Comments on: Core Biopsy of Atypical Micropapillary Hyperplasia and Need for Surgical Biopsy http://www.pacificbreastpathology.com/blog/ask_the_pathologist/core-biopsy-of-atypical-micropapillary-hyperplasia-and-need-for-surgical-biopsy/ Pacific Breast Pathology weblog Thu, 12 Jan 2012 21:28:04 -0800 http://wordpress.org/?v=2.9.2 hourly 1 By: drlawton http://www.pacificbreastpathology.com/blog/ask_the_pathologist/core-biopsy-of-atypical-micropapillary-hyperplasia-and-need-for-surgical-biopsy/comment-page-1/#comment-5851 drlawton Thu, 31 Mar 2011 17:44:40 +0000 http://www.breastpathologyconsults.com/blog/?p=581#comment-5851 Michael-- I understand your concern. Over-treating patients is not the way to go. However, the distinction between ADH and DCIS is a pathologic one. Breast imaging (MRI/Mammo/Ultrasound) cannot distinguish the two. A core biopsy is just a sampling of the area that the breast imager thought was suspicious. Based on the data (and yes, the numbers do vary), there are many cases that are called ADH on core but when more tissue is taken there is DCIS. The current standard of care is to surgically excise ADH when diagnosed on core biopsy. Your wife can obviously opt to not have that done, but please make sure she is aware that if there is DCIS in the breast that was not removed, there is data to suggest that could be a precursor to invasive cancer. I hope this helps. Michael–

I understand your concern. Over-treating patients is not the way to go. However, the distinction between ADH and DCIS is a pathologic one. Breast imaging (MRI/Mammo/Ultrasound) cannot distinguish the two. A core biopsy is just a sampling of the area that the breast imager thought was suspicious. Based on the data (and yes, the numbers do vary), there are many cases that are called ADH on core but when more tissue is taken there is DCIS.

The current standard of care is to surgically excise ADH when diagnosed on core biopsy. Your wife can obviously opt to not have that done, but please make sure she is aware that if there is DCIS in the breast that was not removed, there is data to suggest that could be a precursor to invasive cancer.

I hope this helps.

]]> By: (Mike) Loving Husband http://www.pacificbreastpathology.com/blog/ask_the_pathologist/core-biopsy-of-atypical-micropapillary-hyperplasia-and-need-for-surgical-biopsy/comment-page-1/#comment-5723 (Mike) Loving Husband Sun, 27 Mar 2011 03:28:17 +0000 http://www.breastpathologyconsults.com/blog/?p=581#comment-5723 I am very concerned with what seems to be a rush to excisional biopsy, where previous core biopsy shows ADH. The 20%-30% upgrade stats seem to be contradicted by more and more studies, indicating in actual practice, it may be 15%. Why not use F/u MRI and Mammo to monitor the breast for additional indications of carcinoma. God Bless, Michael I am very concerned with what seems to be a rush to excisional biopsy, where previous core biopsy shows ADH. The 20%-30% upgrade stats seem to be contradicted by more and more studies, indicating in actual practice, it may be 15%. Why not use F/u MRI and Mammo to monitor the breast for additional indications of carcinoma.

God Bless,

Michael

]]> By: drlawton http://www.pacificbreastpathology.com/blog/ask_the_pathologist/core-biopsy-of-atypical-micropapillary-hyperplasia-and-need-for-surgical-biopsy/comment-page-1/#comment-1631 drlawton Sun, 21 Nov 2010 00:12:28 +0000 http://www.breastpathologyconsults.com/blog/?p=581#comment-1631 I apologize for not responding earlier--some comments have not been getting to my mailbox and are being filtered out. Was the diagnosis on core made because of a mass or because of calcifications or another reason? If it was for a mass, the size of the mass would determine the amount of tissue to be taken. If it was for calcifications, then the radiologist would determine the extent of the calcifications and recommend with the surgeon how much tissue should be removed in order to make sure all of the suspicious calcifications are removed at surgery. I hope this helps--and again, apologies for the computer glitch. I hope all goes well for you. I apologize for not responding earlier–some comments have not been getting to my mailbox and are being filtered out. Was the diagnosis on core made because of a mass or because of calcifications or another reason? If it was for a mass, the size of the mass would determine the amount of tissue to be taken. If it was for calcifications, then the radiologist would determine the extent of the calcifications and recommend with the surgeon how much tissue should be removed in order to make sure all of the suspicious calcifications are removed at surgery. I hope this helps–and again, apologies for the computer glitch. I hope all goes well for you.

