Upgrade Rate Research Articles

Computing Unit and Data Migration Strategy under Limited Resources: Taking Train Operation Control System as an Example

There are conflicts between the increasingly complex operational requirements and the slow rate of system platform upgrading, especially in the industry of railway transit-signaling systems. We attempted to address this problem by establishing a model for migrating computing units and data under resource-constrained conditions in this paper. By decomposing and reallocating application functions, optimizing the use of CPU, memory, and network bandwidth, a hierarchical structure of computing units is proposed. The architecture divides the system into layers and components to facilitate resource management. Then, a migration strategy is proposed, which mainly focuses on moving components and data from less critical paths to critical paths and ultimately optimizing the utilization of computing resources. Specifically, the test results suggest that the method can reduce the overall CPU utilization by 27%, memory usage by 6.8%, and network bandwidth occupation by 35%. The practical value of this study lies in providing a theoretical model and implementation method for optimizing resource allocation in scenarios where there is a gap between resource and computing requirements in fixed-resource service architectures. The strategy is compatible for distributed computing architectures and cloud/cloud–edge-computing architectures.

Long-term follow-up of single-chamber atrial pacing - system upgrade and wenckebach block point behavior: potential implications for leadless AAI pacing?

Abstract Introduction Until recently leadless pacemakers (PM) did not support atrial pacing. A novel dual chamber leadless PM system now provides treatment option for a wide range of indications. Single-chamber atrial stimulation (AAI) for the treatment of symptomatic sick sinus syndrome (SSS) is scarcely used due to concerns about the potential development of atrioventricular block (AVB) and development of paroxysmal atrial fibrillation (AF). Long-term follow-up data of AAI-PM is however scarce. Little is known about the role of serial Wenckebach block point (WBP) measurements in AAI-PM patients for risk stratification. Purpose To assess the incidence of dual chamber upgrade of patients treated with AAI-PM for SSS during long-term follow-up and to investigate the role of serial WBP measurements for risk stratification. Methods Prospectively enrolled patients undergoing implantation of an AAI-PM between October 2002 and December 2023. WBP was measured at implantation and serially during follow up. Results We included a total of 178 patients, of which 58% were female and the median age at implantation was 78 [IQR 71 – 83] years. The median follow-up duration was 6.5 [IQR 2.0 – 9.7] years. 24 patients (13.5%) received a system upgrade to DDD including 3 patients (1.7%) with a mode change to ventricular pacing only (VVI). Adjusted for years of follow-up the upgrade rate was 2.1% per year. Median time to system upgrade was 5.2 [IQR 1.6 – 8.7] years. Reasons for system upgrade were high-degree AVB (38%), low WBP (17%), atrial arrhythmias (33%), unclear syncope (8%) and infection (4%). Median WBP at implantation was 130 [120 – 140] bpm, showing a significant decline over time in the upgrade-group with 105 [95 – 130] bpm compared to the rest of the cohort with 130 [120-130] bpm (p = 0.009). A decline in WBP >20 bpm was found in 17.9% patients and a decline of 10-20 bpm in 33.7% of patients. New-onset atrial arrythmias were found in 36 patients (20%), 29% in the upgrade group and 19% in the rest of the cohort (p = 0.3). Neither age at implantation, sex, WBP at implantation, nor atrial arrhythmia prior to implantation were predictive for the need of a future system upgrade. Conclusion In this cohort of patients undergoing AAI-PM implantation for SSS, a system upgrade was required in 2% per year. The WBP remained stable in 48% of patients. Therefore, AAI-PM due to SSS emerges as a judicious and secure therapeutic modality, warranting increased consideration in the light of new treatment options for leadless pacing.

Comparison between 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy and systematic biopsy for tumor detection and grading in selected patients: A prospective randomized controlled trial

