Upgrade Rates of DCIS, Intraductal Papilloma, and the Other High-risk Breast Lesions

Background: In benign breast lesions such as intraductal papilloma (IDP), atypical hyperplasia (AH), flat epithelial atypia (FEA) and lobular carcinoma in situ (LCIS), there is a 3-20% risk of upgrade to invasive or in situ breast cancer following excision. The aim of this study was to determine the upgrade rates for high-risk breast lesions (HRBL), which were diagnosed by core needle biopsy (CNB), to invasive or in situ breast carcinoma, and to determine to upgrade rates for ductal carcinoma in situ (DCIS) to invasive breast carcinoma in the second group. In addition, we investigated in which patient groups these rates are higher. Materials and Methods: It was planned to include all female patients who had undergone surgical procedures following the determination of IDP, AH, FEA, LCIS, or DCIS after CNB under ultrasonographic guidance between April 2014 and August 2020. As there were no patients diagnosed with pure LCIS with biopsy, this was not included in the analysis. Patients were excluded from the study if more than 6 months had elapsed between CNB and excision, or if they had a history of breast cancer or radiotherapy. Demographic data, radiological findings and histopathological results were collected retrospectively from the hospital records. Results: A total of 123 patients with diagnosis following CNB were evaluated. The diagnoses were IDP in 70.7% of patients, AH in 8.9%, FEA in 4.9%, and DCIS in 15.5%. The upgrade rates for invasive breast cancer were 30%, 0%, 16.7%, and 31.6%. The upgrade rates for DCIS were calculated as 3.5% in IDP, 45.5% in AH, and 0% in FEA. Especially, in IDP group upgrade was seen more at older ages, and when there were more than 2 two papilloma (p<0.05). The upgrade risk for DCIS after excision was 31.6%. Conclusion: The upgrade risk for HRBL was found to vary between 5.8% and 45.5%, and the upgrade risk for DCIS after excision was 31.6%. In patients with HBRL; older ages, the presence of a multifocal lesion, a palpable mass, and radiological-histopathological discordance were seen to be risk factors for upgrade.