Aims To fully elucidate the clinicopathological features of breast carcinoma in sclerosing adenosis (SA-BC).
Methods Clinical and histological characteristics of 206 SA-BCs from 180 patients were retrospectively evaluated. Immunohistochemical phenotype was examined. The clinicopathological relevance of the topographical pattern of SA-BCs was analysed.
Results Overall, up to 46 patients (25.6%) had contralateral cancer, either SA associated or not. Of 99 cases who underwent core needle biopsy (CNB), 36 were underestimated as adenosis or atypical ductal hyperplasia at CNB, 5 invasive cases were misinterpreted as in situ carcinomas, whereas 4 ductal carcinoma in situ (DCIS) cases were overdiagnosed as invasive carcinoma. Microscopically, 163 tumours were in situ, including 136 DCIS, 19 lobular carcinomas in situ (LCIS) and 8 mixed DCIS/LCIS; of these carcinomas in situ (CIS), 37 had microinvasion. The DCIS group exhibited low, intermediate and high grades in 53.7%, 34.6% and 11.8% of cases, respectively, mostly with solid (43.4%) or cribriform (41.9%) pattern. Forty out of 43 invasive cases were invasive ductal carcinoma (IDC), mostly DCIS predominant. Immunophenotypically, luminal A phenotype was identified in 55.1%, 63.2% and 45.0% of DCIS, LCIS and IDC cases, respectively. Topographical type A group (carcinoma being entirely confined to SA, n=176) was characterised by smaller size, less invasiveness, lower grade and more frequency of luminal A immunophenotype compared with type B group (≥ 50% but not all of the carcinomatous lesion being located in SA, n=30) (all P<0.05).
Conclusions CIS, especially non-high-grade DCIS, represents the most common variant of SA-BC, and luminal A is the most predominant immunophenotype. CNB assessment might be challenging in some SA-BCs. The topographical pattern has great clinicopathological relevance. Careful evaluation of the contralateral breast and long-term follow-up for patients with SA-BC is necessary given its high prevalence of bilaterality.
- breast pathology
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BHY and SXT are co-first authors and both contributed equally to the paper.
BHY and SXT contributed equally.
Handling editor Dhirendra Govender.
Contributors WTY: conceived the study and revised the manuscript. BHY: designed the study and wrote the manuscript. SXT: collected and analysed the data and reviewed the manuscript. XLX, YFC, RB, RHS, XYT and HFL: performed the morphological study and IHC evaluation. XYZ: performed data interpretation and reviewed the manuscript.
Funding This study was funded by Science and Technology Commission of Shanghai Municipality (15495810300).
Competing interests None declared.
Ethics approval the Institutional Review Board of Fudan University Shanghai Cancer Center, Shanghai, China.
Provenance and peer review Not commissioned; externally peer reviewed.
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