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breast biopsy

Indications: - evaluation of breast lump - diagnosis of breast cancer Procedure: - complications similar for stopping or continuing antiplatelet agents with core needle biopsy [5] Pathology: - risk of breast cancer after benign histology on breast biopsy is relative to specific histologic pattern. - in order of increasing 15 year risk* by histology a) non-proliferative pattern# RR: 1.3 b) proliferative pattern without atypia RR: 1.9 c) atypical hyperplasia RR: 4.2 - risk for breast cancer ~30% over 25 years - found in ~10% of biopsies with benign findings - atypical ductal hyperplasia & atypical lobular hyperplasia occur with equal frequency & confer similar increased risks of later breast cancer [2] * risk relative to reference population # if no family history of breast cancer, no increased risk in this group Notes: - pathologists disagree in on diagnosis 25% of time - concordance by diagnosis [3,4] - 96-97% for invasive cancer - 70-84% for ductal carcinoma in situ (DCIS) - 40-48% for atypical hyperplasia (atypia) - 87-97% for benign lesions without atypia

General

tissue biopsy

References

  1. Hartmann LC et al Benign breast disease and the risk of breast cancer. N Engl J Med. 2005 Jul 21;353(3):229-37. PMID: 16034008
  2. Hartmann LC et al Atypical Hyperplasia of the Breast - Risk Assessment and Management Options. N Engl J Med 2015; 372:78-89. January 1, 2015 PMID: 25551530 http://www.nejm.org/doi/full/10.1056/NEJMsr1407164
  3. Elmore JG et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA 2015 Mar 17; 313:1122. PMID: 25781441 http://jama.jamanetwork.com/article.aspx?articleid=2203798 - Davidson NE and Rimm DL. Expertise vs evidence in assessment of breast biopsies: An atypical science. JAMA 2015 Mar 17; 313:1109 PMID: 25781438 http://jama.jamanetwork.com/article.aspx?articleid=2203783
  4. Elmore JG et al Variability in Pathologists' Interpretations of Individual Breast Biopsy Slides: A Population Perspective. Annals of Internal Medicine. March 22, 2016 http://annals.org/article.aspx?articleid=2505396 - Borowsky A, Esserman L When the Gold Standard Loses Its Luster, Perhaps It Is Time to Change Nomenclature. Annals of Internal Medicine. March 22, 2016 http://annals.org/article.aspx?articleid=2504523
  5. Reichman MB, McMahon P, Dwyer M et al. Bleeding events after image-guided breast biopsies: Comparison of patients temporarily discontinuing versus maintaining antithrombotic therapy during biopsy. AJR Am J Roentgenol 2023 Oct; 221:438. PMID: 37162038
  6. Medline Plus: Breast biopsy http://www.nlm.nih.gov/medlineplus/ency/article/003920.htm
  7. Mayo Clinic: Breast biopsy http://www.mayoclinic.com/health/breast-biopsy/MY00301