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Aljuaid MA, Li J, Lin C, Sitwala P, Daiker D, Khorjekar G, Gupta A, Tirada N. Does the Combination of Phone, Email and Text-Based Reminders Improve No-show Rates for Patients in Breast Imaging? Curr Probl Diagn Radiol 2023; 52:125-129. [PMID: 36336509 DOI: 10.1067/j.cpradiol.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/03/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023]
Abstract
The issue of no-shows in radiology is complicated and challenging. Mammography and ultrasound have the highest rate of no-shows among radiologic exams. Screening mammography is one of the most cost-effective ways to reduce breast cancer related deaths. However, the benefit of screening is heavily dependent on patient compliance to routine exams. Enhancing patients' commitments to their scheduled appointments, thereby improving early detection and decreasing breast cancer related mortality. Retrospective analysis of no-show visits scheduled from August 2017 to December 2017 (before the implementation of combined phone, email and text-based reminders) and from August 2019 to December 2019 (after the implementation of reminder and follow-up phone calls after missed appointments by the coordinator) in an urban academic breast imaging center was conducted. There were 368 no-show patients in 2017 and 238 no-show patients in 2019. Percentage of no-shows, and delay time to the rescheduled missed appointment were calculated. Subgroup analysis of the type of studies that were missed and those who did not reschedule the missed appointment was conducted. Mann Whitney U test was used to analyze differences between group means. No-show visits decreased by 50% in 2019 when compared to 2017. The average wait time between the missed appointment and the rescheduled appointment decreased significantly from 30.7 weeks in 2017 to 12.1 weeks in 2019 (P = 0.047). The percentage of no-show visits was highest among the unemployed, patients scheduled for screening mammograms and patients with a high average of no-show visits. No-show visits adversely impact patient outcome and contribute to increased cost of healthcare. Through a deeper understanding of the factors contributing to no-shows, we can strive to make appropriate interventions to alleviate the consequences of no-shows.
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Affiliation(s)
- Maram A Aljuaid
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD; King Saud University, Riyadh Saudi Arabia.
| | - Joy Li
- University of Maryland School of Medicine
| | - Clarissa Lin
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD
| | - Palak Sitwala
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD
| | - Densie Daiker
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD
| | - Gauri Khorjekar
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD; University of Maryland School of Medicine
| | - Anuj Gupta
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD; University of Maryland School of Medicine
| | - Nikki Tirada
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD; University of Maryland School of Medicine
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2
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Harbhajanka A, Gilmore HL, Calhoun BC. High-risk and selected benign breast lesions diagnosed on core needle biopsy: Evidence for and against immediate surgical excision. Mod Pathol 2022; 35:1500-1508. [PMID: 35654997 DOI: 10.1038/s41379-022-01092-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022]
Abstract
The vast majority of image-detected breast abnormalities are diagnosed by percutaneous core needle biopsy (CNB) in contemporary practice. For frankly malignant lesions diagnosed by CNB, the standard practice of excision and multimodality therapy have been well-defined. However, for high-risk and selected benign lesions diagnosed by CNB, there is less consensus on optimal patient management and the need for immediate surgical excision. Here we outline the arguments for and against the practice of routine surgical excision of commonly encountered high-risk and selected benign breast lesions diagnosed by CNB. The entities reviewed include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, intraductal papillomas, and radial scars. The data in the peer-reviewed literature confirm the benefits of a patient-centered, multidisciplinary approach that moves away from the reflexive "yes" or "no" for routine excision for a given pathologic diagnosis.
