Incidence of Carcinoma and Atypia in Breast Reduction Mammoplasty Specimens
Rita Canas Marques, Melinda F Lerwill. Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal; Massachusetts General Hospital, Boston, MA
Background: Reduction mammoplasty is a common cosmetic procedure. Occult cancers and atypical epithelial proliferations are occasionally found in these specimens, although the incidence of such changes is not well established. Our aim was to define the incidence of carcinomas and atypical proliferations in a large series of mammoplasties, with the goal of using this information to develop recommendations for pathology sampling protocols.
Design: 911 consecutive mammoplasty cases were retrieved from the Massachusetts General Hospital pathology database from 2005-2010. All specimens were processed according to a standard protocol, requiring a minimum of 2 blocks per breast for patients <50 y of age with no history of breast cancer (HBC) and a minimum of 10 blocks per breast for patients ≥50 y of age or with HBC. Clinical and pathological data were recorded. Findings were categorized as invasive carcinoma (IC), DCIS without IC, atypical proliferations (LCIS, ADH, ALH, and flat epithelial atypia (FEA)), and benign.
Results: Patients ranged in age from 14-78 y (median, 43 y). 161/911 (18%) patients had HBC. The median specimen weight was 520 g. The number of blocks ranged from 2-37. 2 (0.2%) patients had occult IC, 1 case of grade 1 ILC and 1 case of grade 2 IDC. 8 (0.9%) patients had DCIS without IC, which was grade 1 in 5 cases, grade 2 in 1 case, and grade 3 in 2 cases. Both patients with IC had HBC, whereas only 1 of 8 patients with DCIS had HBC. Of the remaining 901 patients without IC or DCIS, 167 (19%) had at least one form of atypical proliferation. LCIS was found in 50 (6%) patients, ADH in 75 (8%), ALH in 47 (5%), FEA in 44 (5%), and other epithelial atypia in 5 (0.5%). The median age of patients with atypia/carcinoma was 52 y, while the median age of those with benign findings was 40 y. 113/303 (37%) patients ≥50 y had atypia/carcinoma, while only 64/608 (11%) patients <50 y did so. When stratified according to HBC, 59/161 (37%) HBC+ and 118/750 (16%) HBC- patients had atypia/carcinoma.
Conclusions: Occult IC or DCIS was found in 1% of patients. Atypical proliferations were found in 19% of the remaining patients. In total, 177/911 (19%) patients had significant pathologic findings, either atypia or carcinoma. More than 1/3 of patients ≥50 y of age had significant findings, as did >1/3 of patients with HBC. Increased sampling in patients ≥50 y and those with HBC is recommended for the detection of incidental carcinoma and atypia, which can have important clinical implications.
Monday, March 4, 2013 1:15 PM
Proffered Papers: Section B, Monday Afternoon