ObjectiveTo compare the upgrade rate and cancer detection rate between 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy and systematic biopsy in selected patients with suspected prostate cancer (the multiparametric MRI prostate imaging reporting and data system score ≥4 and molecular imaging prostate-specific membrane antigen score of prostate-specific membrane antigen PET image ≥2). MethodsEighty-seven selected biopsy-naive patients were randomized into two groups: targeted biopsy (n=41) and systematic biopsy (control; n=46). Those with negative initial results underwent a repeat biopsy using the alternative method. Patients diagnosed with clinically significant prostate cancer proceed to radical prostatectomy. The primary outcome was the upgrade rate. Additional outcomes, including the cancer detection rate, incidence of repeat biopsy, positive surgical margin, complications, and prostate-specific antigen level at 6 weeks postoperatively, were compared between the groups using Pearson or Fisher's exact tests, as appropriate. ResultsIn the study, prostate cancer was ultimately detected in all patients. The targeted biopsy group successfully identified all tumors, whereas five patients in the control group initially missed their tumors. The pathological upgrade rates for the targeted biopsy and control groups were 31.7 % and 56.5 %, respectively. Overall, the detection rate for clinically significant prostate cancer (the International Society of Urological Pathology grade ≥2) was significantly higher in the targeted biopsy group (92.7 %) compared with the control group (76.1 %, p=0.035). However, no significant difference was found in the detection rate of all prostate cancer. Complications (Clavien–Dindo grade ≤2) occurred in both the targeted biopsy group (n=11) and the control group (n=13). No statistically significant difference was observed between the groups in terms of positive surgical margin, complications, and 6-week postoperative prostate-specific antigen level. The main limitation is the small population. Conclusion18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy alone was an efficient modality in diagnosing selected patients with prostate cancer.

Determining Long-term Prostate Cancer Outcomes for Active Surveillance Patients Without Early Disease Progression: Implications for Slowing or Stopping Surveillance

Background and objectiveActive surveillance (AS) of prostate cancer (PCa) is the standard of care for low-grade disease, but there is limited guidance on tailoring protocols for stable patients. We investigated long-term outcomes for patients without initial progression and risk factors for upgrade. MethodsMen on AS with Gleason grade group (GG) 1 PCa on three serial biopsies, ≥5 yr without progression, and ≥10 yr of follow-up were included. Outcomes were upgrade (GG ≥2), major upgrade (GG ≥3), progression to treatment, metastasis, PCa-specific survival, and overall survival. Cox proportional hazards regression models were used to estimate the associations between patient characteristics and risk of upgrade. Key findings and limitationsA total of 774 men met the inclusion criteria. At 10, 12, and 15 yr, upgrade-free survival rates were 56%, 45%, and 21%; major upgrade–free survival rates were 88%, 83%, and 61%; treatment-free survival rates were 86%, 83%, and 73%; metastasis-free survival rates were 99%, 99%, and 98%; and overall survival rates were 98%, 96%, and 95%, respectively. PCa-specific survival was 100% at 15 yr. On a multivariable analysis, year of diagnosis, age, body mass index (BMI), and biopsy core positivity were associated with upgrade (all p < 0.01), whereas age and prostate-specific antigen (PSA) density were associated with major upgrade. Conclusions and clinical implicationsPatients without progression for 5 yr on AS had modest rates of upgrade and low rates of metastasis, and mortality at 15 yr of follow-up. Year of diagnosis, older age, increased BMI, and increased biopsy core positivity were associated with upgrade, whereas older age and greater PSA density were associated with an increased risk of major upgrade. A subset of these patients may benefit from deintensification of AS protocols. Patient summaryThere are little reported data or clinical guidelines for patients with prostate cancer (PCa) who are stable for many years on active surveillance (AS). We show, in a large cohort, that PCa patients without progression for 5 yr on AS have modest rates of upgrade and very low rates of metastasis, and mortality rates at 15 yr of follow-up, and that older age, increased body mass index, and increased PCa volume are associated with an increased likelihood of future upgrade. This study supports continued AS in this patient population and deintensification in select patients.

Proportion of Patients With Ductal Carcinoma In Situ That Qualify for Observation Criteria Set Forth by Clinical Trials.

The COMET, LORD, and LORIS clinical trials are investigating the role of active surveillance in low-risk ductal carcinoma in situ (DCIS). The objective of this study was to identify the proportion of patients eligible for these trials amongst a cohort of patients treated at our institution. Retrospective chart review was performed of patients diagnosed with DCIS who were treated from 2013 to 2022. Clinical, tumor, and imaging inclusion and exclusion criteria of the aforementioned observation trials were applied to determine the proportion of patients eligible for each trial. Upgrade rate to invasive cancer were examined across all three groups. Of 1223 patients diagnosed with DCIS, applying the criteria of each trial, 245 (20%), 238 (19.4%), and 264 (21.6%) patients were eligible for the COMET, LORD, and LORIS trials, respectively. High-grade DCIS and mass on imaging had the largest impact on exclusion. Nineteen (7.8%) of women who qualified for COMET were upgraded to invasive disease at excision, compared to 18 (7.6%) for LORD, and 19 (7.2%) for LORIS. One in five patients diagnosed with DCIS at our institution would qualify for observation with current trial eligibility. Observation of DCIS may have limited impact on all DCIS patients.

