High-Risk Lesions at MRI-Guided Breast Biopsy: Frequency and Rate of Underestimation
Abstract
OBJECTIVE. The purpose of this article is to determine the underestimation rate of high-risk lesions diagnosed at MRI-guided breast biopsy.
MATERIALS AND METHODS. This was a retrospective review of 446 MRI-guided breast biopsies from January 2006 through December 2010. Data were collected on examination indication, lesion size and type, and pathology results. Biopsies were performed with a 9-gauge vacuum-assisted device. Biopsy results of atypical ductal hyperplasia (ADH), papillary lesion, radial scar, lobular neoplasia, and atypia were identified and compared with final excisional pathology results. Underestimation rates were calculated and data were compared by patient and lesion characteristics using chi-square analysis.
RESULTS. Of the 446 MRI-guided biopsies, 96 (21.5%) were high-risk lesions. Forty-two of 96 lesions (44%) were masses, and 54 (56%) showed nonmass enhancement. Twenty of 96 lesions (20.8%) were ADH, nine (9.4%) were lobular neoplasia, 27 (28.1%) were papillary lesions, 20 (20.8%) were radial scar, and 20 (20.8%) were other atypias. Sixty-nine of 96 lesions (71.9%) had surgical excisional pathology results available. Sixteen of 69 (23.2%) lesions were upgraded to malignancy; 11 of the 16 (68.8%) were upgraded to ductal carcinoma in situ (DCIS) and five (31.2%) were upgraded to invasive carcinoma. The underestimation rate was 31.6% (6/19) for ADH, 5.9% (1/17) for papillary lesions, 23.1% (3/13) for radial scar, 28.6% (2/7) for lobular neoplasia, and 30.8% (4/13) for other atypias (p = 0.43). There was no statistically significant difference in underestimation rate by lesion type, size, or history of newly diagnosed breast cancer.
CONCLUSION. MRI-guided breast biopsy yielded high-risk lesions in 21.5% of cases, and the underestimation rate was 23.2%. No patient or lesion characteristics correlated with underestimation rate.
Contrast-enhanced breast MRI is a sensitive method for identifying breast cancer and can detect lesions not readily depicted by mammography or ultrasound [1]. Percutaneous core-needle sampling of lesions detected by mammography, ultrasound, or MRI often obviates surgical excision if the results are benign [2–7]. However, high-risk lesions may be histologically upgraded to ductal carcinoma in situ (DCIS) or invasive cancer at the time of surgical excision [3, 8, 9]. For this reason, surgical excision is often recommended after a needle biopsy finding of a high-risk lesion. High-risk histologic lesions, such as atypical ductal hyperplasia (ADH), lobular neoplasia, papillary lesions, and radial scar, have poorly understood and variable biologic profiles [10–13]. Upgrade rates for stereotactic and ultrasound-guided core biopsies have been studied extensively [3, 8, 13–27]. The most common high-risk lesion, ADH, has variable upgrade rates that are most dependent on the needle gauge and number of samples obtained at the time of stereotactic vacuum-assisted sampling [13, 16, 19–24]. Specifically, ADH is upgraded approximately 50% of the time with a 14-gauge needle and 20% of the time with an 11-gauge needle [13, 19–24]. When ADH is sampled with a 9-gauge needle at the time of MRI-guided biopsy, it is upgraded to DCIS or invasive cancer up to 50% of the time [14, 15, 28]. Only a few studies have attempted to identify the pathologic upgrade rates for the most commonly encountered high-risk lesions at the time of MRI biopsy [14, 15, 28, 29]. However, because breast MRI and MRI-guided biopsy are increasingly used in screening high-risk patients or evaluating patients with newly diagnosed breast cancer, information about the upgrade rate for high-risk lesions is critical to informed patient counseling. To our knowledge, this is the largest single study of high-risk lesions identified at MRI-guided biopsy. The purpose of this study is to evaluate the upgrade rate for high-risk lesions at MRI-guided biopsy and to correlate upgrade rates with lesion and patient characteristics.
