Ultrasound Features and Rate of Upgrade to Malignancy in Atypical Apocrine Lesions of the Breast

Objectives To evaluate the ultrasound (US) features and rate of upgrade to malignancy in atypical apocrine lesions (AALs) of the breast, diagnosed on percutaneous needle biopsy. Methods This retrospective study included 17 AALs diagnosed by needle biopsy in 15 patients. For 16 of the 17 AALs, subseq...

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Bibliographic Details
Published in:Journal of ultrasound in medicine 2020-08, Vol.39 (8), p.1517-1524
Main Authors: Jung, Hyun Kyung, Kim, Suk Jung, Kim, Woogyeong, Lim, Yun‐Jung, Lee, Yedaun, Hahn, Seok, Lee, Ho‐Joon
Format: Article
Language:English
Subjects:
atypical apocrine lesion
Biopsy, Needle
breast
Breast - diagnostic imaging
Breast Neoplasms - diagnostic imaging
Female
Fibrocystic Breast Disease - diagnostic imaging
Humans
Retrospective Studies
Ultrasonography
ultrasound
upgrade rate
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Summary:Objectives To evaluate the ultrasound (US) features and rate of upgrade to malignancy in atypical apocrine lesions (AALs) of the breast, diagnosed on percutaneous needle biopsy. Methods This retrospective study included 17 AALs diagnosed by needle biopsy in 15 patients. For 16 of the 17 AALs, subsequent surgical excision (n = 14) or 8‐gauge vacuum‐assisted biopsy (n = 2) was performed. Ultrasound features were retrospectively analyzed according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. Results Of 17 AALs, 13 (76.5%) were atypical apocrine hyperplasia; 3 (17.6%) were atypical apocrine adenosis; and 1 (5.9%) was combined atypical apocrine hyperplasia and atypical apocrine adenosis on needle biopsy. Subsequently, 4 of 16 AALs (25%) were upgraded to malignancy at surgical excision. On US imaging, all 17 lesions presented as masses, which were mainly irregular and noncircumscribed (n = 8) or oval/round and noncircumscribed (n = 7) with isoechogenicity or hypoechogenicity. Rarely, an AAL would show complex cystic and solid echogenicity (n = 1) or appear as a hypoechoic mass with oval shape and a circumscribed margin (n = 1). Conclusions Atypical apocrine lesions of the breast often showed suspicious malignant features on US imaging. Given the high upgrade rate (25%), the diagnosis of an AAL by needle biopsy warrants subsequent surgical excision.
ISSN:0278-4297
1550-9613
DOI:10.1002/jum.15240