Natural history of PIRADS-2 lesions on serial multiparametric magnetic resonance imaging: Real-life data from an Academic Center

Introduction/BackgroundThe natural history of prostate imaging reporting and data system (PIRADS) score 2 lesions on serial mpMRIs is largely unknown. Herein, we aimed to evaluate the patients with PIRADS-2 index lesions by using serial mpMRI scans to reveal the rates of mpMRI upgrade in PIRADS score and prostate cancer (PCa) detection. Methods/MaterialsAll mpMRI scans with a PIRADS-2 index lesion from our mpMRI database were evaluated retrospectively. Data from 214 biopsy-naïve patients with a PIRADS-2 index lesion on the initial mpMRI who then underwent at least 1 follow-up mpMRI were reevaluated by an experienced uroradiologist and only those (n = 172) who had a PIRADS-2 index lesion on the initial mpMRI according to PIRADS v2.1 were included in the study. mpMRI progression was defined as the detection of any PIRADS ≥3 lesion at follow-up mpMRI. Histopathological results were evaluated in patients undergoing biopsy upon mpMRI progression. ResultsA total of 172 patients with a mean age of 60.1 ± 8.6 years were evaluated. The median PSA at baseline mpMRI was 4.7 (IQR; 3.3–6.7) ng/dl. Overall mpMRI progression was detected in 54 patients (31.4%), 37 were upgraded to PIRADS-3, 16 to PIRADS-4, and one to PIRADS-5. Multivariate logistic regression analysis revealed that a PSA increase of ≥25% during follow-up was the only predictor of mpMRI upgrade (P = 0.019, OR: 2.384). 30 out of 54 patients underwent a prostate biopsy and PCa was detected in 15 patients; 5 with ISUP grade 1, 10 with ISUP grade 2. ConclusionsAlmost half of the patients with a PIRADS-2 index lesion were upgraded to PIRADS ≥3 when evaluated with serial mpMRI when a PSA increase of ≥25% was observed during follow-up. PCa was detected in half of the patients who underwent a biopsy. Serial mpMRI can be recommended when monitoring patients with elevating PSA ≥25%, a prostate biopsy can be considered upon a mpMRI progression.

Radial Sclerosing Lesion (Radial Scar): Radiologic-Pathologic Correlation.

Radial sclerosing lesions (RS, also referred to as "radial scars") and complex sclerosing lesions (CSL) are uncommon breast lesions often grouped together as a single entity in practice. RS/CSL have an incidence of <0.1% to 1% at core needle biopsy (CNB). When detected on CNB, imaging and pathology features must be carefully evaluated to determine appropriate surgical management or imaging follow-up due to potential for malignant upgrade at surgery. Detection of RS/CSL has increased with the advent of tomosynthesis, in which an RS/CSL is typically detected as architectural distortion with or without associated mass with spiculated margins. On US, an RS/CSL is most often occult or manifests as subtle distortion with adjacent cysts. Imaging findings cannot distinguish benign RS/CSL from those upgraded to malignancy at surgery, although larger lesion size may be associated with higher upgrade rates. Histologically, an RS has a central fibroelastotic nidus with entrapped-appearing ducts and proliferative changes at the periphery appearing to radiate from the center; CSL are larger than RS, more disorganized, and typically include multiple patterns of epithelial proliferations, including sclerosing adenosis, sclerosing papillomas, usual ductal hyperplasia, and cysts. RS/CSL with associated atypia at CNB have a 16%to 29% rate of upgrade to malignancy on surgical excision, thus rendering surgical excision essential. Conversely, an RS/CSL without associated atypia, particularly when ≤1 cm in size, has <3% rate of upgrade to malignancy at surgery, allowing consideration of imaging follow-up in lieu of excision. Here, we review recent literature as well as radiology and pathology findings of RS/CSL.

