1
|
Ecanow JS, Ecanow DB, Hack B, Leloudas N, Prasad PV. Feasibility of Diffusion Tensor Imaging for Decreasing Biopsy Rates in Breast Imaging: Interim Analysis of a Prospective Study. Diagnostics (Basel) 2023; 13:2226. [PMID: 37443620 DOI: 10.3390/diagnostics13132226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Because of the limited specificity of diagnostic imaging, many breast lesions referred for biopsy turn out to be benign. The objective of this study was to evaluate whether diffusion tensor MRI (DTI) parametric maps can be used to safely avoid biopsy of breast lesions. Individuals referred for breast biopsy based on mammogram (MG), ultrasound (US), and/or contrast enhanced (CE)-MRI were recruited. Scans consisting of T2-weighted and DTI sequences were performed. Multiple DTI-derived parametric color maps were evaluated semi-quantitatively to characterize lesions as "definitely benign," "not definitely benign," or "suspicious." All patients subsequently underwent biopsy. In this moderately-sized prospective study, 21 out of 47 pathologically proven benign lesions were characterized by both readers as "definitely benign," which would have precluded the need for biopsy. Biopsy was recommended for 11 out of 13 cancers that were characterized as "suspicious." In the remaining two cancers and 26 of 47 benign lesions, the scans were characterized as "not definitely benign" and hence required biopsy. The main causes for "not definitely benign" scans were small lesion sizes and noise. The results suggest that in appropriately selected patients, DTI may be used to safely reduce the number of unnecessary breast biopsies.
Collapse
Affiliation(s)
- Jacob S Ecanow
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - David B Ecanow
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Bradley Hack
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Nondas Leloudas
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Pottumarthi V Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| |
Collapse
|
2
|
Mehta TS, Lourenco AP, Niell BL, Bennett DL, Brown A, Chetlen A, Freer P, Ivansco LK, Jochelson MS, Klein KA, Malak SF, McCrary M, Mullins D, Neal CH, Newell MS, Ulaner GA, Moy L. ACR Appropriateness Criteria® Imaging After Breast Surgery. J Am Coll Radiol 2022; 19:S341-S356. [PMID: 36436961 DOI: 10.1016/j.jacr.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Given that 20% to 40% of women who have percutaneous breast biopsy subsequently undergo breast surgery, knowledge of imaging women with a history of benign (including high-risk) disease or breast cancer is important. For women who had surgery for nonmalignant pathology, the surveillance recommendations are determined by their overall risk. Higher-than-average risk women with a history of benign surgery may require screening mammography starting at an earlier age before 40 and may benefit from screening MRI. For women with breast cancer who have undergone initial excision and have positive margins, imaging with diagnostic mammography or MRI can sometimes guide additional surgical planning. Women who have completed breast conservation therapy for cancer should get annual mammography and may benefit from the addition of MRI or ultrasound to their surveillance regimen. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Tejas S Mehta
- Director of Diversity, Equity Inclusion and Population Health in Radiology, UMass Memorial Medical Center, Worchester, Massachusetts.
| | - Ana P Lourenco
- Panel Chair; Residency Program Director, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bethany L Niell
- Panel Vice-Chair; Section Chief of Breast Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Commission Government Relations Chair
| | - Debbie L Bennett
- Section Chief - Breast Imaging, Mallinckrodt Institute of Radiology/Washington University School of Medicine, Saint Louis, Missouri
| | - Ann Brown
- Assistant Section Chief, University of Cincinnati, Cincinnati, Ohio
| | - Alison Chetlen
- Vice Chair of Education, Division Chief Breast Imaging, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Phoebe Freer
- Section Chief, Breast Imaging, University of Utah/Huntsman Cancer Institute, Salt Lake City, Utah; ACR/SCBI Screening Leadership Group Inaugural Class
| | - Lillian K Ivansco
- Assistant Chief, Department of Radiology, Section Chief for Breast Imaging and Quality, Co-Chair, Breast Imaging Sourcing and Standards Team, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Maxine S Jochelson
- Chief of the Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Marion McCrary
- Associate Director of Duke GME Coaching, Duke Signature Care, Durham, North Carolina; American College of Physicians; Governor-Elect, American College of Physicians, North Carolina Chapter
| | - David Mullins
- Chief of Staff, Princeton Community Hospital, Princeton, West Virginia; American College of Surgeons
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York
| |
Collapse
|
3
|