Materials and Methods
Patient Population
This institutional review board–approved HIPAA-compliant retrospective study reviewed 446 consecutive MRI-guided breast biopsies performed from January 2006 through December 2010 at two institutions with dedicated breast imaging centers. The institutional review board waived patient consent.
Breast MRI Technique and Interpretation
Dynamic contrast-enhanced breast MRI was performed at our institutions on closed 1.5-T (January 2006 through October 2010) and 3-T (from October 2010 onward) systems. A dedicated seven-channel breast coil was used from January 2006 through October 2010, and a 16-channel coil was used from October 2010 onward. Gadolinium-based contrast agent was administered at a concentration of 0.1 mmol/kg. From 2006 through 2007, gadodiamide (Omniscan, Amersham Health) was used. From 2007 (n = 93 patients) through 2010, gadopentetate dimeglumine (Magnevist, Bayer HealthCare Pharmaceuticals) was used (n = 353 patients). Premenopausal women were imaged on days 7–14 of the menstrual cycle unless the MRI was done for a newly diagnosed cancer, when patients were scheduled as soon as possible.
Breast MRI technique at 1.5 T included bilateral axial dynamic 3D T1-weighted fat-suppressed gradient-recalled echo pulse sequences obtained before and after contrast agent was administered. Dynamic images were obtained every 70 seconds for a total of six acquisition times. Section thickness was 2 mm. Sagittal contrast-enhanced images of each breast were obtained after the dynamic axial acquisition. Subtraction images were obtained from the dynamic series. Fluid-sensitive T2-weighted images were also obtained.
At 3 T, bilateral axial dynamic 3D T1-weighted gradient-recalled echo pulse sequences were obtained before and at 1, 2, and 6 minutes after administration of contrast agent. Section thickness was 1 mm. In addition, a higher-spatial-resolution axial sequence was performed between the early and delayed phases of the dynamic scans, with a 0.8-mm slice thickness. Sagittal reformatted contrast-enhanced images were created from this higher resolution sequence. Subtraction images were created from the dynamic series. STIR images were also obtained.
All datasets were reviewed on a PACS workstation (Centricity, GE Healthcare; or Horizon Medical Imaging, McKesson Medical Imaging) with computer-aided diagnosis (DynaCAD version 2.1.7.113583, Invivo) immediately adjacent and available for review of lesion enhancement kinetics, multiplanar reconstructions, and maximum-intensity-projection images. Examinations were interpreted in conjunction with any available prior breast imaging and clinical history.
All breast MRI studies were interpreted by one of seven radiologists with 3–10 years of experience in breast MRI and 3–5 years of experience in MRI-guided biopsy. The same radiologists performed all MRI-guided biopsies. Lesions detected by MRI were categorized using the BI-RADS MRI lexicon as outlined by the American College of Radiology [30]. Patients with BI-RADS category 4 or 5 lesions identified by MRI underwent a targeted ultrasound before MRI biopsy at the discretion of the reporting radiologist. In our practice, targeted ultrasound is recommended most commonly for masses and is infrequently used for nonmass lesions. If a sonographic correlate is identified, the biopsy is done with ultrasound guidance. In cases where ultrasound is negative, MRI-guided biopsy is done. Only cases where the biopsy was done with MRI guidance are included in this study. This was done to avoid the inevitable ambiguity that exists about whether the lesion detected on MRI corresponds to the lesion identified and biopsied at ultrasound.