Risk factors for pathological upgrading and noncurative resection in patients with gastric mucosal lesions after endoscopic submucosal dissection

BackgroundThe pathological results obtained from endoscopic forceps biopsy (EFB) do not always align with the findings of postoperative endoscopic submucosal dissection (ESD). Furthermore, as ESD becomes more widespread, the number of noncurative endoscopic cases increases; thus, an accurate preoperative diagnosis and an appropriate treatment method are crucial. The purpose of this study was to explore the risk factors for postoperative pathological upgrading and noncurative resection and to gather experience in clinical and pathological diagnosis.MethodsFrom March 2016 to November 2023, 292 ESD specimens were collected from 262 patients with gastric mucosal lesions. Clinicopathological information, the coincidence rate of pathological diagnosis between EFB and ESD specimens, and risk factors related to noncurative resection were analyzed retrospectively.ResultsThe overall upgraded pathological diagnosis rate between EFB and ESD was 26.4%. The independent predictors for the upgraded group included proximal stomach lesions, lesion size > 2 cm, surface ulceration, and surface nodules. Twenty of the 235 early gastric cancer (EGC) patients underwent noncurative ESD resection. Multivariate analysis showed that undifferentiated carcinoma and tumor infiltration into the submucosa were significantly associated with noncurative resection.ConclusionBiopsy cannot fully represent the lesions of gastric intraepithelial neoplasia (GIN). When a suspected epithelial dysplasia is suspected, a careful endoscopic examination should be conducted to evaluate the lesion site, size, and surface characteristics to ensure an accurate diagnosis. Noncurative endoscopic resection is associated with undifferentiated carcinoma and submucosal infiltration. Clinicians must be familiar with these predictive factors for noncurative resection and select the appropriate treatment for their patients.

Distance of Biopsy-Confirmed High-Risk Breast Lesion from Concurrently Identified Breast Malignancy Associated with Risk of Carcinoma at the High-Risk Lesion Site.

High-risk breast lesions including incidental intraductal papilloma without atypia (IPA), lobular hyperplasia (LCIS or ALH), flat epithelial atypia (FEA) and complex sclerosing lesion (CSL) are not routinely excised due to low upgrade rates to carcinoma. We aim to identify features of these lesions predictive of upgrade when identified concurrently with invasive disease. Methods: A single-center retrospective cohort study was performed for patients who underwent multi-site lumpectomies with invasive disease at one site and a high-risk lesion at another site between 2006 and 2021. A multinomial logistic regression was performed. Results: Sixty-five patients met the inclusion criteria. Four patients (6.2%) had an upgrade to in situ disease (DCIS) and one (1.5%) to invasive carcinoma. Three upgraded high-risk lesions were ipsilateral to the concurrent carcinoma and two were contralateral. In the multivariate model, a high-risk lesion within 5 cm of an ipsilateral malignancy was associated with increased risk of upgrade. The 3.8% upgrade rate for high-risk lesions located greater than 5 cm from ipsilateral malignancy or in the contralateral breast suggests that omission of excisional biopsy may be considered. Excisional biopsy of lesions within 5 cm of ipsilateral malignancy is recommended given the 25% upgrade risk in our series.

An Enhanced Tree-Seed Algorithm for Function Optimization and Production Optimization.

As the fields of engineering, energy, and geology become increasingly complex, decision makers face escalating challenges that require skilled solutions to meet practical production needs. Evolutionary algorithms, inspired by biological evolution, have emerged as powerful methods for tackling intricate optimization problems without relying on gradient data. Among these, the tree-seed algorithm (TSA) distinguishes itself due to its unique mechanism and efficient searching capabilities. However, an imbalance between its exploitation and exploration phases can lead it to be stuck in local optima, impeding the discovery of globally optimal solutions. This study introduces an improved TSA that incorporates water-cycling and quantum rotation-gate mechanisms. These enhancements assist the algorithm in escaping local peaks and achieving a more harmonious balance between its exploitation and exploration phases. Comparative experimental evaluations, using the CEC 2017 benchmarks and a well-known metaheuristic algorithm, demonstrate the upgraded algorithm's faster convergence rate and enhanced ability to locate global optima. Additionally, its application in optimizing reservoir production models underscores its superior performance compared to competing methods, further validating its real-world optimization capabilities.

