Pathologic Upgrade Rates of High-Risk Breast Lesions on Digital Two-Dimensional vs Tomosynthesis Mammography Leslie R. Lamb, MD, MSc, Manisha Bahl, MD,

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Pathologic Upgrade Rates of High-Risk Breast Lesions on Digital Two-Dimensional vs Tomosynthesis Mammography Leslie R. Lamb, MD, MSc, Manisha Bahl, MD, MPH, Kevin S. Hughes, MD, FACS, Constance D. Lehman, MD, PhD Journal of the American College of Surgeons Volume 226, Issue 5, Pages 858-867 (May 2018) DOI: 10.1016/j.jamcollsurg.2017.12.049 Copyright © 2018 American College of Surgeons Terms and Conditions

Figure 1 A 46-year-old female presented with screen-detected architectural distortion in the right breast. Tomosynthesis-guided core needle biopsy and final surgical excision yielded radial scar. (A) Mediolateral oblique spot compression tomosynthesis image demonstrated architectural distortion (arrow). (B) Gross surgical specimen marked with ink shows a poorly defined, spiculated mass (arrow) composed of white tissue with slender radial bands of pale stroma extending from the core into the fat. (C) Routine staining with hematoxylin and eosin reveals the classic stellate configuration seen with a radial scar (2× magnification). Journal of the American College of Surgeons 2018 226, 858-867DOI: (10.1016/j.jamcollsurg.2017.12.049) Copyright © 2018 American College of Surgeons Terms and Conditions

Figure 2 A 75-year-old female presented with a screen-detected mass in the right breast. Ultrasound-guided core needle biopsy yielded an atypical papilloma, and final surgical pathology revealed a grade 1 invasive ductal carcinoma. (A) Craniocaudal and (B) mediolateral oblique mammographic views demonstrate a mass in the upper outer breast (arrow). (C) Ultrasound demonstrated a 6-mm oval hypoechoic mass without peripheral color Doppler flow (arrow). Journal of the American College of Surgeons 2018 226, 858-867DOI: (10.1016/j.jamcollsurg.2017.12.049) Copyright © 2018 American College of Surgeons Terms and Conditions

Figure 3 A 46-year-old female presented for evaluation of an area of palpable concern in the right breast. Transverse ultrasound image demonstrated a 16-mm hypoechoic mass (arrow). Core needle biopsy yielded a biphasic neoplasm, suspicious for phyllodes. Surgical excision revealed a low-grade phyllodes tumor, with few clusters of carcinoma cells in lymphatic vessels, associated with lobular carcinoma in situ and a radial scar. Journal of the American College of Surgeons 2018 226, 858-867DOI: (10.1016/j.jamcollsurg.2017.12.049) Copyright © 2018 American College of Surgeons Terms and Conditions