Abstract P4-02-12: Predicting surgical upgrade of breast lesions detected by MRI-guided biopsy

Abstract

Abstract Background: Patients who have suspicious breast lesions identified with MRI without mammographic- or ultrasound-correlated biopsy require MRI-guided biopsy. However, MRI-guided biopsy may underestimate the pathology due to intrinsic heterogeneity, in which subsequent surgical excision may reveal an upgrade. The reported upgrade rate is variable across studies, subclasses of lesion, and needle gauge, and no associative factors have been identified. This study investigated demographic and histologic characteristics of lesions that underwent MRI-guided biopsy to determine possible factors for predicting later upgrade at surgery. Methods: All MRI-guided vacuum biopsies performed between 2012 and 2017 at GWU Breast Imaging Center were reviewed. Surgical excision was performed for high risk lesions and imaging discordance in benign lesions. Variables investigated include patient age, menopausal status, personal/family history of breast cancer and breast pathology. T-test and Pearson's chi-squared test were used to determine statistical significance (alpha=0.05). Results: Of 379 lesions from 295 patients that underwent MRI-guided biopsy, 117 lesions from 96 patients underwent subsequent surgical excision. Pathology of the 117 lesions included benign (14/117; 12%), ALH (17/117; 15%), LCIS (10/117; 9%), ADH (10/117; 9%), papilloma (25/117; 21%), radial scar (12/117; 10%), DCIS (13/117; 11%), invasive cancer (10/117; 9%), and others (6/117; 5%). 14 of 117 lesions (12%) were upgraded at surgery: 5 upgraded from benign to high-risk, 1 upgraded from benign to DCIS, 4 upgraded from high risk to DCIS, 1 upgraded from high risk to invasive cancer and 3 upgraded from DCIS to invasive cancer. All 14 patient with upgrades (100%) had a personal history of breast cancer. No association was found with age, menopausal status, breast pathology, or family history. Conclusions: Our study demonstrated a surgical upgrade rate of 12%. All upgrades occurred in women with a personal history. We suggest that patients with a personal history of breast cancer pose a higher risk of surgical upgrade at excision. Citation Format: Chen A, Brem R. Predicting surgical upgrade of breast lesions detected by MRI-guided biopsy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-12.