Biopsy Technique
After we obtained standard informed consent and performed patient identification, the patient was positioned prone in a dedicated breast biopsy coil with the breast in compression using a grid device. Unenhanced and contrast-enhanced fat-suppressed gradient-echo T1-weighted images were obtained in the axial and sagittal planes. After lesions were identified on the MRI console, the biopsy images were transferred to a standalone computer with dedicated breast MRI biopsy software (DynaCAD version 2.1.7.113583, Invivo) and the lesion was targeted. Using standard biopsy technique, which has been described elsewhere [31], a minimum of six core biopsy samples were obtained using a 9-gauge vacuum-assisted device (Suros ATEC, Suros Surgical Systems, Hologic). A biopsy marking clip was placed into the biopsy cavity at the conclusion of the biopsy, and a mammogram was performed to verify clip placement. Diagnostic MR images, biopsy MR images, and postprocedure mammograms were reviewed in conjunction to determine whether the lesion of interest was accurately targeted. Core needle biopsy specimens were placed in formalin for histopathologic analysis. Surgical excision is routinely recommended for high-risk lesions in our practice. Patients who did not undergo mastectomy instead underwent preoperative mammographic needle localization of the biopsy marking clip. Specimen radiography was subsequently done to confirm excision of the biopsy marking clip. In patients undergoing mastectomy, the tissue was imaged mammographically and the biopsy marking clip was localized for pathology. Pathologists noted the presence of the biopsy site or marking clip in their reports.
Data Collection and Analysis
Data were collected from the MRI report and electronic medical record on patient age, indication for MRI, lesion type (mass vs nonmass) and size, number of biopsy cores obtained, presence or absence of known breast cancer, and pathology results from needle biopsy and surgical excision. All cases were included in the study if the MRI biopsy yielded ADH, atypia (flat epithelial atypia or atypia not otherwise specified), atypical lobular hyperplasia, lobular carcinoma in situ, radial scar, papillary lesion (both with and without atypia), or papilloma. Biopsies with malignant findings and those with benign findings without high-risk lesions were excluded. Cases with high-risk lesions on needle biopsy, but without available surgical excisional pathology, were also excluded for purposes of upgrade rate calculation. Surgical excisional pathology reports were compared with needle biopsy reports, and upgrade rates to DCIS and invasive cancer were calculated for each high-risk lesion. Data were also analyzed comparing upgrade rates by lesion type (mass vs nonmass lesion enhancement), lesion size, and presence or absence of newly diagnosed breast cancer, using chi-square analysis (Stata version 12, Stata-Corp). Chi-square analysis was also used to compare the upgrade rates.
Results
Patient and MRI Lesion Characteristics
Of the 446 MRI-guided needle biopsies, 96 (21.5%) found high-risk lesions. Three hundred twenty-nine MRI examinations and 94 biopsies were done at 1.5 T, and 117 MRI examinations and two biopsies were done at 3 T. A mean of 10 core biopsy samples (range, 6–13 samples) were obtained. The mean patient age was 52 years (range, 34–79 years). The average lesion size on MRI was 1.6 cm (range, 0.4–6.0 cm). Indications for breast MRI were preoperative staging in 45 of 96 (46.9%) cases, high-risk screening (lifetime risk of breast cancer > 20% as calculated by the referring provider, most frequently using the Gail or Tyrer-Cuzick models) in 41 (42.7%) cases, and other reasons (including abnormalities on mammogram or ultrasound, 6-month follow-up of probably benign findings on MRI or after benign MRI-guided biopsy, and palpable abnormality with negative mammogram and ultrasound) in 10 (10.4%) cases. For 45 patients with newly diagnosed breast cancers, the MRI biopsy target was in the contralateral breast in 28 (62.2%) cases, in a different quadrant of the ipsilateral breast in 15 (33.3%) cases, and in the same quadrant of the ipsilateral breast in two (4.4%) cases. Both of these biopsies in the same quadrant of the ipsilateral breast were done for linear nonmass enhancement extending anteriorly toward the nipple over more than 5 cm. Forty-two of the 96 high-risk lesions (44%) were masses and 54 (56%) were nonmass enhancement. The distribution of high-risk lesions is shown in Table 1.