van Bekkum S, Dams FEM, Westenend PJ, van Rosmalen J, Menke-Pluijmers MBE, Kock MCJM. Ten years follow-up of histologically benign calcifications in the breast after vacuum-assisted stereotactic biopsy (VASB): Is additional mammographic follow-up warranted? Breast 2021; 59:135-143. [PMID: 34242963 PMCID: PMC8271159 DOI: 10.1016/j.breast.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective This study assessed the short-term and the long-term breast cancer rate in patients with benign histopathologic results after a vacuum-assisted stereotactic biopsy (VASB) for calcifications. Methods In a retrospective cohort study, all consecutive patients who had a benign diagnosis after VASB to analyze breast calcifications. Data of breast cancer development at short-term (four years) and long-term follow-up was gathered. Breast cancer rates in our cohort were compared to the breast cancer incidence in the general population. Results Of 1376 patients who underwent VASB to analyze breast calcifications, 823 had a benign histopathologic diagnosis. During short-term follow-up, eight patients developed breast cancer. During the mean long-term follow-up period of 9.3 ± 3.1 years, 22 patients were diagnosed with ipsilateral breast cancer. The incidence rate of breast cancer after benign biopsy was comparable to the rate in the general population. Conclusion In patients with VASB-confirmed benign calcifications of the breast, we found no excess incidence of ipsilateral breast cancer during ten years follow-up. Therefore, in patients with an increased risk of breast cancer (due to a history of breast cancer or familial risk) annual mammography should be sufficient. Patients with a population-based risk may be monitored via biennial mammography by the national screening program. More frequent screening would provide no benefit. 1% developed ipsilateral breast cancer in four-year follow-up after biopsy. 3% developed ipsilateral breast cancer in ten-years follow-up after biopsy. No statistically significant excess incidence of breast cancer after benign calcifications. A benign histopathologic result after VASB can be considered a safe decision tool.
Collapse
Affiliation(s)
- Sara van Bekkum
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Francina E M Dams
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Pieter J Westenend
- Department of Pathology, Laboratory of Pathology, Dordrecht, Netherlands
| | | | | | - Marc C J M Kock
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, Netherlands.
| |
Collapse
|
4
|
van Bekkum S, Dams FEM, Westenend PJ, van Rosmalen J, Menke-Pluijmers MBE, Kock MCJM. The reassurance of the diagnosis benign calcifications after vacuum-assisted stereotactic breast biopsy. Breast J 2021; 27:681-683. [PMID: 33913580 DOI: 10.1111/tbj.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sara van Bekkum
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Francina E M Dams
- Department of Radiology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands.,Department of Radiology, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands
| | - Pieter J Westenend
- Department of Pathology, Laboratory of Pathology, Dordrecht, The Netherlands
| | | | | | - Marc C J M Kock
- Department of Radiology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| |
Collapse
|
5
|
Ong A, Azizi A, Ambinder EB, Oluyemi ET, Harvey SC, Hung J. Image-guided Procedure Versus 2-year Follow-up for a BI-RADS 3 Probably Benign Lesion: A Cost Comparison Analysis. JOURNAL OF BREAST IMAGING 2021; 3:57-63. [PMID: 38424837 DOI: 10.1093/jbi/wbaa087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Perform a comparison between the costs of image-guided breast procedures versus 2-year imaging follow-up for findings classified as BI-RADS assessment category 3-probably benign. METHODS The national payment amount costs at non-facility locations were obtained from the Centers for Medicare and Medicaid Services physician fee schedule for breast imaging-related Current Procedural Terminology codes. Total costs were calculated and compared for management algorithms of 2-year imaging follow-up of a BI-RADS 3 lesion from 2018 through 2019 versus performing an image-guided procedure of the lesion in 2018 after the initial diagnostic imaging. RESULTS Two-year mammographic follow-up of a BI-RADS 3 finding costs $484. This was less than a stereotactic-guided breast biopsy, which cost at least $1055. Two-year follow-up for a probably benign US finding cost $615 compared to $1173 for the least expensive US-guided breast biopsy scenario. For breast MRI, 2-year imaging follow-up cost $1510, which was also less than most MRI-guided breast biopsy scenarios. The one exception in which biopsy costs less than 2-year imaging follow-up was in the setting of an MRI-guided biopsy in the average-risk population without a post-benign biopsy follow-up breast MRI; in this setting, MRI biopsy cost $1235. CONCLUSION In 2018-2019, 2-year imaging follow-up of a BI-RADS 3 finding continues to be less costly than an immediate procedure, except for MRI-guided breast biopsy in the average-risk population without a post-benign biopsy follow-up MRI.