Upgrading a single-chamber leadless pacemaker to a dual-chamber leadless pacemaker system

Abstract Background/Introduction The first global dual-chamber leadless pacemaker (DR-LP) study included a group of subjects with a pre-existing upgradeable ventricular single chamber leadless pacemaker (VR-LP) in whom the addition of an atrial leadless pacemaker (AR-LP) was undertaken to allow upgrading to a dual chamber leadless pacing (DR-LP) system. Purpose Summarize success rates of single to dual chamber leadless pacemaker upgrades, as well as device and i2i throughput measurements, serious adverse device effects (SADEs) and mortality in this cohort. Methods Subjects with a pre-existing VR-LP who were indicated for a dual-chamber pacemaker were included. Upgrade procedures included downloading firmware to existing VR-LP, placing AR-LP, and pairing the devices to operate in a DR-LP mode. Electrical and i2i throughput measurements were collected at implant, pre-discharge, 1-mo, 3-mo, 6-mo, and 12-mo. Upgrade success rate was defined as an AR-LP upgrade procedure that resulted in a functional DR-LP system. SADEs included all reported events that were adjudicated as serious and possibly, probably or causally related to the procedure or system. SADEs and deaths were adjudicated by an independent clinical events committee. Results Out of 36 enrolled subjects (61.1% male, 70.4 ± 13.8 yrs., 55.6% sinus node dysfunction, 38.9% AV block), 35 had an attempted implant, and 32 of these were successful (91.4%). The 3 unsuccessful upgrade attempts were related to unsuccessful placement of the AR-LP due to complications during the procedure (n = 2) or an inability to implant an AR-LP (n = 1). Figure 1 illustrates a declining early mean pacing capture threshold, rising early P-wave amplitudes, and stable impedance for the AR-LP over the 12 months. Mean i2i throughput for communication from the RV to RA and the RA to RV improved from pre-discharge to 3 months and remained stable through the subsequent 9 months (Figure 2). A total of 5 subjects (5 of 36; 13.9%) experienced 7 SADEs (all procedure-related; 2 related to the AR-LP and 2 to the delivery catheter). One non-cardiovascular, non-device, non-procedure related death occurred in the upgrade population. Conclusions The single to dual-chamber upgrade cohort demonstrated a high upgrade success rate (91.4%), stable atrial and ventricular electrical measurements and consistently high i2i communication throughout the 12 months. AV synchrony (AVS) was not specifically measured in this upgrade cohort, but data from the main DR-LP study suggest that i2i throughput correlates with, but significantly underestimates AVS. Further, the rate of complications was acceptable (13.9%) and limited to the procedure. These data confirm the feasibility, safety and longer-term effectiveness of adding an atrial LP in patients with a pre-existing ventricular LP order to achieve effective dual chamber pacing.Fig. 1: Upgrade Electrical measurementsFig. 2: i2i communication for Upgrades

Nanobubbles improve peroxymonosulfate-based advanced oxidation: High efficiency, low toxicity/cost, and novel collaborative mechanism

Cl- activated peroxymonosulfate (PMS) oxidation technology can effectively degrade pollutants, but the generation of chlorinated disinfection byproducts (DBPs) limits the application of this technology in water treatment. In this study, a method of nanobubbles (NBs) synergistic Cl-/PMS system was designed to try to improve this technology. The results showed the synergistic effects of NBs/Cl-/PMS were significant and universal while its upgrade rate was from 12.89% to 34.97%. Moreover, the synergistic effects can be further improved by increasing the concentration and Zeta potential of NBs. The main synergistic effects of NBs/Cl-/PMS system were due to the electrostatic attraction of negatively charged NBs to Na+ from NaCl, K+ from PMS, and H+ from phenol, which acted as a "bridge" between Cl- and HSO5- as well as phenol and Cl-/HSO5-, increasing active substance concentration. In addition, the addition of NBs completely changed the oxidation system of Cl-/PMS from one that increases environmental toxicity to one that reduces it. The reason was that the electrostatic attraction of NBs changed the active sites and degradation pathway of phenol, greatly reducing the production of highly toxic DBPs. This study developed a novel environmentally friendly oxidation technology, which provides an effective strategy to reduce the generation of DBPs in the Cl-/PMS system.

