Development of MRI-Based Deep Learning Signature for Prediction of Axillary Response After NAC in Breast Cancer

RATIONALE AND OBJECTIVES

To develop a MRI-based deep learning signature for predicting axillary response after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients.

MATERIALS AND METHODS

We enrolled 327 BC patients with axillary lymph node (ALN) metastases receiving axillary operations after NAC. The deep learning features were extracted by ResNet34, which was pretrained by a large, well-annotated dataset from ImageNet. Then we identified deep learning radiomics on magnetic resonance imaging with dynamic contrast enhancement (DCE-MRI) in predicting axillary response after NAC in BC patients.

RESULTS

The extraction of 128 deep learning radiomics (DLR) features relied on the DCE-MRI for each patient. After the least absolute shrinkage and selection operator regression analysis, 13, 8, and 21 features remained from the pre-treatment, post-treatment, and combined DCE-MRI, respectively. The DLR signature established based on the combined DCE-MRI achieved good capacity in ALN response after NAC. The support vector machine achieved the best performance with an 0.99 area under the curve (AUC) of (95% confidence interval (CI), 0.98-1.00) and 0.83 (95% CI, 0.73-0.92) in the training and test sets, respectively. The LR model established with clinical parameters represented the best performance with 0.73 AUC (95% CI, 0.62-0.84), 0.73 sensitivity, 0.73 specificity, 0.63 PPV, and 0.81 NPV in the test set, respectively. Finally, the integration of radiomic signature and clinical signature resulted in establishing a predictive radiomic nomogram, with an AUC of 0.99 (95%CI, 0.99-1.00).

CONCLUSION

In conclusion, our current study constructed a predictive nomogram through the deep learning method, demonstrating favorable performance in the training and test cohort. The present prognostic model furnishes a precise and objective foundation for directing the surgical strategy toward ALN management in BC patients receiving NAC.

Annual report of the Japanese Breast Cancer Registry for 2019

This is an annual report by the Japanese Breast Cancer Society regarding the clinical data on breast cancer extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR) of Japan. Here, we present an updated summary of 98,300 breast cancer cases registered in 2019. The median age at cancer diagnosis was 61 years (interquartile range 49-72 years), and 30.6% of the breast cancer patients were premenopausal. Of the 93,840 patients without distant metastases, 14,118 (15.0%) and 42,047 (44.8%) were diagnosed with stage 0 and I disease, respectively. Breast-conserving surgery was performed in 42,080 (44.8%) patients. Regarding axillary procedures, 62,677 (66.8%) and 7371 (7.9%) patients underwent sentinel node biopsy and axillary node dissection after biopsy, respectively. Whole breast irradiation was administered to 29,795 (70.8%) of the 42,080 patients undergoing breast-conserving surgery. Chest wall irradiation was administered to 5524 (11.1%) of the 49,637 patients who underwent mastectomy. Of the 6912 clinically lymph node-negative patients who received preoperative therapy, 5250 (76.0%) and 427 (6.2%) underwent sentinel node biopsy and axillary node dissection after biopsy, respectively; however, 602 (8.7%) patients initially underwent axillary node dissection without biopsy.

Dirofilariasis of Breast Mimicking Malignancy - A Rare Entity

Human dirofilarial infection usually presents as pulmonary coin lesion or as subcutaneous nodule. We report the case of a 60-year-old female presented clinically with swelling in the lower-outer quadrant of the right breast for 2 weeks. Ultrasound reported as atypical lesion suggest fine-needle aspiration cytology (FNAC) correlation and follow-up. Clinical examination - subcutaneous nodule of size 2 cm × 2 cm presents in the lower-outer quadrant. Clinical suspicious of carcinoma was considered and FNAC was done. Aspirated pus-like material and adult worm about 4 cm in length were attached to the needle. Smear was air-dried and stained with Giemsa. Smears were cellular and showed numerous neutrophils, eosinophils, and a few histiocytes in a necrotic background and also noted coiled adult dirofilarial worm. Cellblock was prepared and it showed the cut section of dirofilarial worm with cuticle, muscular layer, intestine, and reproductive tube. We report this case entity due to diagnostic confusion with breast malignancy clinically and radiologically.