Collapse
Affiliation(s)
- Andrew Ong
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Armina Azizi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Emily B Ambinder
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Eniola T Oluyemi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Susan C Harvey
- Hologic, Inc., Department of Breast and Skeletal Health, Danbury, CT
| | - Jessica Hung
- Christiana Care Health System, Department of Radiology, Newark, DE
| |
Collapse
|
6
|
Yonekura R, Horii R, Iwase T, Gomi N, Kitagawa M, Akiyama F, Ohno S. A diagnostic strategy for breast calcifications based on a long-term follow-up of 615 lesions. Jpn J Radiol 2018; 37:237-244. [DOI: 10.1007/s11604-018-0803-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
|
7
|
Oligane HC, Berg WA, Bandos AI, Chen SS, Sohrabi S, Anello M, Zuley ML. Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy. Radiology 2018; 288:671-679. [DOI: 10.1148/radiol.2018172406] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hayley C. Oligane
- From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.)
| | - Wendie A. Berg
- From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.)
| | - Andriy I. Bandos
- From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.)
| | - Sue S. Chen
- From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.)
| | - Sahand Sohrabi
- From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.)
| | - Maria Anello
- From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.)
| | - Margarita L. Zuley
- From the Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213 (H.C.O., W.A.B., S.S.C., S.S., M.A., M.L.Z.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (W.A.B., A.I.B., M.A., M.L.Z.); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa (A.I.B.)
| |
Collapse
|
8
|
Daroles J, Borget I, Suciu V, Mazouni C, Delaloge S, Balleyguier C. Value of a short-term imaging follow-up after a benign result in a one-stop breast unit: Is it still useful? Eur J Cancer 2017; 85:23-30. [DOI: 10.1016/j.ejca.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/01/2017] [Indexed: 11/25/2022]
|
9
|
Plecha DM, Garlick C, Dubchuck C, Thompson C, Constantinou N. Comparing cancer detection rates of patients undergoing short term follow-up vs routine follow-up after benign breast biopsies, is follow-up needed? Clin Imaging 2016; 42:37-42. [PMID: 27875760 DOI: 10.1016/j.clinimag.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/02/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare cancer rates after benign breast biopsies between patients with short term imaging follow-up (STFU) and those with routine follow-up (RFU). MATERIALS & METHODS Retrospective review of benign stereotactic, US or DCE-MRI breast biopsies. RESULTS Of 580 lesions, 192 (33%) had STFU, and 388 (67%) had RFU. For US and mammographic detected lesions, there is no difference in cancer rates between the STFU (1 cancer, n=148) and the RFU group (0 cancer, n=365) (p=0.29). There were 2 cancers in the STFU group versus 0 in the RFU DCE-MRI group (p=0.54). CONCLUSION Our results support RFU after benign ultrasound and stereotactic breast biopsies.
Collapse
Affiliation(s)
- Donna M Plecha
- University Hospitals Case Medical Center, Department of Radiology, Mather Pavilion, B402, 11100 Euclid Ave, Cleveland, OH 11406, United States.
