Incidental High Risk Lesions in Reduction Mammaplasty Specimens: Analysis of 2351 Cases from Large Women's Health Centers
Mohamed M Desouki, Oluwole Fadare, Chenquan Zhao. Vanderbilt University School of Medicine, Nashville, TN; Magee-Womens Hospital, Pittsburgh, PA
Background: Atypical proliferative lesions (APL) are occasionally found in breast reductions. The aim of the study is to investigate the prevalence of APL in reduction mammoplasty from patients that were treated primarily for macromastia.
Design: A retrospective chart review of pathology records on patients that underwent reduction mammoplasty for macromastia from 2006-11 retrieved 2351 cases. Exclusion criteria were a history of invasive or in-situ carcinoma on prior excision. Laterality, weight, and presence of APL were recorded and analyzed. APL included invasive carcinoma, ductal or lobular carcinoma in-situ (DCIS or LCIS), atypical ductal or lobular hyperplasia (ADH or ALH), and flat epithelial atypia (FEA). The presence of papillomas and radial scars were also noted.
Results: Among 2351 cases of reduction mammoplasty, 108 (4.6%) cases were diagnosed with an APL (table 1). Only one case of invasive duct carcinoma measured 0.2 cm and was assigned a Nottingham grade 1 was fond. Cases of ADH were associated with bilateral lobular neoplasia (n=4), ipsilateral ALH (n=6) and contralateral FEA (n=2). Papillomas and radial scars identified in 78 cases (3.3%). The former were interpreted as unilateral intraductal papilloma (IDP), unilateral multiple IDPs/papillomatosis, bilateral single IDP and bilateral multiple IDPs in 50, 14, 3 and 2 cases, respectively. Radial scars were identified in 9 cases. Out of the 108 cases with APL, 101 (93.5%) underwent bilateral and 7 cases (6.5%) underwent unilateral reduction. The average weight of right and left reductions with APL was 712 and 732 grams, respectively.
|Atypical Proliferative lesion||Bilateral (%)||Right (%)||Left (%)||Total (%)|
|Invasive carcinoma||0||0||1||1 (0.04)|
|Total||13 (0.6)||54 (2.3)||41 (1.7)||108 (4.6)|