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Clinical Management of Mucocele-Like Lesions of the Breast with Limited or no Epithelial Atypia on Core Biopsy: Experience from Two Institutions

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Mucocele-like lesions of the breast identified on core biopsy are rare high-risk lesions associated with variable upgrade rates to carcinoma on excision. We aimed to identify the clinicoradiopathological features that can help optimize management of this lesion.

Methods

We evaluated 50 mucocele-like lesions identified on core biopsies from two institutions, including 36 with no atypia and 14 with limited atypia. Outcome data from excision or clinicoradiological follow-up were reviewed with core biopsy results.

Results

Radiological targets were calcifications in 74% of cases, calcifications with associated mass or density in 16%, and mass in 10%. One of the 16 excised lesions without atypia on core biopsy, which was a mass lesion, was upgraded to mucinous carcinoma on excision. Of the 12 excised lesions with limited atypia, none were upgraded on excision. Among the lesions not excised, 20 without atypia had a median follow-up of 61 months, and 2 with limited atypia had follow-up of 97 and 109 months. None of these 22 patients had new development of their lesions on follow-up. The upgrade rate was 2% in our entire cohort, 3% for lesions without atypia, and 0% for lesions with limited atypia.

Conclusions

Clinicoradiological surveillance can be appropriate when a mucocele-like lesion without atypia is identified on core biopsy for a non-mass lesion with pathological-radiological concordance. For mucocele-like lesions with limited atypia, a nonsurgical approach could be considered if the atypia by itself does not warrant excision. The latter recommendation requires careful clinicopathological correlation and support from additional studies.

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Acknowledgment

The authors thank Kim-Anh Vu in the Department of Pathology at The University of Texas MD Anderson Cancer Center for her assistance with the figures and Sarah Bronson, ELS, in the Department of Scientific Publications at MD Anderson for editing the manuscript.

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Author notes

  1. Tanya W. Moseley and Sejal S. Shah are co-first authors.

Authors and Affiliations

  1. Department of Diagnostic Radiology, Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Tanya W. Moseley MD & Juliana Rosenblat MD

  2. Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA

    Sejal S. Shah MD

  3. Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Christopher V. Nguyen MD, Erika Resetkova MD, PhD, Nour Sneige MD & Lei Huo MD, PhD

  4. Department of Radiology, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Kathy R. Brandt MD

Authors
  1. Tanya W. Moseley MD
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  2. Sejal S. Shah MD
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  3. Christopher V. Nguyen MD
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  4. Juliana Rosenblat MD
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  5. Erika Resetkova MD, PhD
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  6. Nour Sneige MD
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  7. Kathy R. Brandt MD
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  8. Lei Huo MD, PhD
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Corresponding authors

Correspondence to Kathy R. Brandt MD or Lei Huo MD, PhD.

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Moseley, T.W., Shah, S.S., Nguyen, C.V. et al. Clinical Management of Mucocele-Like Lesions of the Breast with Limited or no Epithelial Atypia on Core Biopsy: Experience from Two Institutions. Ann Surg Oncol 26, 3478–3488 (2019). https://doi.org/10.1245/s10434-019-07377-w

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  • DOI: https://doi.org/10.1245/s10434-019-07377-w

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