Mucocele-like lesions; is it time to stop routine excision?
Association of Breast Surgery ePoster Library. Dash I. 05/15/17; 166183; P014
Ms. Isabella Dash
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Abstract
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Introduction; Mucocele like lesions (MLL) are classified as an indeterminate 'B3' lesion, due to difficulties distinguishing them from mucinous carcinoma on percutaneous breast biopsy (PBB). Current guidelines for surgical excision biopsy (EB) are based on small case series with varying rates of upgrade.
Aim; To asses our rates of upgrade in order to identify whether EB is necessary.
Methods; We performed a retrospective review of the Breast Screen Western Australia (BSWA) database from 1995-2014.
Results; Of the 32,400 (9%) women undergoing PBB in the time period, 89 were diagnosed with an MLL (0.4%). The mean age was 51 (40-80 years). The mammographic abnormality for 67 (75%) was 'localised cluster of calcifications'. Stereotactic PBB was performed for 73 (82%). Seventy-six (85%) underwent Hookwire EB. Fifty-seven patients (75%) had a final benign result, 12 (16%) had an indeterminate result and 7 (9%) had a malignant result. This included a grade 1 papillary carcinoma, a mucinous high grade ductal carcinoma in situ (DCIS) and 5 cases of low grade DCIS.
The mean length of follow up was 5 years (1-15 years). Three (3%) further ipsilateral cancers were identified, all in patients who had had previous excision biopsies, 3, 4 and 9 years subsequently.
Conclusion; None of our patients had an upgrade to mucinous carcinoma. The upgrade rate for MLL with atypia is 18%, however MLL without atypia is upgraded in only 7.5%. The increasing use of Vacuum assisted excision biopsy, may allow careful selection of patients with pure MLL who can avoid EB.
Aim; To asses our rates of upgrade in order to identify whether EB is necessary.
Methods; We performed a retrospective review of the Breast Screen Western Australia (BSWA) database from 1995-2014.
Results; Of the 32,400 (9%) women undergoing PBB in the time period, 89 were diagnosed with an MLL (0.4%). The mean age was 51 (40-80 years). The mammographic abnormality for 67 (75%) was 'localised cluster of calcifications'. Stereotactic PBB was performed for 73 (82%). Seventy-six (85%) underwent Hookwire EB. Fifty-seven patients (75%) had a final benign result, 12 (16%) had an indeterminate result and 7 (9%) had a malignant result. This included a grade 1 papillary carcinoma, a mucinous high grade ductal carcinoma in situ (DCIS) and 5 cases of low grade DCIS.
The mean length of follow up was 5 years (1-15 years). Three (3%) further ipsilateral cancers were identified, all in patients who had had previous excision biopsies, 3, 4 and 9 years subsequently.
Conclusion; None of our patients had an upgrade to mucinous carcinoma. The upgrade rate for MLL with atypia is 18%, however MLL without atypia is upgraded in only 7.5%. The increasing use of Vacuum assisted excision biopsy, may allow careful selection of patients with pure MLL who can avoid EB.
Introduction; Mucocele like lesions (MLL) are classified as an indeterminate 'B3' lesion, due to difficulties distinguishing them from mucinous carcinoma on percutaneous breast biopsy (PBB). Current guidelines for surgical excision biopsy (EB) are based on small case series with varying rates of upgrade.
Aim; To asses our rates of upgrade in order to identify whether EB is necessary.
Methods; We performed a retrospective review of the Breast Screen Western Australia (BSWA) database from 1995-2014.
Results; Of the 32,400 (9%) women undergoing PBB in the time period, 89 were diagnosed with an MLL (0.4%). The mean age was 51 (40-80 years). The mammographic abnormality for 67 (75%) was 'localised cluster of calcifications'. Stereotactic PBB was performed for 73 (82%). Seventy-six (85%) underwent Hookwire EB. Fifty-seven patients (75%) had a final benign result, 12 (16%) had an indeterminate result and 7 (9%) had a malignant result. This included a grade 1 papillary carcinoma, a mucinous high grade ductal carcinoma in situ (DCIS) and 5 cases of low grade DCIS.
The mean length of follow up was 5 years (1-15 years). Three (3%) further ipsilateral cancers were identified, all in patients who had had previous excision biopsies, 3, 4 and 9 years subsequently.
Conclusion; None of our patients had an upgrade to mucinous carcinoma. The upgrade rate for MLL with atypia is 18%, however MLL without atypia is upgraded in only 7.5%. The increasing use of Vacuum assisted excision biopsy, may allow careful selection of patients with pure MLL who can avoid EB.
Aim; To asses our rates of upgrade in order to identify whether EB is necessary.
Methods; We performed a retrospective review of the Breast Screen Western Australia (BSWA) database from 1995-2014.
Results; Of the 32,400 (9%) women undergoing PBB in the time period, 89 were diagnosed with an MLL (0.4%). The mean age was 51 (40-80 years). The mammographic abnormality for 67 (75%) was 'localised cluster of calcifications'. Stereotactic PBB was performed for 73 (82%). Seventy-six (85%) underwent Hookwire EB. Fifty-seven patients (75%) had a final benign result, 12 (16%) had an indeterminate result and 7 (9%) had a malignant result. This included a grade 1 papillary carcinoma, a mucinous high grade ductal carcinoma in situ (DCIS) and 5 cases of low grade DCIS.
The mean length of follow up was 5 years (1-15 years). Three (3%) further ipsilateral cancers were identified, all in patients who had had previous excision biopsies, 3, 4 and 9 years subsequently.
Conclusion; None of our patients had an upgrade to mucinous carcinoma. The upgrade rate for MLL with atypia is 18%, however MLL without atypia is upgraded in only 7.5%. The increasing use of Vacuum assisted excision biopsy, may allow careful selection of patients with pure MLL who can avoid EB.
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