• The Korean Journal of Cytopathology
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• v.5 no.1
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• pp.52-56
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• 1994

We experienced a case of fine-needle aspiration (FNA) cytology of breast which showed atypical proliferative lesion. It was very difficult to differentiate this case from malignancy, because of hypercellular smear and many clusters composed of large, atypical ductal cells. However, it showed other features favoring benignancy, such as tendency of cellular cohesiveness, only slightly increased nucleus/cytoplasm ratio and most importantly presence of myoepithelial cells. It's histologic diagnosis was intraductal hyperplasia with atypia. This case indicates that all atypical breast FNA specimen should lead to the suggestion of surgical biopsy for avoiding over- or under-diagnosis.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.3733-3736
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• 2016

HER2/neu is a well-established prognostic and predictive factor for invasive breast cancer. However, the role of HER2/neu in ductal breast carcinoma in situ (DCIS) is debated and recent data have suggested that it is mainly linked to in situ local recurrence. Although molecular data suggest that atypical ductal hyperplasia (ADH) and duct carcinoma in situ (DCIS) are related lesions, albeit with vastly different clinical implications, the role of HER2/neu expression in atypical ductal hyperplasia is not well defined either. The aim of this study was to evaluate over expression of HER2/neu in DCIS and cases of ADH in comparison with invasive breast carcinoma. Archival primary breast carcinoma paraffin blocks (n=15), DCIS only (n=10) and ductal epithelial hyperplasia and other breast benign lesions (n=25) were analyzed for HER2/neu immunoexpression. Follow up was available for 40% of the patients. HER2/neu was positive in 80%of both DCIS and invasive carcinoma, and 67% of atypical ductal hyperplasia (ADH) cases. Thus at least a subset of patients with preinvasive breast lesions were positive, which strongly suggests a role for Her2/neu in identifying high-risk patients for malignant transformation. Although these are preliminary data, which need further studies of gene amplification within these patients as well as a larger patient cohort with longer periods of follow up, they support the implementation of routine Her2/neu testing in patients diagnosed as pure DCIS and in florid ADH.

• The Journal of Korean Obstetrics and Gynecology
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• v.33 no.1
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• pp.36-58
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• 2020

Objectives: We conducted a literature study on the treatment trends in China to find out the possibility of Oriental medicine treatment of atypical hyperplasia of breast (AHB). Methods: RCTs (randomized controlled trial) on AHB were collected from CNKI (China National Knowledge Infrastructure). The search words were "乳腺增生", "乳腺囊性增生", "乳癖", "中医", "中药" and "中西医结合". The search period was limited from July 2006 to May 2017. Finally, we selected 107 RCTs which were clinical studies to find out the effectiveness of Chinese herbal medicine in comparison with Western medicine. After reviewing, we investigated Chinese herbal medication guide, Chinese treatment method and prescriptions. And the correlation between the treatments and the medicinal herbs was investigated to be useful in the clinical practice. Results: 1. The administration of herbal medicine was 58.9 percent in 63 cases, followed by menstrual cycles, and 41.1 percent in 44 cases, regardless of menstrual cycles. 2. In the basic frequency analysis between the treatment and the medicinal herb, the frequency of dissipate binds (散結) was the highest. Next, there was a high frequency of therapies such as activating blood-activating (活血), relieve pain (止痛), soothe the liver (疏肝), regulate qi (理氣), resolve phlegm (化痰), soften hardness (軟堅), resolve depression (解鬱), move qi (行氣) of frequency was high. In herbal medicine, bupleuri radix (柴胡), cyperi rhizoma (香附子), angelicae gigantis radix (當歸), fritillaria thunbergii bulb (貝母), paeoniae radix alba (白芍藥), prunellae spica (夏枯草), corydalis rhizoma (玄胡索) showed high frequency. 3. We finded out the correlation between the frequent treatment methods and the medicinal herbs using Text Mining. Conclusions: These findings are thought to help implement Korean traditional medicine treatments for AHB.

• Journal of the Korean Society of Radiology
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• v.81 no.6
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• pp.1504-1510
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• 2020

In this case report, we present the radiologic and pathologic findings of atypical ductal hyperplasia (ADH) in the male breast. It is well known that a high-risk lesion such as ADH is a precursor of breast cancer in females. However, the clinical significance of these lesions in the male breast is still uncertain because male breasts mainly consist of ducts without lobule formation, unlike the female breast. To our knowledge, imaging findings of ADH in the male breast have not been reported previously, except for a few studies on the pathologic findings of these lesions. Through this paper, we would like to present the possible imaging features of this high-risk lesion in the male breast and review the related literature.