Abstract PO1-23-03: Management and risk of upgrade of Atypical Ductal Hyperplasia in the breast – a population-based retrospective cohort analysis

Abstract Introduction International guidelines recommend open surgery for Atypical Ductal Hyperplasia (ADH) in the breast due to risk of underestimating malignant disease. The aim here was to evaluate the management and risk for upgrade of lesions diagnosed as ADH in percutaneous breast biopsies in two Swedish institutions. Methods All women with a screen-detected or symptomatic ADH diagnosed on percutaneous biopsy between 2013-2022 at Sundsvall and Umeå University Hospitals were included. Women with lesions classified as Breast imaging-reporting and data system (BI-RADS) 5 (highly suspicious) or 6 (confirmed malignancy) were excluded. Data were retrieved from medical records and histopathology reports. Odds ratio (OR) and 95 % confidence intervals (CI) for upgrade to malignant diagnosis after surgery was calculated by logistic regression analysis. Results Altogether, 101 women were included, mean age 56.1 years (range 36-93 years). Most women were selected from the national mammography screening program due to microcalcifications. Biopsies were performed with vacuum-assisted biopsy (VAB)(60.4%) or core-needle biopsy (CNB)(39.6%). Forty-eight women (47.5%) underwent surgery. Presence of a first degree relative with breast cancer (p &amp;lt; 0.001), more extensive microcalcifications (p=0.01), biopsies with ADH bordering DCIS (p=0.01) and CNB as opposed to VAB (p=0.02) increased the likelihood of surgical excision. Among the women undergoing surgery, eleven were upgraded to Ductal Carcinoma in Situ and seven to invasive breast cancer (overall upgrade rate 37.5%). In these women, no variable correlating to risk of upgrade in the surgical specimen was identified. After median 74 months of follow-up (range 4-105 months), one out of 53 women managed conservatively (1.9%) developed subsequent ipsilateral DCIS. Conclusion The upgrade rate to carcinoma was 37.5% after surgery while the estimated 5-year risk of ipsilateral upgrade in women managed conservatively was 1.9%. Acknowledging the short median follow-up time, these results indicate that the selection for non-surgical management in a subset of women was appropriate. Summary of histopathological results after surgical excision of ADH Citation Format: Charlotta Wadsten, Gunilla Rask. Management and risk of upgrade of Atypical Ductal Hyperplasia in the breast – a population-based retrospective cohort analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-23-03.

Abstract PO3-07-09: B3 breast lesions in Asian Centers: malignant upgrade rates and risk factors

Abstract Background Lesions of uncertain malignant potential in the breast (B3 lesions) are composed of a wide spectrum of pathologies with differing risks of breast cancer. With the widespread implementation of screening programs globally, the incidence of these lesions has increased substantially. Asian women tend to have smaller and denser breasts than Western women, making identifying and treating these lesions more challenging. Previous papers quote an upgrade of B3 lesions to malignancy such as ductal carcinoma in situ (DCIS) or cancer at rates of 9.9% to 35.1%. Malignant upgrade on final histology increases patient anxiety and healthcare costs as a second surgical intervention is often required for pathological clearance or lymph node staging. This study aimed to assess the malignant upgrade rate of B3 lesions in Asian women and to evaluate any key factors that may predict the risk of a malignant upgrade. Materials and Methods A retrospective multicentre international study was done on patients at Seoul National University Hospital (SNUH), South Korea, from April 2021 to 2023, and Tan Tock Seng Hospital (TTSH), Singapore, between March 2006 and 2023. Patients who were diagnosed with a B3 lesion on initial breast core needle biopsy and underwent surgical open excision were included in the study. Results A total of 1049 patients were diagnosed with B3 lesions, with 154 (14.7%) upgrading to malignancy. The most common malignancy was DCIS, 118 (76.6%), followed by invasive ductal carcinoma (IDC), 20 (13.0%) and papillary carcinoma, 4 (2.6%). Within the types of B3 lesions, the malignant upgrade rates were found: atypical ductal hyperplasia (ADH), 88/252 (35%); intraductal papilloma (IDP) with atypia, 16/55 (29%); lobular neoplasia (LN), 9/34 (26%); and radial scar (RS), 5/21 (24%). Most patients had both ultrasound and mammographic evaluation, and all lesions in the study were graded BIRADS 4A and above. Univariate analysis showed that age &amp;gt;50 (OR 2.30 [1.61-3.31], p&amp;lt; 0.001), BMI &amp;gt;23 (OR 2.21 [1.20-4.12], p=0.01), post-menopausal status (OR 2.43 [1.34-4.34], p&amp;lt; 0.001), lesion being identified on mammography (OR 3.00 [2.04-4.51], p&amp;lt; 0.001) and presence of microcalcifications on mammography (OR 0.63 [0.41-0.98], p=0.04) were risk factors for malignant upgrade. Conclusion Based on our analysis of Asian women, post-menopausal patients with microcalcifications on mammography and a B3 biopsy result should be treated with a higher degree of suspicion for underlying malignancy. Surgical excision with adequate margins should be routinely considered for B3 lesions such as ADH, IDP with atypia, LN and RS. Avoidance of surgery or vacuum-assisted removal can be considered for younger patients with only ultrasound findings and diagnosis of FEA and IDP. Table 1. Malignant upgrade after excision Table 2. Clinical characteristics of all patients according to malignant upgrade Table 3. Univariate and multivariate analysis for malignant upgrade Citation Format: Wei Wen Ang, Ji-Jung Jung. B3 breast lesions in Asian Centers: malignant upgrade rates and risk factors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-09.