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Affiliation(s)
- Aparna Harbhajanka
- Department of Pathology, Case Western University School of Medicine, Cleveland, OH, 44106, USA
| | - Hannah L Gilmore
- Department of Pathology, Case Western University School of Medicine, Cleveland, OH, 44106, USA
| | - Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
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3
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Cullinane C, Byrne J, Kelly L, O Sullivan M, Antony Corrigan M, Paul Redmond H. The positive predictive value of vacuum assisted biopsy (VAB) in predicting final histological diagnosis for breast lesions of uncertain malignancy (B3 lesions): A systematic review & meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1464-1474. [PMID: 35491362 DOI: 10.1016/j.ejso.2022.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High-risk or B3 breast lesions are considered lesions of uncertain malignant potential and comprise between 5 and 12% of initial biopsy results. We sought to perform a systematic review and meta-analysis of studies published within the last twenty years to determine the pooled Positive Predictive Value (PPV) of VAB in selected B3 lesions. METHODS The study report is based on the guidelines of PRISMA and Meta-Analysis of Observational Studies in Epidemiology. OUTCOMES The primary outcome of this study was to determine the PPV of VAB in determining final histological diagnosis in B3 breast lesions using pooled estimates. The secondary outcomes were to determine if needle gauge or the re-classification of Lobular Carcinoma in Situ(LCIS) introduced in 2012 influenced pooled estimates. RESULTS 78 studies incorporating 6,377 B3 lesions were included in this review, 1214 of which were upgraded to DCIS or invasive malignancy following surgical excision(19%). The pooled PPV of VAB in Atypical Ductal Hyperplasia(ADH) and Lobular Neoplasia(LN) were 0.79(CI 0.76-0.83) and 0.84(CI 0.8-0.88). VAB of Flat Epithelial Atypia(FEA), radial scar and papillary lesions with/without atypia all had a pooled PPV >90% (underestimation rates 7%, 1%, 5% and 3% respectively). Needle gauge size and the change in LCIS classification did not appear to influence underestimation rates on subgroup analysis. CONCLUSION Results from this meta-analysis suggests it is reasonable to perform VAB as definitive treatment for certain B3 lesions, specifically LN, FEA, radial scar, and papillary lesions when specific criteria are fulfilled. Surgical excision should continue as the mainstay of treatment for ADH.
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Girardi V, Guaragni M, Ruzzenenti N, Palmieri F, Fogazzi G, Cozzi A, Lucchini D, Buffoli A, Schiaffino S, Sardanelli F. B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies. Cancers (Basel) 2021; 13:5443. [PMID: 34771606 PMCID: PMC8582448 DOI: 10.3390/cancers13215443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
The rate of upgrade to cancer for breast lesions with uncertain malignant potential (B3 lesions) diagnosed at needle biopsy is highly influenced by several factors, but large series are seldom available. We retrospectively assessed the upgrade rates of a consecutive series of B3 lesions diagnosed at ultrasound- or mammography-guided vacuum-assisted biopsy (VAB) at an EUSOMA-certified Breast Unit over a 7-year timeframe. The upgrade rate was defined as the number of ductal carcinoma in situ (DCIS) or invasive cancer at pathology after excision or during follow-up divided by the total number of B3 lesions. All lesions were reviewed by one of four pathologists with a second opinion for discordant assessments of borderline cases. Excision or surveillance were defined by the multidisciplinary tumor board, with 6- and 12-month follow-up. Out of 3634 VABs (63% ultrasound-guided), 604 (17%) yielded a B3 lesion. After excision, 17/604 B3 lesions were finally upgraded to malignancy (2.8%, 95% confidence interval [CI] 1.8-4.5%), 10/17 (59%) being upgraded to DCIS and 7/17 (41%) to invasive carcinoma. No cases were upgraded during follow-up. B3a lesions showed a significantly lower upgrade rate (0.4%, 95% CI 0.1-2.1%) than B3b lesions (4.7%, 95% CI 2.9-7.5%, p = 0.001), that had a 22.0 adjusted odds ratio for upgrade (95% CI 2.1-232.3). No significant difference was found in upgrade rates according to imaging guidance or needle caliper. Surveillance-oriented management can be considered for B3a lesions, while surgical excision should be pursued for B3b lesions.
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Affiliation(s)
- Veronica Girardi
- Breast Radiology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Monica Guaragni
- Breast Pathology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy; (M.G.); (N.R.)
| | - Nella Ruzzenenti
- Breast Pathology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy; (M.G.); (N.R.)