]]> By: Deb http://www.pacificbreastpathology.com/blog/ask_the_pathologist/core-biopsy-of-atypical-micropapillary-hyperplasia-and-need-for-surgical-biopsy/comment-page-1/#comment-1431 Deb Wed, 27 Oct 2010 02:29:58 +0000 http://www.breastpathologyconsults.com/blog/?p=581#comment-1431 Dear Dr. Lawton, I too have been given the same diagnosis as above with a core biopsy. I am wondering how does one determine how much tissue to excise? I am getting a different answer from the Surgeon I was referred to who says about the size of a golf ball (1/3 of my breast) vs the Dr who did the core biopsy who said much smaller.. like a large grape. I am confused... and not sure if a golf ball is normal or excessive. Thoughts? Thanks, Deb Dear Dr. Lawton,
I too have been given the same diagnosis as above with a core biopsy. I am wondering how does one determine how much tissue to excise? I am getting a different answer from the Surgeon I was referred to who says about the size of a golf ball (1/3 of my breast) vs the Dr who did the core biopsy who said much smaller.. like a large grape. I am confused… and not sure if a golf ball is normal or excessive. Thoughts?
Thanks,
Deb

]]> By: drlawton http://www.pacificbreastpathology.com/blog/ask_the_pathologist/core-biopsy-of-atypical-micropapillary-hyperplasia-and-need-for-surgical-biopsy/comment-page-1/#comment-185 drlawton Mon, 08 Feb 2010 06:24:50 +0000 http://www.breastpathologyconsults.com/blog/?p=581#comment-185 Sharon-- I am not sure if you had a breast pathologist read your initial slides, so if you wanted a second opinion on your diagnosis, I would recommend getting a second opinion from a breast pathology specialist to either confirm the presence of atypical hyperplasia or not. It's easy to get a copy of your pathology report and at the bottom of that report you can see the pathologist's name and can search that person online. It is the pathologist's diagnosis of "atypia" that is driving further surgical biopsy. Your radiologist or surgeon is simply responding to that diagnosis and the current standard of care. Let me know if you need any more assistance. Thomas J. Lawton MD Sharon–

I am not sure if you had a breast pathologist read your initial slides, so if you wanted a second opinion on your diagnosis, I would recommend getting a second opinion from a breast pathology specialist to either confirm the presence of atypical hyperplasia or not. It’s easy to get a copy of your pathology report and at the bottom of that report you can see the pathologist’s name and can search that person online. It is the pathologist’s diagnosis of “atypia” that is driving further surgical biopsy. Your radiologist or surgeon is simply responding to that diagnosis and the current standard of care.

Let me know if you need any more assistance.

Thomas J. Lawton MD

]]> By: sharon http://www.pacificbreastpathology.com/blog/ask_the_pathologist/core-biopsy-of-atypical-micropapillary-hyperplasia-and-need-for-surgical-biopsy/comment-page-1/#comment-184 sharon Mon, 08 Feb 2010 05:58:13 +0000 http://www.breastpathologyconsults.com/blog/?p=581#comment-184 Dear Dr. Lawton, Thanks for your quick response. It's very much appreciated. Who should I go to for the second opinion... Oncologist, Pathologist. Please advise. With Best Regards, Sharon Dear Dr. Lawton,
Thanks for your quick response. It’s very much appreciated. Who should I go to for the second opinion… Oncologist, Pathologist.
Please advise.
With Best Regards,
Sharon

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