Outcomes of atypical lobular hyperplasia managed by active surveillance or immediate surgery.

Atypical lobular hyperplasia (ALH) is typically diagnosed via needle core biopsy (NCB) and is commonly removed surgically in light of upgrade to malignancy rates of 1%-5%. As studies on radiographic outcomes of ALH managed by active surveillance (AS) are limited, we investigated the upgrade rates of surgically excised ALH as well as radiographic progression during AS. In this retrospective study, 125 patients with 127 ALH lesions diagnosed via NCB at Weill Cornell Medicine from 2015 to 2021 were included. The upgrade rate to cancer was determined for patients who had surgical management ≤6months after biopsy. Among patients with ALH managed by AS, we investigated radiographic progression on 6-month interval imaging. Of 127 ALH lesions, 75% (n=95) were immediately excised and 25% (n=32) were observed under AS. The upgrade rate of immediately excised ALH was 2.1% (n=2; invasive ductal carcinoma [IDC], T1N0 and IDC, and T1Nx). In the AS cohort, no ALH lesions progressed radiographically during the follow-up period of 22.5months (median), with all remaining stable (50%, n=16), resolving (47%, n=15), or decreasing in size (3%, n=1). In this study, NCB-diagnosed ALH had a low upgrade to malignancy rate (2.1%), and no ALH lesions managed by AS progressed radiographically during the follow-up period of 22.5months. These results support AS as the favorable option for patients with pure ALH on biopsy, with surgical excision for lesions that progress on surveillance.

Atypia Involving Fibroadenomas: Outcomes and Upgrade Rates.

Fibroadenomas (FAs) involved by atypia are rare. Consensus guidelines for management of FAs involved by atypia when diagnosed on image-guided biopsy do not exist because of limited data reporting surgical upgrade rates to ductal carcinoma in situ (DCIS) or invasive malignancy. Therefore, these lesions commonly undergo surgical excision. This single-institution retrospective study identified cases of FAs involved by atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) diagnosed on image-guided biopsy between January 2014 and April 2023 to determine upgrade rates. Cases with incidental atypia adjacent to but not involving FAs were excluded. Among 1736 FAs diagnosed on image-guided biopsy, 32 cases (1.8%) were FAs involved by atypia including 43.8% (14/32) ALH, 28.1% (9/32) ADH, 18.8% (6/32) LCIS, 6.3% (2/32) LCIS + ALH, and 3.1% (1/32) unspecified atypia. The most common imaging finding was a mass. Most cases, 81.3% (26/32), underwent subsequent surgical excisional biopsy. A single case of ADH involving and adjacent to an FA was upgraded to FA involved by low-grade DCIS on excision for an overall surgical upgrade rate of 3.8%. There were no cases upgraded to invasive malignancy. For those omitting surgical excision, there was no subsequent malignancy diagnosis at the FA biopsy site over a mean follow-up of 73 months. Cases of radiologic-pathologic concordant FAs involved by atypia have a low upgrade rate of 3.8% and should undergo multidisciplinary review. Larger multi-institutional analysis is needed to determine whether guidelines for excision of atypia should apply to atypia involving FAs.