• Korean Journal of Radiology
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• v.21 no.11
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• pp.1220-1229
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• 2020

Objective: Stereotactic vacuum-assisted breast biopsy (VABB) is considered a reliable alternative to surgical biopsy for suspicious calcifications. In most cases, the management of flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) after VABB with residual calcifications requires surgical excision. This study aimed to evaluate the impact of pathology of non-calcified specimens on the underestimation of malignancy. Materials and Methods: We retrospectively reviewed 1147 consecutive cases of stereotactic VABB of suspicious calcifications without mass from January 2010 to December 2016 and identified 46 (4.0%) FEA and 52 (4.5%) ADH cases that were surgically excised for the retrieval of residual calcifications. Mammographic features and pathology of the calcified and non-calcified specimens were reviewed. Results: Seventeen specimens (17.3%) were upgraded to malignancy. Mammographic features associated with the underestimation of malignancy were calcification extent (> 34.5 mm: odds ratio = 6.059, p = 0.026). According to the pathology of calcified versus non-calcified specimens, four risk groups were identified: Group A (ADH vs. high-risk lesions), Group B (ADH vs. non-high-risk lesions), Group C (FEA vs. high-risk lesions), and Group D (FEA vs. non-high-risk lesions). The lowest underestimation rate was observed in Group D (Group A vs. Group B vs. Group C vs. Group D: 35.0% vs. 20.0% vs. 15.0% vs. 3.6%, p = 0.041, respectively). Conclusion: Considering that the calcification extent and pathology of non-calcified specimens may be beneficial in determining the likelihood of malignancy underestimation, excision after FEA or ADH diagnosis by VABB is required, except for the diagnoses of FEA coexisting without atypia lesions in non-calcified specimens.

• The Korean Journal of Cytopathology
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• v.5 no.2
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• pp.106-112
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• 1994

Fine needle aspiration biopsy has been proved as a safe, accurate and cost-effective diagnostic modality in palpable breast lesions. Cytologically, fibrocystic disease can be classified into 3 categories as nonproliferative breast disease, proliferative breast disease without atypia, and proliferative breast disease with atypia. This terminology for fine needle aspirates is compatible with that of diagnostic histopathology. Cytologic differentiation of nonproliferative disease from proliferative breast disease is important, since the risk of cancer development in cases of atypical hyperplasia is 4-5 times higher than that of general population. Twenty five fine needle aspirates of fibrocystic disease confirmed by subsequent histopathology were re-evaluated and classified into 3 categories depending on their architectural and nuclear features. In addition, these aspirates were scored according to the cytologic grading system, devised by Masood et al. and based on six cytologic criteria. Concordance rates between cytomorpholgic diagnosis and cytologic diagnosis using the cytologic criteria grading system and histologic diagnosis were 88% and 92%, respectively.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.5
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• pp.2385-2392
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• 2012

The lack of effective treatment targets for triple-negative breast cancers make them unfitted for endocrine or HER2 targeted therapy, and their prognosis is poor. Transcription factor ER81, a downstream gene of the HER2, is highly expressed in breast cancer lines, breast atypical hyperplasia and primary breast cancers including triple-negative examples. However, whether and how ER81 affects breast cancer carcinogenesis have remained elusive. We here assessed influence on a triple-negative cell line. ER81-shRNA was employed to silence ER81 expression in the MDA-MB-231 cell line, and MTT, colony-forming assays, and flow cytometry were used to detect cell proliferation, colony-forming capability, cell cycle distribution, and cell apoptosis in vitro. MDA-MB-231 cells stably transfected with ER81-shRNA were inoculated into nude mice, and growth inhibition of the cells was observed in vivo. We found that ER81 mRNA and protein expression in MDA-MB-231 cells was noticeably reduced by ER81-shRNA, and that cell proliferation and clonality were decreased significantly. ER81-shRNA further increased cell apoptosis and the residence time in $G_0/G_1$ phase, while delaying tumor-formation and growth rate in nude mice. It is concluded that ER81 may play an important role in the progression of breast cancer and may be a potentially valuable target for therapy, especially for triple negative breast cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.7
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• pp.3179-3183
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• 2014

