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Moon HJ, Kim MJ, Yoon JH, Kim EK. Follow-up interval for probably benign breast lesions on screening ultrasound in women at average risk for breast cancer with dense breasts. Acta Radiol 2018; 59:1045-1050. [PMID: 29231050 DOI: 10.1177/0284185117745906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Women at high risk for breast cancer and women at average risk have different pretest probabilities. Probably benign lesions on screening ultrasound (US) should be assessed and managed differently for these two risk groups. Purpose To evaluate the effectiveness of short-term follow-up for probably benign lesions on screening US in women at average risk for breast cancer with dense breasts. Material and Methods A total of 445 women at average risk for breast cancer with probably benign lesions on screening US, dense breasts, and negative or benign mammography results were included. Women were classified into the six-month group (n = 345) or 12-month group (n = 100) according to when the first follow-up was performed (3-9 months or 9-15 months). The cancer detection rate, frequencies of newly developed lesions and progressed lesions, and biopsy rate were compared. Results There were no malignancies from three to 15 months. Three cancers newly developed after 15 months. One was a 3-mm ductal carcinoma in situ and two were 10-mm and 18-mm invasive ductal carcinoma without lymph node metastasis. The frequency of newly developed lesions and progressed lesions and biopsy rate were not significantly different between the six-month and 12-month groups ( P = 0.320, 0.621, and >0.999). Conclusion A follow-up at 12 months can be considered for probably benign lesions on screening US in women at average risk for breast cancer with dense breasts. However, a large series prospective study is needed before clinical application.
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Affiliation(s)
- Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University, College of Medicine, Seoul, Republic of Korea
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Grimm LJ, Shelby RA, Knippa EE, Langman EL, Miller LS, Whiteside BE, Soo MSC. Patient Perceptions of Breast Cancer Risk in Imaging-Detected Low-Risk Scenarios and Thresholds for Desired Intervention: A Multi-Institution Survey. J Am Coll Radiol 2018; 15:911-919. [PMID: 29606632 DOI: 10.1016/j.jacr.2018.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine women's perceptions of breast cancer risk and thresholds for desiring biopsy when considering BI-RADS 3 and 4A scenarios and recommendations, respectively. MATERIALS AND METHODS Women presenting for screening mammography from five geographically diverse medical centers were surveyed. Demographic information and baseline anxiety were queried. Participants were presented with scenarios of short-term imaging follow-up recommendations (ie, BI-RADS 3) and biopsy recommendations (ie, BI-RADS 4A) for low-risk mammographic abnormalities and asked to estimate their breast cancer risk for each scenario. Participants reported the threshold (ie, likelihood of cancer) where they would feel comfortable undergoing short-term imaging follow-up and biopsy and their anticipated regret for choosing short-term follow-up versus biopsy. RESULTS Analysis of 2,747 surveys showed that participants estimated breast cancer risk of 32.8% for a BI-RADS 3 and 41.1% for a BI-RADS 4A scenarios are significantly greater rates than clinically established rates (<2% [P < .001] and 2%-10% [P < .001], respectively). Over one-half (55.4%) of participants reported they would never want imaging follow-up if there was any chance of cancer; two-thirds (66.2%) reported they would desire biopsy if there was any chance of cancer. Participants reported greater anticipated regret (P < .001) and less relief and confidence (P < .001) with the decision to undergo follow-up imaging versus biopsy. CONCLUSION Women overestimate breast cancer risk associated with both BI-RADS 3 and 4A scenarios and desire very low biopsy thresholds. Greater anticipated regret and less relief and confidence was reported with the choice to undergo short-term imaging follow-up compared with biopsy.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Emily E Knippa
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Eun L Langman
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Lauren S Miller
- Riverside Radiology and Interventional Associates, Inc., Columbus, Ohio
| | - Beth E Whiteside
- Department of Radiology, Albany Medical Center, Albany, New York
| | - Mary Scott C Soo
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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3
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Hall FM. Guidelines for Screening Mammography. J Am Coll Radiol 2017; 15:8-9. [PMID: 29141780 DOI: 10.1016/j.jacr.2017.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ferris M Hall
- Beth Israel Deaconess Medical Center (Emeritus), Harvard Medical School (Emeritus), 33 Brookline Avenue, Boston, MA 02215.
