The Incidence Of Occult Malignant And High-risk Pathology In Breast Reduction And Contralateral Symmetry Reduction Specimens.
Amir Razavi, MD, Alexandra Hart, MD, Udayan Betarbet, MD, Xiaoxian Li, MD, Grant Carlson, MD, Albert Losken, MD.
Emory, Atlanta, GA, USA.
PURPOSE: The goal of the study was to determine the incidence of occult malignancy and high-risk breast pathology in patients who undergo breast reduction procedures.
METHODS: Patients who underwent reduction mammoplasty (reduction weight ≥ 350 grams) by the senior authors at Emory university hospital between 1997-2018 were included. Patients were categorized into group A: reduction for symptomatic macromastia and group B: contralateral reduction for unilateral breast cancer treated with oncoplastic partial or total breast cancer reconstruction. Pathology findings were divided into four groups; normal breast pathology, benign (fibrocystic change, fibroadenoma, intraductal papilloma or sclerosing adenosis), high-risk (lobular carcinoma in situ, atypical ductal or lobular hyperplasia or papilloma with atypia) and malignant (ductal carcinoma in situ or invasive carcinoma).
RESULTS: Total 1014 patients (1419 breast reductions) were included in the study. Comparing group A and B, mean age was 37.8±16.2 vs 54.5±11.1 (P<0.001), BMI was 34.1±7.6 vs 33.3±7.4 (P=0.2) and average reduction weight was 948.9±493 vs 723.6±370 grams (P<0.001). The incidence of high-risk or malignant lesions was 1.9% (n=15) in group A and 8.1% (n=49) in group B (P<0.001).
CONCLUSION: The incidence of abnormal pathology in breast reduction specimens is not uncommon, and occult malignancy or high-risk lesions can be found especially in patients with a history of breast cancer. Appropriate specimen orientation, diligence with checking the pathology and open communication with the pathologist is crucial.
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