Background: The purpose of study was to evaluate radiologic or clinical features of breast cancer undergoing ultrasound (US)-guided 14G core needle biopsy (CNB) and analyze the differences between underestimated and accurately diagnosed groups. Materials and Methods: Of 1,898 cases of US-guided 14G CNB in our institute, 233 cases were proven to be cancer by surgical pathology. The pathologic results from CNB were invasive ductal carcinoma (IDC) (n=157), ductal carcinoma in situ (DCIS) (n=40), high-risk lesions in 22 cases, and benign in 14 cases. Among high-risk lesions, 7 cases of atypical ductal hyperplasia (ADH) were reported as cancer and 11 cases of DCIS were proven IDC in surgical pathology. Some 29 DCIS cases and 157 cases of IDC were correctly diagnosed with CNB. The clinical and imaging features between underestimated and accurately diagnosed breast cancers were compared. Results: Of 233 cancer cases, underestimation occurred in 18 lesions (7.7%). Among underestimated cancers, CNB proven ADH (n=2) and DCIS (n=11) were diagnosed as IDC and CNB proven ADH (n=5) were diagnosed at DCIS finally. Among the 186 accurately diagnosed group, the CNB results were IDC (n=157) and DCIS (n=29). Comparison of underestimated and accurately diagnosed groups for BI-RADS category, margin of mass on mammography and US and orientation of lesion on US revealed statistically significant differences. Conclusions: Underestimation of US-guided 14G CNB occurred in 7.7% of breast cancers. Between underestimated and correctly diagnosed groups, BI-RADS category, margin of the mass on mammography and margin and orientation of the lesions on US were different.

• Journal of the Korean Society of Radiology
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• v.83 no.3
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• pp.632-644
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• 2022

Purpose To determine the incidence of atypical ductal hyperplasia (ADH) in needle biopsy and the upgrade rate to carcinoma, and to evaluate difference in findings between the upgrade and non-upgrade groups. Materials and Methods Among 9660 needle biopsies performed over 48 months, we reviewed the radiologic and histopathologic findings of ADH and compared the differences in imaging findings (mammography and breast US) and biopsy methods between the upgrade and non-upgrade groups. Results The incidence of ADH was 1.7% (169/9660). Of 112 resected cases and 30 cases followed-up for over 2 years, 35 were upgraded to carcinoma (24.6%, 35/142). The upgrade rates were significantly different according to biopsy methods: US-guided core needle biopsy (USCNB) (40.7%, 22/54) vs. stereotactic-vacuum-assisted biopsy (S-VAB) (16.0%, 12/75) vs. USguided VAB (US-VAB) (7.7%, 1/13) (p = 0.002). Multivariable analysis showed that only US-CNB (odds ratio = 5.19, 95% confidence interval: 2.16-13.95, p < 0.001) was an independent predictor for pathologic upgrade. There was no upgrade when a sonographic mass was biopsied by US-VAB (n = 7) Conclusion The incidence of ADH was relatively low (1.7%) and the upgrade rate was 24.6%. Surgical excision should be considered because of the considerable upgrade rate, except in the case of US-VAB.

• The Korean Journal of Nuclear Medicine
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• v.33 no.1
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• pp.76-83
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• 1999

Purpose: We performed this study to compare T1-201 and Tc-99m MIBI scans for the differentiation of malignant from benign breast mass. Materials and Methods: Thirty-eight female patients underwent T1-201 breast scan and thirty-two of them also underwent Tc-99m MIBI scan of the breast. After intravenous injection of 74-111 MBq of T1-201, early (10 minutes) and delayed (3 hours) images were obtained. Then, 555-740 MBq of Tc-99m MIBI was injected and images after 30 minutes were obtained. We compared T1-201 and Tc-99m MIBI scans with pathologic results. Results: Twenty-three patients were confirmed to have infiltrating duct carcinoma and fifteen patients to have benign breast mass by excisonal biopsy. The sensitivity of early and delayed T1-201 scan and Tc-99m MIBI scan in the detection of malignant breast lesion were 100% (23/23), 82% (18/22), and 90% (18120), respectively. The sensitivity of early T1-201 scan was significantly higher than that of delayed T1-201 scan (p<0.05). The specificity of early and delayed T1-201 scan and Tc-99m MIBI scan were 73% (l1/15), 73% (l1/15) and 83% (10/12), respectively (p: not significant). Three patients out of nine with fibroadenoma and one patient with atypical duct hyperplasia were false positive in both early and delayed T1-201 scans. The size of fibroadenoma with false positive in early and delayed T1-201 scan (4 cases) was larger than that of 11 fibroadenoma with true negative scan (p<0.01). Metastatic axillary lymph node involvement was present in fifteen patients. The sensitivity to detect metastatic nodes was 38% (5/13) for early T1-201 images, 15% (2/13) for delayed T1-201 images, 58% (7/12) for Tc-99m MIBI planar images and 67% (4/6) for Tc-99m MIBI SPECT. The sensitivity of Tc-99m MIBI planar or SPECT was significantly higher than that of delayed T1-201 images (p<0.05). Conclusion: Early T1-201 and Tc-99m MIBI scan are useful noninvasive methods to differentiate malignant from benign mass of breast Tc-99m MIBI scan was sensitive in detecting axillary lymph node metastasis in patients with breast cancer.