Nano-Based Drug Delivery of Anticancer Chemotherapeutic Drugs Targeting Breast Cancer

BACKGROUND

Chemotherapeutic drugs are principally intended to treat breast cancer. However, sooner or later, tumor drug resistance developed. These chemo drugs are effective but with numerous side effects. Breast cancer care may be extremely difficult since recurring cancer is frequently pre-treated with powerful agents. Cancer cells acquire high resistance to earlier therapies, necessitating alternative and more powerful drugs. Nanoparticles (NPs) as a medication delivery technology can overcome medication resistance in breast cancer and significantly reduce the effective dose. The off-targeted nature of chemo drugs can be resolved by encapsulating or attaching chemo drugs in nanocarriers, specifically targeting breast cancer cells.

OBJECTIVES

This review highlights various chemo drugs for breast cancer and their encapsulation or bioconjugation with nanoparticles for its targeted delivery.

CONCLUSION

Nanoparticles may subsist valuable abet in breast cancer management in this regard. Given that traditional chemotherapy approaches have been demonstrated to have several side effects and defects during treatment, the NPs-mediated drug delivery mechanism is a possible contender for replacement as a new technique.

Noninvasive discrimination of benign and malignant breast lesions using genome-wide nucleosome profiles of plasma cell-free DNA

BACKGROUND

Breast malignancy is the most frequently diagnosed malignancy in women worldwide, and the diagnosis relies on invasive examinations. However, most clinical breast changes in women are benign, and invasive diagnostic approaches cause unnecessary suffering for the patients. Thus, a novel noninvasive approach for discriminating malignant breast lesions from benign lesions is needed.

METHODS

We performed cell-free DNA (cfDNA) sequencing on plasma samples from 173 malignant breast lesion patients, 158 benign breast lesion patients, and 102 healthy women. We then analyzed the cfDNA-based nucleosome profiles, which reflect the various tissues of origin and transcription factor activities. Moreover, by using machine learning classifiers along with the cfDNA sequencing data, we built classifiers for discriminating benign from malignant breast lesions. Receiver operating characteristic curve analyses were used to evaluate the performance of the classifiers.

RESULTS

cfDNA-based nucleosome profiles reflected the various tissues of origin and transcription factor activities in benign and malignant breast lesions. The cfDNA-based transcription factor activities and breast malignancy-specific transcription factor-binding site accessibility profiles could accurately distinguish benign and malignant breast lesions, with area under the curve values of 0.777 and 0.824, respectively.

CONCLUSIONS

Our proof-of-principle study established a methodology for noninvasively discriminating benign from malignant breast lesions.

Radiomics- Quantitative Biomarker Analysis for Breast Cancer Diagnosis and Prediction: A Review

BACKGROUND

Cancer of the breast has become a global problem for women's health. Though concerns regarding early detection and accurate diagnosis were raised, an effort is required for precision medicine as well as personalized treatment. In the past years, the area of medicinal imaging has seen an unprecedented growth that leads to an advancement of radiomics, which provides countless quantitative biomarkers extracted from modern diagnostic images, including a detailed tumor characterization of breast malignancy.

DISCUSSION

In this research, we presented the methodology and implementation of radiomics, together with its future trends and challenges by the basis of published papers. Radiomics could distinguish between malignant from benign tumors, predict prognostic factors, molecular subtypes of breast carcinoma, treatment response to neoadjuvant chemotherapy (NAC), and recurrence survival. The incorporation of quantitative knowledge with clinical, histopathological and genomic information will enable physicians to afford customized care of treatment for patients with breast cancer.

CONCLUSION

Our research was intended to help physicians and radiologists learn fundamental knowledge about radiomics and also to work collaboratively with researchers to explore evidence for further usage in clinical practice.