| | - Courtney Garlick
- 1500 E Sherman Blvd., Mercy Health, Muskegon, MI 49444, United States
| | - Christina Dubchuck
- University Hospitals Case Medical Center, Department of Radiology, Mather Pavilion, B402, 11100 Euclid Ave, Cleveland, OH 11406, United States
| | - Cheryl Thompson
- Case Western Reserve University, Case Comprehensive Cancer Center, Department of Family Medicine and Community Health, Cleveland, OH 44106, United States
| | - Niki Constantinou
- University Hospitals Case Medical Center, Department of Radiology, Mather Pavilion, B402, 11100 Euclid Ave, Cleveland, OH 11406, United States
| |
Collapse
|
10
|
Heller SL, Jaglan S, Babb JS, Melsaether A, Toth HB, Moy L. Frequency of Discordant Lesions and False-negative Cancers at Stereotactic Vacuum-assisted Biopsy. Acad Radiol 2016; 23:994-9. [PMID: 27161209 DOI: 10.1016/j.acra.2016.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to determine frequency of discordant lesions and discordant false-negative cancers at stereotactic vacuum-assisted biopsy (SVAB). MATERIALS AND METHODS Institutional database was searched for discordant SVAB results between January 1, 2005 and December 31, 2012, in this retrospective institutional review board-approved Health Insurance Portability and Accountability Act-compliant study. Patient age, indication for initial mammogram, breast density, lesion size, Breast Imaging Reporting and Data System categorization, operator experience, biopsy needle gauge, biopsy histology, and final surgical histology of discordant lesions were collected and entered into a Microsoft Excel spreadsheet. Discordant rate and false-negative rates were calculated. Fisher exact test was used to assess prevalence of discordance using 11-Gauge needles versus 9-Gauge needles. Patient age, lesion Breast Imaging Reporting and Data System, operator days of experience, mammographic density, and lesion size were evaluated for association with false-negative discordant lesions using an exact Mann-Whitney U test. RESULTS A total of 1861 SVABs were performed, 224 (12%) with an 11-Gauge VAB device and 1637 (88%) with a 9G Suros or Eviva device. Majority (1409 of 1861; 76%) of SVABs targeted calcifications. Twenty-three of 1861 (1.2%) discordant lesions were identified in 23 women. Seven of 23 (30%) discordant lesions were found to be cancers after final surgical pathology. Needle gauge was not associated with discordance. Operator experience was not associated with false-negative discordance. CONCLUSIONS A relatively low discordance rate (1.2%) was observed. However, a high percentage (30%; range in literature 11.7%-53.8%) of our discordant lesions were false negatives. This study emphasizes the need for careful radiological-pathologic review after SVAB and for repeat biopsy or surgical excision in the setting of discordance.
Collapse
Affiliation(s)
- Samantha L Heller
- NYU Langone School of Medicine, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street, 3rd Floor, New York, NY 10016.
| | - Sonam Jaglan
- NYU Langone School of Medicine, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street, 3rd Floor, New York, NY 10016
| | - James S Babb
- NYU Langone School of Medicine, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street, 3rd Floor, New York, NY 10016
| | - Amy Melsaether
- NYU Langone School of Medicine, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street, 3rd Floor, New York, NY 10016
| | - Hildegard B Toth
- NYU Langone School of Medicine, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street, 3rd Floor, New York, NY 10016
| | - Linda Moy
- NYU Langone School of Medicine, Laura and Isaac Perlmutter Cancer Center, 160 East 34th Street, 3rd Floor, New York, NY 10016
| |
Collapse
|
11
|
Six-Month Short-Interval Imaging Follow-Up for Benign Concordant Core Needle Biopsy of the Breast: Outcomes in 1444 Cases With Long-Term Follow-Up. AJR Am J Roentgenol 2016; 207:912-917. [PMID: 27340732 DOI: 10.2214/ajr.15.15853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to assess whether 6-month imaging follow-up after benign core needle breast biopsy is important for patient outcomes and whether it depends on nonspecific versus definitive benign biopsy results. MATERIALS AND METHODS Consecutive breast biopsies from 2003 to 2010 were analyzed. Benign concordant lesions with at least 2 years of follow-up were assessed. Pathologic abnormalities were further characterized as having definitive or nonspecific features. A two-tailed Fisher exact test was used to assess the difference in pathologic features among lesions that had progressed. RESULTS Of 3256 cases, 1705 biopsies in 1602 women were benign concordant and were recommended for 6-month imaging follow-up; the compliance rate was 94.9%. Of these, 1444 biopsies were confirmed as benign with long-term follow-up or excision. At pathologic analysis, 805 (55.7%) benign lesions had definitive features and 639 (44.3%) had nonspecific features. Thirty-four (2.4%) lesions progressed; this was similar for the lesions with definitive (2.6%) and nonspecific (2.0%) features (p = 0.60). The false-negative rate was 0.18%, with a mean of 5.0 cores sampled per lesion. CONCLUSION For lesions with benign concordant biopsy results, selection of the follow-up interval should not be dictated by whether the pathologic features are definitive or nonspecific. The number of lesions that progress at imaging follow-up is low. The false-negative rate is low, regardless of modality or lesion type. A low false-negative rate is achievable with a reasonable number of core samples. The 6-month follow-up interval benefits only a small number of patients. Our results suggest that routine imaging after core needle biopsy is safe.
