 12.2% (88/719). CD experienced higher UR than pure (17.7% (45/254) vs. 9.2% (43/465), p = 0.001). ADH/LN had the highest UR of all CD (34.6% (9/26), p = 0.001). Increased size (15.6 vs. 10.5 mm, p < 0.001), distance from nipple (79 vs. 66 mm, p < 0.001), and personal history of breast cancer (p = 0.04) were associated with UR.

Conclusions: CD was associated with increased UR. ADH/LN had the highest UR.

Keywords: Atypia; Biopsy combinations; Breast; Excision; Factors; Upstage.