Accuracy of mammography and ultrasonography and their BI-RADS in detection of breast malignancy

BACKGROUND

We aimed to compare the diagnostic accuracy of mammography and ultrasonography and their breast imaging-reporting and data system (BI-RADS) classification versus breast core needle biopsy (CNB) findings in distinguishing the breast masses.

METHODS

This cross-sectional study was conducted during 2016-2018 on female patients who were referred to a radiology center in Babol, northern Iran, for routine screening and/or for CNB. Patients underwent sonography and mammography by a senior radiologist. The breast lesions were also evaluated according to BI-RADS classification. CNB was performed on the breast masses by the same radiologist and pathological procedures were performed by an expert pathologist. Descriptive statistics were used to analyze the data.

RESULTS

In total, 213 breast masses were finally assessed, of which 107 (50.2 %) masses were benign and 106 (49.8 %) masses were malignant. The sensitivity for mammography and ultrasound alone was 72.6% and 68.9%, respectively. This rate for combined mammography and ultrasound was 84.9%. About BI-RADS classification, 28 masses were classified as BI-RADS 3, 99 as BI-RADS 4A, 4 as BI-RADS 4B, 18 as BI-RADS 4C, and 64 as BI-RADS 5. BI-RADS 4A had the highest sensitivity (70.1%) among BI-RADS categories. The highest specificity pertained to BI-RADS 3 and 5 (100%) among BI-RADS categories. Also, the highest accuracy was related to BI-RADS 5 (80.3%).

CONCLUSION

The results of the present study showed that combined mammography and ultrasound had a higher rate of accuracy than mammography or ultrasound alone. Furthermore, the imaging methods BI-RADS classification had an acceptable positive predictive value.

A rare etiology of a large tumoral mass of the breast - Case report primary leiomyosarcoma and osteosarcoma of the breast

•

Leiomyosarcoma and osteosarcoma are exceedingly rare subtypes of breast sarcoma.

•

Given the exceeding rarity of breast leiomyosarcoma and osteosarcoma, consensus on ideal management of this diseases is still on debate.

•

We report a case of an 87-year-old female with giant breast leiomyosarcoma and osteosarcoma, treated by surgical resection and radiotherapy.

•

Osteosarcoma may have a rapid growth pattern with no other clinical features distinguishable to other malignant breast neoplasms.

Breast sarcomas are a rare group of malignant tumors accounting for less than 1% of all malignant neoplasms of the breast and fewer than 5% of all sarcomas.

We report a case of an 87-year-old caucasian female who recurred to the emergency department with complaints of a painful mass of the left breast with purulent discharge. Observation revealed a volumous mass in the inferior quadrants of the breast, ill defined, with petrous consistency, areas of necrosis, and inflammatory signs. She was admitted to Surgery ward for further study and therapy of a probable inflammatory tumor of the breast. Magnetic resonance image was obtained, raising suspicion on papillary carcinoma and classified the breast as BIRADS5. Microbiological and cytological exams of the exudate were negative. An incisional biopsy of the tumoral mass was also obtained, and the patient discharged while waiting for surgery. Histological exam and immunohistochemical essay were compatible with leiomyosarcoma. Left mastectomy was performed and the patient was discharged with no morbidities on the 5th day after surgery. Histological exam of mastectomy piece showed a metaplastic carcinoma, with osteosarcomatous and focal leiomyosarcomatous differentiation. The lesion was classified as pT4N0M0 and subsequent radiotherapy was performed. Twenty months after surgery the patient was being followed-up on Oncology and Senology consultations and remained asymptomatic.

Consensus on ideal management of this diseases is still on debate. Some authors defend the treatment of this entity in a similar way to sarcoma of the breast. More studies are needed to better understand this entity.

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

BACKGROUND

Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup.

METHODS

We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included.

RESULTS

We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing.

CONCLUSION

Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.

