The unexpected unpleasant surprise: Malignancy on histopathology following duct excision surgery- is it avoidable?
Association of Breast Surgery ePoster Library. Cartlidge C. 05/13/19; 257071; P027
Mr. Christopher Cartlidge
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P027
Topic: Benign disease
Background: The unexpected diagnosis of cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, we still occasionally fail to detect malignant disease preoperatively.AimTo review the pathological findings of total duct excision with reference to pre-operative symptoms, ultrasound or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods Data were collected retrospectively of all patients who underwent total duct excision surgery in single centre (2011-2017). Pre-operative demographics, symptoms and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data was available for 211. Median age was 53y. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10.0%) had ‘risk' lesions (papilloma with atypia, ADH) and 15/211 (7.1%) had malignancy (DCIS).Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1).71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7.0%) had ‘risk' and 6/71 (8.5%) had malignant lesions.83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk and 10/83 (12.0%) malignancy.38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk and 2/38 (5.3%) malignant lesions.ConclusionNeither imaging nor presenting symptoms correlate with likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.
Topic: Benign disease
Background: The unexpected diagnosis of cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, we still occasionally fail to detect malignant disease preoperatively.AimTo review the pathological findings of total duct excision with reference to pre-operative symptoms, ultrasound or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods Data were collected retrospectively of all patients who underwent total duct excision surgery in single centre (2011-2017). Pre-operative demographics, symptoms and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data was available for 211. Median age was 53y. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10.0%) had ‘risk' lesions (papilloma with atypia, ADH) and 15/211 (7.1%) had malignancy (DCIS).Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1).71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7.0%) had ‘risk' and 6/71 (8.5%) had malignant lesions.83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk and 10/83 (12.0%) malignancy.38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk and 2/38 (5.3%) malignant lesions.ConclusionNeither imaging nor presenting symptoms correlate with likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.
P027
Topic: Benign disease
Background: The unexpected diagnosis of cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, we still occasionally fail to detect malignant disease preoperatively.AimTo review the pathological findings of total duct excision with reference to pre-operative symptoms, ultrasound or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods Data were collected retrospectively of all patients who underwent total duct excision surgery in single centre (2011-2017). Pre-operative demographics, symptoms and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data was available for 211. Median age was 53y. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10.0%) had ‘risk' lesions (papilloma with atypia, ADH) and 15/211 (7.1%) had malignancy (DCIS).Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1).71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7.0%) had ‘risk' and 6/71 (8.5%) had malignant lesions.83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk and 10/83 (12.0%) malignancy.38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk and 2/38 (5.3%) malignant lesions.ConclusionNeither imaging nor presenting symptoms correlate with likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.
Topic: Benign disease
Background: The unexpected diagnosis of cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, we still occasionally fail to detect malignant disease preoperatively.AimTo review the pathological findings of total duct excision with reference to pre-operative symptoms, ultrasound or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods Data were collected retrospectively of all patients who underwent total duct excision surgery in single centre (2011-2017). Pre-operative demographics, symptoms and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data was available for 211. Median age was 53y. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10.0%) had ‘risk' lesions (papilloma with atypia, ADH) and 15/211 (7.1%) had malignancy (DCIS).Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1).71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7.0%) had ‘risk' and 6/71 (8.5%) had malignant lesions.83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk and 10/83 (12.0%) malignancy.38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk and 2/38 (5.3%) malignant lesions.ConclusionNeither imaging nor presenting symptoms correlate with likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.
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