Upgrade Rates of Variant Lobular Carcinoma In Situ Compared to Classic Lobular Carcinoma In Situ Diagnosed in Core Needle Biopsies: A 10-Year Single Institution Retrospective Study

The primary aim of this study was to determine the upgrade rates of variant lobular carcinoma in situ (V-LCIS, ie, combined florid [F-LCIS] and pleomorphic [P-LCIS]) compared with classic LCIS (C-LCIS) when diagnosed on core needle biopsy (CNB). The secondary goal was to determine the rate of progression/development of invasive carcinoma on long-term follow-up after primary excision. After institutional review board approval, our institutional pathology database was searched for patients with “pure” LCIS diagnosed on CNB who underwent subsequent excision. Radiologic findings were reviewed, radiologic–pathologic (rad-path) correlation was performed, and follow-up patient outcome data were obtained. One hundred twenty cases of LCIS were identified on CNB (C-LCIS = 97, F-LCIS = 18, and P-LCIS = 5). Overall upgrade rates after excision for C-LCIS, F-LCIS, and P-LCIS were 14% (14/97), 44% (8/18), and 40% (2/5), respectively. Of the total cases, 79 (66%) were deemed rad-path concordant. Of these, the upgrade rate after excision for C-LCIS, F-LCIS, and P-LCIS was 7.5% (5 of 66), 40% (4 of 10), and 0% (0 of 3), respectively. The overall upgrade rate for V-LCIS was higher than for C-LCIS (P = .004), even for the cases deemed rad-path concordant (P value: .036). Most upgraded cases (23 of 24) showed pT1a disease or lower. With an average follow-up of 83 months, invasive carcinoma in the ipsilateral breast was identified in 8/120 (7%) cases. Six patients had died: 2 of (contralateral) breast cancer and 4 of other causes. Because of a high upgrade rate, V-LCIS diagnosed on CNB should always be excised. The upgrade rate for C-LCIS (even when rad-path concordant) is higher than reported in many other studies. Rad-path concordance read, surgical consultation, and individualized decision making are recommended for C-LCIS cases. The risk of developing invasive carcinoma after LCIS diagnosis is small (7% with ∼7-year follow-up), but active surveillance is required to diagnose early-stage disease.

Management and risk of upgrade of atypical ductal hyperplasia in the breast: A population-based retrospective cohort study.

International guidelines recommend open surgery for atypical ductal hyperplasia (ADH) in the breast due to risk of underestimating malignant disease. Considering the ongoing randomized trials of active surveillance of low-risk ductal carcinoma in situ (DCIS), it seems reasonable to define a low-risk group of women with ADH where a conservative approach is appropriate. The aim here was to evaluate the management and risk for upgrade of lesions diagnosed as ADH in percutaneous breast biopsies in two Swedish hospitals. All women with a screen-detected or symptomatic breast lesion breast imaging-reporting and data system (BI-RADS) 2-4 and a percutaneous biopsy showing ADH between 2013 and 2022 at Sundsvall Hospital and Umeå University Hospital were included. Information regarding imaging, histopathology, clinical features, and management was retrieved from medical records. Odds ratio (OR) and 95% confidence intervals (CI) for upgrade to malignant diagnosis after surgery were calculated by logistic regression analysis. Altogether, 101 women were included with a mean age 56.1 (range 36-93) years. Most women were selected from the national mammography screening program due to microcalcifications. Biopsies were performed with vacuum-assisted biopsy (60.4%) or core-needle biopsy (39.6%). Forty-eight women (47.5%) underwent surgery, of which 11 were upgraded to DCIS, and 7 to invasive breast cancer (upgrade rate 37.5%). Among the 53 women managed conservatively (median follow-up 74 months), one woman (1.9%) developed subsequent ipsilateral DCIS. The combined upgrade rate was 18.8%. No clinical variable statistically significantly correlating to risk of upgrade was identified. The upgrade rate of 37.5% in women undergoing surgery compared to an estimated 5-year risk of ipsilateral malignancy at 1.9% in women managed conservatively indicate that non-surgical management of select women with ADH is feasible. Research should focus on defining reproducible criteria differentiating high-risk from low-risk ADH.

Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention.

This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively, p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.

ASO Visual Abstract: Upgrade Rates and Breast Cancer Development Among Germline Pathogenic Variant Carriers with High-Risk Breast Lesions.

ASO Visual Abstract: Upgrade Rates and Breast Cancer Development Among Germline Pathogenic Variant Carriers with High-Risk Breast Lesions.