| High-Risk Lesion | No. (%) of Cases |
|---|---|
| Atypical ductal hyperplasia | 20 (20.8) |
| Lobular neoplasia | 9 (9.4) |
| Papillary lesion | 27 (28.1) |
| Radial scar | 20 (20.8) |
| Other atypia | 20 (20.8) |
Pathology findings from surgical excision were available in 69 of 96 (71.9%) cases. Of these, 16 (23.2%) lesions were upgraded to malignancy (11 [68.8%] were upgraded to DCIS and five [31.2%] were upgraded to invasive carcinoma). Details are shown in Figure 1. Of the 27 women without excisional pathology findings available, 12 had benign follow-up breast imaging findings (one with mammography alone, six with MRI alone, and five with both mammography and MRI). The mammography follow-up interval after the high-risk MRI biopsy was 2–6 years (mean, 4.2 years). The range of MRI follow-up was 6 months to 5 years (mean, 2.6 years). Clinical notes in the electronic medical record reported that three patients underwent surgery at an outside institution, and none were upgraded to malignancy. Twelve patients did not have any available follow-up information.
Underestimation and Correlation to Lesion and Patient Characteristics
The underestimation rate by high-risk lesion is shown in Table 2. The underestimation rate for masses was 21.9% (7/32) and that for nonmass enhancement was 24.3% (9/37) (p = 0.81). The underestimation rate was 21.4% (6/28) for lesions smaller than 1 cm and 24.4% (10/41) for lesions 1 cm or larger (p = 0.77). Underestimation rates were 27.3% (9/33) for patients with newly diagnosed breast cancer and 19.4% (7/36) for those without a known cancer (p = 0.44).
| High-Risk Lesion | Underestimation Rate, No. of Lesions/Total (%) |
|---|---|
| Atypical ductal hyperplasia | 6/19 (31.6) |
| Lobular neoplasia | 2/7 (28.6) |
| Papillary lesion | 1/17 (5.9) |
| Radial scar | 3/13 (23.1) |
| Other atypia | 4/13 (30.8) |
Note—p = 0.43 for all underestimation rates.
Discussion
MRI-guided breast biopsies are now frequently performed as breast MRI has become more widely available. Data regarding the risk of upgrade to malignancy is important for patient counseling and for appropriate management recommendations when high-risk lesions are encountered during an MRI-guided breast biopsy. Although several studies [14, 15, 28, 29] have looked at upgrade rates for high-risk lesions, the numbers of patients in all studies is small, making it important to continue evaluating additional data as practice patterns evolve. Our study found high-risk lesions in 21.5% of MRI-guided biopsies, which is at the higher end of the range previously reported (3–21%) [29]. This may be related to the high-risk status of most patients in this study, where nearly 90% of all examinations were performed for either newly diagnosed breast cancer (46.9%) or for high-risk screening (42.7%). In prior studies [14, 15], 80–83% of breast MRI examinations were done for newly diagnosed breast cancer and high-risk screening, which is slightly lower than in our study.
The underestimation rate in our study, 23.2% for all high-risk lesions combined, is within the range previously reported [29]. The rate of underestimation was highest for ADH (31.6%) and lowest for papillary lesions (5.9%). Our study differs from previously published reports in that it contains the highest number of papillary lesions and radial scars reported in studies evaluating MRI-detected high-risk lesions. Some studies of high-risk lesions have excluded papillary lesions [6, 7, 14, 32, 33], but others have reported upgrade rates for papillary lesions ranging from 0% to 29% [28, 34, 35]. Our relatively low upgrade rate for papillary lesions raises questions about the need for surgical excision in patients with this result at needle biopsy. The upgrade rate for radial scars was 23.1% in this study, which supports surgical excision. Importantly, our study adds to the number of previously published reports of radial scar at MRI-guided biopsy, which was quite low, ranging from one to three [5, 6, 14, 28]. The increased numbers of radial scars and the high upgrade rate in this study may be, at least in part, related to the high-risk patient population.
Our study found no significant difference in upgrade rates when comparing mass versus nonmass enhancement, lesion size, and patient history of newly diagnosed breast cancer versus no known breast cancer. This is in keeping with other published studies [14, 28, 29]. This is not surprising, given the biologic heterogeneity of high-risk lesions and the inherent sampling limitations in MRI-guided needle biopsy. It may be useful to evaluate the number of biopsy cores obtained in relation to underestimation rate in future studies.