Collapse
|
12
|
Miglioretti DL, Lange J, van den Broek JJ, Lee CI, van Ravesteyn NT, Ritley D, Kerlikowske K, Fenton JJ, Melnikow J, de Koning HJ, Hubbard RA. Radiation-Induced Breast Cancer Incidence and Mortality From Digital Mammography Screening: A Modeling Study. Ann Intern Med 2016; 164:205-14. [PMID: 26756460 PMCID: PMC4878445 DOI: 10.7326/m15-1241] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Estimates of risk for radiation-induced breast cancer from mammography screening have not considered variation in dose exposure or diagnostic work-up after abnormal screening results. OBJECTIVE To estimate distributions of radiation-induced breast cancer incidence and mortality from digital mammography screening while considering exposure from screening and diagnostic mammography and dose variation among women. DESIGN 2 simulation-modeling approaches. SETTING U.S. population. PATIENTS Women aged 40 to 74 years. INTERVENTION Annual or biennial digital mammography screening from age 40, 45, or 50 years until age 74 years. MEASUREMENTS Lifetime breast cancer deaths averted (benefits) and radiation-induced breast cancer incidence and mortality (harms) per 100,000 women screened. RESULTS Annual screening of 100,000 women aged 40 to 74 years was projected to induce 125 breast cancer cases (95% CI, 88 to 178) leading to 16 deaths (CI, 11 to 23), relative to 968 breast cancer deaths averted by early detection from screening. Women exposed at the 95th percentile were projected to develop 246 cases of radiation-induced breast cancer leading to 32 deaths per 100,000 women. Women with large breasts requiring extra views for complete examination (8% of population) were projected to have greater radiation-induced breast cancer risk (266 cancer cases and 35 deaths per 100,000 women) than other women (113 cancer cases and 15 deaths per 100,000 women). Biennial screening starting at age 50 years reduced risk for radiation-induced cancer 5-fold. LIMITATION Life-years lost from radiation-induced breast cancer could not be estimated. CONCLUSION Radiation-induced breast cancer incidence and mortality from digital mammography screening are affected by dose variability from screening, resultant diagnostic work-up, initiation age, and screening frequency. Women with large breasts may have a greater risk for radiation-induced breast cancer. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality, U.S. Preventive Services Task Force, National Cancer Institute.
Collapse
Affiliation(s)
- Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA 95616
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, 95817
- Group Health Research Institute, Seattle, WA 98101
| | - Jane Lange
- Group Health Research Institute, Seattle, WA 98101
| | - Jeroen J. van den Broek
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, the Netherlands
| | - Christoph I. Lee
- Department of Radiology, University of Washington, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
- Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Nicolien T. van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, the Netherlands
| | - Dominique Ritley
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, 95817
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
| | - Joshua J. Fenton
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, 95817
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, 95817
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817
| | - Harry J. de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, the Netherlands
| | - Rebecca A. Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104
| |
Collapse
|
13
|
Moon HJ, Jung I, Youk JH, Kim MJ, Kim EK. Short-term follow-up in 6 months is unnecessary for asymptomatic breast lesions with benign concordant results obtained at ultrasonography-guided 14-gauge core needle biopsy. Am J Surg 2015; 211:152-8. [PMID: 26381659 DOI: 10.1016/j.amjsurg.2015.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/10/2015] [Accepted: 03/31/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated whether short-term follow-up in 6 months was appropriate for asymptomatic benign concordant lesions on ultrasonography-guided core needle biopsy (ultrasonography-guided CNB). METHODS Of 1,111 lesions, 944 underwent follow-up within 4 to 9 months after CNB, and 359 of 944 underwent a 2nd follow-up within 9 to 15 months. One hundred sixty-seven underwent a 1st follow-up within 9 to 15 months. Follow-up intervals were classified according to an interval of 6 and 12 months with 2 different methods. First, 944 and 167 lesions were classified into the 6- and 12-month groups. Second, 944 and 526 lesions (sum of 167 and 359 lesions) were classified into the 6- and 12-month groups. Clinicopathologic factors were compared between the 2 groups. RESULTS None of the benign concordant lesions were malignant; 1.4% of the lesions showed progression in the 6-month group, not significantly different from 1.2% and .8% of the 12-month group. Mean age, mean lesion size, final assessments, and specific or nonspecific pathologies were not different between the 2 groups. CONCLUSIONS Short-term follow-up in 6 months is unnecessary for asymptomatic benign concordant breast lesions at ultrasonography-guided CNB.
Collapse
Affiliation(s)
- Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
| | - Inkyung Jung
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Youk
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
| |
Collapse
|