| | - Fabrizio Palmieri
- Breast Surgery, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Gianluca Fogazzi
- Breast Medical Oncology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy;
| | - Diana Lucchini
- Breast Psycho-Oncology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Alberto Buffoli
- Radiation Oncology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy;
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy;
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy;
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Rahbar H. Demystifying Which High-risk Lesions Truly Require Surgical Excision-A Call to Action. JOURNAL OF BREAST IMAGING 2021; 3:581-582. [PMID: 38424946 DOI: 10.1093/jbi/wbab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 03/02/2024]
Affiliation(s)
- Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
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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
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Polat DS, Schopp JG, Arjmandi F, Porembka J, Sarode V, Farr D, Xi Y, Dogan BE. Performance of a clinical and imaging-based multivariate model as decision support tool to help save unnecessary surgeries for high-risk breast lesions. Breast Cancer Res Treat 2020; 185:479-494. [PMID: 33010022 DOI: 10.1007/s10549-020-05947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions. METHODS In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our institution between July 1, 2014-July 1, 2017. Lesions were categorized high-risk-I (HR-I = atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ and atypical papillary lesion) and II (HR-II = Flat epithelial atypia, radial scar, benign papilloma). Patient risk factors, lesion features, detection and biopsy modality, excision and cancer upgrade rates were collected. Reference standard for upgrade was either excision or at least 2-year imaging follow-up. Multiple logistic regression analysis was performed to develop a multivariate model using HRL type, lesion and biopsy needle size for surgical cancer upgrade with performance assessed using ROC analysis. RESULTS Of 699 HRL in 652 patients, 525(75%) had reference standard available, and 48/525(9.1%) showed cancer at surgical excision. Excision (84.5% vs 51.1%) and upgrade (17.6%vs1.8%) rates were higher in HR-I compared to HR-II (p < 0.01). In HR-I, small needle size < 12G vs ≥ 12G [32.1% vs 13.2%, p < 0.01] and less cores [< 6 vs ≥ 6, 28.6%vs13.7%, p = 0.01] were significantly associated with higher cancer upgrades. Our multivariate model had an AUC = 0.87, saving 28.1% of benign surgeries with 100% sensitivity, based on HRL subtype, lesion size(mm, continuous), needle size (< 12G vs ≥ 12G) and biopsy modality (US vs MRI vs stereotactic) CONCLUSION: Our multivariate model using lesion size, needle size and patient age had a high diagnostic performance in decreasing unnecessary surgeries and shows promise as a decision support tool.
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Affiliation(s)
- Dogan S Polat
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jennifer G Schopp
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Firouzeh Arjmandi
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jessica Porembka
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Venetia Sarode
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Deborah Farr
- Department of Surgery, Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Basak E Dogan
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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8
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Atypical Ductal Hyperplasia and Lobular Neoplasia: Update and Easing of Guidelines. AJR Am J Roentgenol 2019; 214:265-275. [PMID: 31825261 DOI: 10.2214/ajr.19.21991] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS) are among high-risk lesions that have been previously recommended for surgical excision when diagnosed on core needle biopsy. Recent studies have examined whether imaging surveillance is a reasonable alternative to surgical management for these lesions. This article synthesizes the evidence regarding management of atypical hyperplasia and LCIS diagnosed on core needle biopsy and clinical implications of these diagnoses on future breast cancer risk as well as highlights areas of further research needed to improve practice guidelines for these high-risk lesions. CONCLUSION. Although surgical excision is still recommended after diagnosis of ADH on core needle biopsy, in specific circumstances ALH and LCIS can safely be managed by imaging surveillance.
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9
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Luiten JD, Korte B, Voogd AC, Vreuls W, Luiten EJT, Strobbe LJ, Rutten MJCM, Plaisier ML, Lohle PN, Hooijen MJH, Tjan-Heijnen VCG, Duijm LEM. Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study. Int J Cancer 2019; 145:2720-2727. [PMID: 31001821 PMCID: PMC6766874 DOI: 10.1002/ijc.32353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/21/2019] [Accepted: 04/11/2019] [Indexed: 11/18/2022]
Abstract
Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high‐risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6‐year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high‐risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high‐risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high‐risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high‐risk lesions at CNB tripled in a 6‐year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome. What's new? Screening mammography aims to catch breast cancer early to reduce associated morbidity and mortality. Women with suspect findings at mammography frequently are recalled for further testing with core needle biopsy (CNB). In this investigation, the proportion of high‐risk lesions detected at CNB was found to have tripled among women in the Netherlands who underwent mammographic screening between 2011 and 2016. This increase was accompanied by an increase in lesion excision rates. Of excised lesions, little more than 14% proved to be malignant at two‐year follow‐up. The remainder of lesions exhibited benign pathology, suggesting that many women underwent potentially unnecessary surgery.
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Affiliation(s)
- Jacky D Luiten
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,School for Oncology and Developmental Biology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands
| | - Bram Korte
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ernest J T Luiten
- Department of Surgical Oncology, Amphia Hospital, Breda, The Netherlands
| | - Luc J Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Vivianne C G Tjan-Heijnen
- School for Oncology and Developmental Biology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, Nijmegen, The Netherlands
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