This study is limited by lack of surgical follow-up in 27 of 96 (28%) of cases, though this is within the range reported by others, which ranged up to 36% [14]. However, half of these patients without surgical follow-up had benign follow-up breast imaging, making the likelihood of occult malignancy in these patients relatively low. Additionally, pathology results were taken from the reports and slides were not rereviewed for this study. Because some patients were evaluated by MRI at higher field strength (3 vs 1.5 T), a selection bias is possible. A smaller percentage of radial scars (65% [13/20]) and papillary lesions (65% [13/20]) were excised as compared with ADH (95% [19/20]) and lobular neoplasia (78% [7/9]), which is another limitation of the study. However, this may be related to the controversial management of these particular high-risk lesions, because there remains considerable debate about the need for subsequent surgical excision when these lesions are identified on needle biopsy. Also, pathologists were not blinded to the clinical history or prior biopsies at the time of their interpretation, which may have biased their interpretations. However, this is reflective of actual clinical practice, where pathologists have such information accessible at the time of interpretation. Finally, there is interobserver variability in pathology reporting for atypias [36] and for distinguishing ADH from DCIS [37].
In conclusion, this study shows high-risk lesions are identified in 21.5% of all MRI-guided breast biopsies with an overall underestimation rate of 23.2%, which supports prior studies. We report the largest number of radial scars and papillary lesions identified at MRI-guided breast biopsy, with a relatively high underestimation rate of 23.1% for radial scars and a relatively low underestimation rate for papillary lesions of 5.9%. This information may help guide patient management decisions about surgical excision.
Acknowledgment
We thank Steven E. Reinert (Life Span Corporation) for assistance with statistical analysis.
References
1.
Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004; 351:427–437
2.
Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA Jr, Finkelstein SI, Shepard MJ. Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 1999; 210:799–805
3.
Kohr JR, Eby PR, Allison KH, et al. Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology 2010; 255:723–730
4.
Lehman CD, Deperi ER, Peacock S, McDonough MD, Demartini WB, Shook J. Clinical experience with MRI-guided vacuum-assisted breast biopsy. AJR 2005; 184:1782–1787
5.
Liberman L, Bracero N, Morris E, Thornton C, Dershaw DD. MRI-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience. AJR 2005; 185:183–193
6.
Orel SG, Rosen M, Mies C, Schnall MD. MR imaging-guided 9-gauge vacuum-assisted core-needle breast biopsy: initial experience. Radiology 2006; 238:54–61
7.
Perlet C, Heywang-Kobrunner SH, Heinig A, et al. Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Cancer 2006; 106:982–990
8.
Foster MC, Helvie MA, Gregory NE, Rebner M, Nees AV, Paramagul C. Lobular carcinoma in situ or atypical lobular hyperplasia at core-needle biopsy: is excisional biopsy necessary? Radiology 2004; 231:813–819
9.
Liberman L, Dershaw DD, Glassman JR, et al. Analysis of cancers not diagnosed at stereotactic core breast biopsy. Radiology 1997; 203:151–157
10.
Brem RF, Lechner MC, Jackman RJ, et al. Lobular neoplasia at percutaneous breast biopsy: variables associated with carcinoma at surgical excision. AJR 2008; 190:637–641
11.
Brenner RJ, Jackman RJ, Parker SH, et al. Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR 2002; 179:1179–1184
12.
Douglas-Jones AG, Denson JL, Cox AC, Harries IB, Stevens G. Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy. J Clin Pathol 2007; 60:295–298
13.
Jackman RJ, Birdwell RL, Ikeda DM. Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision? Radiology 2002; 224:548–554
14.
Strigel RM, Eby PR, Demartini WB, et al. Frequency, upgrade rates, and characteristics of high-risk lesions initially identified with breast MRI. AJR 2010; 195:792–798
15.
Liberman L, Holland AE, Marjan D, et al. Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR 2007; 188:684–690
16.
Lourenco AP, Mainiero MB, Lazarus E, Giri D, Schepps B. Stereotactic breast biopsy: comparison of histologic underestimation rates with 11-and 9-gauge vacuum-assisted breast biopsy. AJR 2007; 189:[web]W275–W279
17.
