Secretory and Cystic Hypersecretory Changes at Breast Core Needle Biopsy: Clinical, Radiologic and Pathologic Findings in 67 Cases
Lanie Galman, Jeffrey Catalano, Anibal Cordero, Muzaffar Akram, Edi Brogi. Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Focal secretory changes (SC) of the mammary epithelium, including cystic hypersecretory changes (CH-SC), can occur independent of pregnancy and lactation. Information about the significance of these findings at breast core needle biopsy (CNB) of radiologically-detected lesions is limited.
Design: We searched for CNBs with diagnosis including the term “secretory” or “hypersecretory” and performed at our center between 1992 and 2012. Patient (pt) data were extracted from the e-medical records. CNBs with malignant diagnosis, from lactating/pregnant pts, or with diffuse SC in all cores were excluded from the study. A pathologist (LG) reviewed all available slides from the CNBs and selected those with SC for review with another pathologist (EB). Subsequent ipsilateral breast specimens were also reviewed.
Results: We found 67 CNBs with SC, including 2 CH-SC. Patients (pts) had mean age 46 years (range 29-72), with 17 (25%) >50 years. Thirty-five (52%) pts had family history (hx) of breast carcinoma, 12 had ductal carcinoma (10 invasive, 2 in situ; 11 contralateral, 1 ipsilateral), 1 had ipsilateral atypical ductal hyperplasia (ADH), 2 had atypical lobular hyperplasia (ALH) and 1 had lobular carcinoma in situ (LCIS). Two pts had hx of mantle radiation. At the time of CNB, 18/67 (27%) pts took hormone replacement therapy or oral contraceptives. CNB sampled calcifications (Ca2+) (42/67, 63%), MRI abnormality (17/67, 25%), and mammographic/sonographic mass (M/S) (8/67, 12%). Only 3/67 (4%) SC were atypical, including an atypical CH-SC showing nuclear crowding, hyperchromasia and mitoses. SC involved 2.8 lobules (range 1, 13) per case and had mean span of 1.5 mm (range 0.4, 3). Of note, the lesion span in the two cases of CH-SC was 1.7 mm and 2.3 mm. SC, including one CH-SC, contained Ca2+ and were the primary finding in 33/42 (78%) CNBs targeting Ca2+. No other lesion beside SC was consistently present in CNBs targeting MRI abnormalities. In addition to SC, CNBs for M/S yielded 4 fibroadenomas, and papilloma, adenosis, and stromal fibrosis in the rest. Additional tissue from 9/67 pts was benign, and contained ADH+LCIS, ALH, and atypical CH-SC in one case each.
Conclusions: Focal SC, including CH-SC, are a rare finding at CNB. Most CNBs yielding SC target mammographic Ca2+ and SC with associated Ca2+ account for the radiologic lesion in over 75% of case. All CNBs with SC in our series are benign, including those with CH-SC. Our results can be useful to pathologists and clinicians who encounter these rare lesions in their practice.
Monday, March 4, 2013 2:00 PM
Proffered Papers: Section B, Monday Afternoon