[142] 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.

Frequency of atypical proliferative lesions in breast reduction mammoplasty performed for macromastia (n=2351)
Atypical Proliferative lesionBilateral (%)Right (%)Left (%)Total (%)
Invasive carcinoma0011 (0.04)
DCIS0404 (0.2)
ADH6221644 (1.9)
LCIS18716 (0.7)
ALH6181640 (1.7)
FEA0213 (0.1)
Total13 (0.6)54 (2.3)41 (1.7)108 (4.6)

Conclusions: This is the largest retrospective study that has assessed the prevalence of APL in reduction mammoplasty. The frequency of detection of these lesions in patients with no history of invasive or in situ carcinoma is low (4.6%). Detection of invasive and DCIS lesions is extraordinarily low at 0.2%. The most common APL is lobular neoplasia (56/2351; 2.4%). ADH and FEA represent 2% (47/2351). Our findings provide data on the distribution of these lesions in this setting, as well as some insight on the prevalence in the general population.
Category: Breast

Monday, March 4, 2013 1:00 PM

Proffered Papers: Section B, Monday Afternoon


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