Niell B, Specht M, Gerade B, Rafferty E. Is excisional biopsy required after a breast core biopsy yields lobular neoplasia? AJR 2012; 199:929–935
18.
Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR 2006; 186:1328–1334
19.
Liberman L. Percutaneous image-guided core breast biopsy. Radiol Clin North Am 2002; 40:483–500 [vi]
20.
Jackman RJ, Nowels KW, Shepard MJ, Finkelstein SI, Marzoni FA Jr. Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology 1994; 193:91–95
21.
Liberman L, Cohen MA, Dershaw DD, Abramson AF, Hann LE, Rosen PP. Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy. AJR 1995; 164:1111–1113
22.
Liberman L, Kaplan JB, Morris EA, Abramson AF, Menell JH, Dershaw DD. To excise or to sample the mammographic target: what is the goal of stereotactic 11-gauge vacuum-assisted breast biopsy? AJR 2002; 179:679–683
23.
Winchester DJ, Bernstein JR, Jeske JM, et al. Upstaging of atypical ductal hyperplasia after vacuum-assisted 11-gauge stereotactic core needle biopsy. Arch Surg 2003; 138:619–622; discussion, 22–23
24.
Pandelidis S, Heiland D, Jones D, Stough K, Trapeni J, Suliman Y. Accuracy of 11-gauge vacuum-assisted core biopsy of mammographic breast lesions. Ann Surg Oncol 2003; 10:43–47
25.
Chang JM, Moon WK, Cho N, et al. Management of ultrasonographically detected benign papillomas of the breast at core needle biopsy. AJR 2011; 196:723–729
26.
Youk JH, Kim EK, Kim MJ. Atypical ductal hyperplasia diagnosed at sonographically guided 14-gauge core needle biopsy of breast mass. AJR 2009; 192:1135–1141
27.
Jang M, Cho N, Moon WK, Park JS, Seong MH, Park IA. Underestimation of atypical ductal hyperplasia at sonographically guided core biopsy of the breast. AJR 2008; 191:1347–1351
28.
Crystal P, Sadaf A, Bukhanov K, McCready D, O'Malley F, Helbich TH. High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted? Eur Radiol 2011; 21:582–589
29.
Heller SL, Moy L. Imaging features and management of high-risk lesions on contrast-enhanced dynamic breast MRI. AJR 2012; 198:249–255
30.
D'Orsi CJ, Mendelson EB, Ikeda DM, et al. Breast Imaging Reporting and Data System: ACR BI-RADS—breast imaging atlas. Reston, VA: American College of Radiology, 2003
31.
Liberman L, Morris EA, Dershaw DD, Thornton CM, Van Zee KJ, Tan LK. Fast MRI-guided vacuum-assisted breast biopsy: initial experience. AJR 2003; 181:1283–1293
32.
Rauch GM, Dogan BE, Smith TB, Liu P, Yang WT. Outcome analysis of 9-gauge MRI-guided vacuum-assisted core needle breast biopsies. AJR 2012; 198:292–299
33.
Tozaki M, Yamashiro N, Sakamoto M, Sakamoto N, Mizuuchi N, Fukuma E. Magnetic resonance-guided vacuum-assisted breast biopsy: results in 100 Japanese women. Jpn J Radiol 2010; 28:527–533
34.
Tseng HS, Chen YL, Chen ST, et al. The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol 2009; 35:21–24
35.
Daniel BL, Gardner RW, Birdwell RL, Nowels KW, Johnson D. Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging 2003; 21:887–892
36.
Darvishian F, Singh B, Simsir A, Ye W, Cangiarella JF. Atypia on breast core needle biopsies: reproducibility and significance. Ann Clin Lab Sci 2009; 39:270–276
37.
Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol 1992; 23:1095–1097
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Presented in part as an oral presentation at the RSNA 2011 annual meeting, Chicago, IL.
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Submitted: September 13, 2013
Accepted: December 21, 2013
First published: August 22, 2014
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