Help with biopsy report

[mrkd]

Please help me understand my report, They highlighted "mitotic rate" so i guess that is important?  They want me to have a surgical excision, do you think i need one?  It seems they got a lot of tissue with the biopsy, and when he called he said it was not cancer- would keeping a close eye on it work?  I do not know what some of the words they use mean?
Thanks
Pathologic Diagnosis:
Right nodular lesions, stereotactic core biopsy
Combined cystic and papillary proliferation
Rare benign microcalcifications observed

Note:
The papillary lesions appears to represent a portion of a benign ductal papilloma in the setting of proliferative fibrocystic disease.  Close clinical and radiologic followup is recommended, and a surgical excision might be considered for complete lesional characterization.

Microscopic description:
The biopsy is generous and evaluated on multiple levels showing proliferative fibrocystic changes as well as dominate partially cystic and partially papillary proliferation.  The lesion is associated with patchy apocrine metaplasia and usual ductal hyperplasia without cytoarchitectural atypism.  A slightly increased mitotic rate is noted focally within the papillary process that retains a histologically apparent myoepithelial cell layer.  Rare benign microcalcifications are noted within the proliferative compartment.

Gross Description:
The specimen consists of many (approximately 12) partially disrupted and hemorrhagic needle core biopsies.  1x1x1 cm overall aggregate dimensions.

[kittyluv1]

A related discussion, Excision of Ductal Papillomas was started.

[mrkd]

I saw my surgeon today, he wants me to come back for a mamogram and follow up in three month's.  He wants to keep a close eye on it- no surgery at this time.  Hopefully this is the right thing to do. Thanks so much for the help.

[CCF-RN,MSN-rf]

Dear mrkd:  The samples obtained so far are benign.  In theory, close followup would be adequate.  The only reason to do a surgical excision is if there is concern that surrounding areas not in the sample may contain cells that would indicate more aggressive intervention.

[mrkd]

Thanks so much for the answer, i do have a few more questions.  What is papillary proliferation and apocrine metapla?
I did have breast cancer 14 years ago, it was ER positive. I took tamoxifen for 5 years.
thanks

[surgeon]

papillary proliferation means that the cells that are growing form finger-like projections in the duct. Its significance is mixed: any extra growth of the cells is noteable, but papillary proliferation without atypia is not considered highly significant. Apocrine is the type of glands of which breast glands are an example; others include sweat glands, etc. Metaplasia is a process of changing appearance; again, it's noteable but not, per se,  of great significance in terms of cancer risk. Taken together with your personal history, it tells you what you already know: you have greater than average risk of developing breast cancer, and need a regular plan of surveillance. Your personal history, which I believe you hadn't mentioned in your first post, is another reason, I'm sure, the more definitive biopsy was suggested.

[surgeon]

Among the things we don't fully understand about breast behavior is why some women have lots more action within the ducts than others. Meaning that sometimes we see lots of cells dividing and growing more than normal. Why this occurs, and what is its significance is not well known. Some features seem more significant than others, and the question is when such changes are found, does it indicate a higher risk of developing cancer in the future; or could it also indicate something going on nearby that could have been missed by the biopsy. Mitotic rate means how fast cells are dividing; in cancer it's usually much higher than normal. Atypia means changes in the way cells look that can be along the spectrum between normal on one end and cancer on the other. So your biopsy was a bit equivocal. It shows lots of proliferation. Increased mitotic rate sort of goes along with it (you can't have proliferation without cells dividing). But there's no atypia, which is good. Whether to have an excisional biopsy depends also on what it was that was orginally seen that led to the core biopsy, so it's hard to make a comment without that knowledge. It boils down to this: given what was seen on the multiple cores, the chances that something else would be found (assuming it was an adequate sampling of whatever it was that had been noted on the xray) is quite low. But not absolutely zero. Likewise, based on the biopsy, there may be some increased risk of future development of cancer (it's possible that risk could be better assessed by a more complete excision of that area). So no matter whether you have an excisional biopsy or not, you'll need to be very regular in your followup. How best to deal with all this is a matter of personal comfort, derived from clear discussions with your doctors