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Grimm LJ, Ryser MD, Partridge AH, Thompson AM, Thomas JS, Wesseling J, Hwang ES. Surgical Upstaging Rates for Vacuum Assisted Biopsy Proven DCIS: Implications for Active Surveillance Trials. Ann Surg Oncol 2017; 24:3534-3540. [PMID: 28795370 DOI: 10.1245/s10434-017-6018-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to determine invasive cancer upstaging rates at surgical excision following vacuum-assisted biopsy of ductal carcinoma in situ (DCIS) among women meeting eligibility for active surveillance trials. METHODS Patients with vacuum-assisted, biopsy-proven DCIS at a single center from 2008 to 2015 were retrospectively reviewed. Imaging and pathology reports were interrogated for the imaging appearance, tumor grade, hormone receptor status, and presence of comedonecrosis. Subsequent surgical reports were reviewed for upstaging to invasive disease. Cases were classified by eligibility criteria for the COMET, LORIS, and LORD DCIS active surveillance trials. RESULTS Of 307 DCIS diagnoses, 15 (5%) were low, 95 (31%) intermediate, and 197 (64%) high nuclear grade. The overall upstage rate to invasive disease was 17% (53/307). Eighty-one patients were eligible for the COMET Trial, 74 for the LORIS trial, and 10 for the LORD Trial, although LORIS trial eligibility also included real-time, multiple central pathology review, including elements not routinely reported. The upstaging rates to invasive disease were 6% (5/81), 7% (5/74), and 10% (1/10) for the COMET, LORIS, and LORD trials, respectively. Among upstaged cancers (n = 5), four tumors were Stage IA invasive ductal carcinoma and one was Stage IIA invasive lobular carcinoma; all were node-negative. CONCLUSIONS DCIS upstaging rates in women eligible for active surveillance trials are low (6-10%), and in this series, all those with invasive disease were early-stage, node-negative. The careful patient selection for DCIS active surveillance trials has a low risk of missing occult invasive cancer and additional studies will determine clinical outcomes.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University, Durham, NC, USA
| | - Marc D Ryser
- Department of Mathematics, Duke University, Durham, NC, USA
| | - Ann H Partridge
- Division of Oncology, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alastair M Thompson
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy S Thomas
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Jelle Wesseling
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E Shelley Hwang
- Department of Surgery, Duke University Comprehensive Cancer Center, Durham, NC, USA.
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Keen JD, Jørgensen KJ. Given Overdiagnosis, Recall Reduction Should Trump DCIS Detection. Radiology 2017; 284:608-610. [DOI: 10.1148/radiol.2017170702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John D. Keen
- Department of Radiology, John H. Stroger Jr Hospital of Cook County, 1901 W Harrison St, Chicago, IL 60612
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Grimm LJ, Johnson DY, Johnson KS, Baker JA, Soo MS, Hwang ES, Ghate SV. Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors. Eur Radiol 2016; 27:2275-2281. [DOI: 10.1007/s00330-016-4617-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/22/2016] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
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Park VY, Kim EK, Kim MJ, Yoon JH, Moon HJ. Mammographically Occult Asymptomatic Radial Scars/Complex Sclerosing Lesions at Ultrasonography-Guided Core Needle Biopsy: Follow-Up Can Be Recommended. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2367-2371. [PMID: 27444865 DOI: 10.1016/j.ultrasmedbio.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
An increasing number of radial scars are detected by ultrasound (US), but their management is controversial. This study investigated the upgrade rate in mammographically occult radial scars/complex sclerosing lesions without epithelial atypia at US-guided 14-gauge core needle biopsy in asymptomatic patients. Nineteen mammographically occult benign radial scars/complex sclerosing lesions (median size, 7 mm; range, 3-23 mm) were included. Patients underwent surgical excision (n = 10) or vacuum-assisted excision, with follow-up US at least 6 mo after benign vacuum-assisted excision results (n = 8), or underwent US follow-up for 2 y after core needle biopsy (n = 1). Any cases with change in diagnosis to high-risk lesions or malignancy at excision were considered upgrades. The upgrade rate was 0.0%. Based on US findings, 15.8% (3/19) were Breast Imaging Reporting and Data System (BI-RADS) category 3, 68.4% (13/19) were BI-RADS category 4a and 15.8% (3/19) were BI-RADS category 4b. Follow-up with US can be considered for mammographically occult benign radial scar/complex sclerosing lesions diagnosed by US core needle biopsy in asymptomatic patients.
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Affiliation(s)
- Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Michaels A, Chung CS, Birdwell RL, Frost EP, Giess CS. Imaging and Histopathologic Features of BI-RADS 3 Lesions Upgraded during Imaging Surveillance. Breast J 2016; 23:10-16. [DOI: 10.1111/tbj.12677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aya Michaels
- Department of Radiology Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Chris SungWon Chung
- Department of Radiology Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
- Mid-Atlantic Permanente Medical Group; Kaiser Permanente Capitol Hill Medical Center; Washington DC
| | - Robyn L. Birdwell
- Department of Radiology Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Elisabeth P. Frost
- Department of Radiology Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Catherine S. Giess
- Department of Radiology Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
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9
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Kim SY, Kim EK, Lee HS, Kim MJ, Yoon JH, Koo JS, Moon HJ. Asymptomatic Benign Papilloma Without Atypia Diagnosed at Ultrasonography-Guided 14-Gauge Core Needle Biopsy: Which Subgroup can be Managed by Observation? Ann Surg Oncol 2016; 23:1860-6. [DOI: 10.1245/s10434-016-5144-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Indexed: 11/18/2022]
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McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. Clinical Diagnosis and Management of Breast Cancer. J Nucl Med 2016; 57 Suppl 1:9S-16S. [DOI: 10.2967/jnumed.115.157834] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Cohen MA. Malpractice and Public Policy: Are they Separable? Radiology 2015; 276:929-30. [DOI: 10.1148/radiol.2015154094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Meyer J. Screening Mammography Guidelines. Radiology 2015; 276:312. [DOI: 10.1148/radiol.2015142922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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