Comparative Effectiveness of Adjuvant Chemotherapy in Early-Stage Breast Cancer: A Network Meta-analysis

BACKGROUND

There are several regimens recommended by the National Comprehensive Cancer Network (NCCN) for HER2-negative operable breast cancer. To our knowledge, no trials have yet been performed comparing these regimens head to head. We performed a network meta-analysis comparing the efficacy of NCCN-recommended chemotherapy regimens.

METHODS

We searched Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception to February 2020. We included randomized clinical trials comparing adjuvant regimens in predominantly node-positive operable breast cancer patients. We compared (1) DDACT, (2) TCx4 cycles, (3) TAC, and (4) ACWKT. Common comparators were (5) AC, (6) ACT, and (7) ACD. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. The Cochrane risk of bias tool assessed quality of the studies. Odds ratios (ORs) were calculated as measures of treatment effects with AC as reference. We used Bayesian hierarchical random-effects models with noninformative priors for mixed multiple treatment comparisons. Effectiveness was estimated by disease-free and overall survival using ORs. Sensitivity analyses were performed. Safety outcomes included febrile neutropenia.

RESULTS

We identified 7 randomized controlled trials with 16,332 patients. TC (odds ratio [95% confidence interval], 0.71 [0.36-1.40]), TAC (0.77 [0.37-1.57]), ACWKT (0.68 [0.34-1.38]), and DDACT (0.72 [0.35-1.42]) were similar for overall survival. TC (0.64 [0.36-1.14]), TAC (0.67 [0.39-1.15]), ACWKT (0.63 [0.37-1.07]), and DDACT (0.59 [0.35-1.01]) had similar disease-free survival benefit. With regard to toxicity, TAC (2.67 [0.30-21.04]) had the highest odds of febrile neutropenia.

CONCLUSION

The current generation of regimens are similar in efficacy. Given the lower toxicity of TCx4 comparatively, it is an acceptable alternative for lower-risk early-stage HER2-negative breast cancers.

Unusual recurrent metastasizing benign breast papilloma: a case report

BACKGROUND

Papillary breast lesions may be benign, atypical, and malignant lesions. Pathological and clinical differentiation of breast papillomas can be a challenge. Unlike malignant lesions, benign breast papillomas are not classically associated with lymph node and distant metastasis. We report a unique case of a recurrent, benign breast papilloma presenting as an aggressive malignant tumor.

CASE PRESENTATION

Our patient was a 56-year-old postmenopausal African American woman who was followed in the breast clinic with a long history of multiple breast papillomas. She underwent multiple resections over the course of 7-9 years. After being lost to follow-up for 2 years, she once again presented with a slowly enlarging left breast mass. Subsequent imaging revealed a predominantly cystic mass in the left breast, as well as a suspicious hypermetabolic internal mammary node and a hypermetabolic nodule in the pretracheal space. Biopsy of the internal mammary node demonstrated papillary neoplasm with benign morphology and immunostains positive for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2/Neu. Due to the clinical picture concerning for malignancy, the patient was then started on endocrine therapy with palbociclib and letrozole before surgery. She then underwent simple mastectomy and sentinel lymph node dissection with negative nodes and pathology once again revealing benign papillary neoplasm. She underwent adjuvant chest wall radiation for 6 weeks and received letrozole following completion of her radiation therapy. She was without evidence of disease 30 months after surgery.

CONCLUSIONS

We present an unusual case of multiple recurrent peripheral papillomas with entirely benign histologic features exhibiting malignant behavior over a protracted period of many years, with an invasion of pectoralis musculature and possibly internal mammary and mediastinal nodes. Her treatment course included multiple surgeries (ultimately mastectomy), radiation therapy, and endocrine therapy.

Breast Microcalcifications as the Only Imaging Manifestation of Metastatic Serous Peritoneal Adenocarcinoma in the Breast

We present a case of a 65 year old female with newly diagnosed primary peritoneal serous carcinoma who was found to have indeterminate segmental microcalcifications in the right upper outer quadrant with a mildly enlarged right axillary node on mammogram. There was no associated breast mass on ultrasound. Core biopsy of the right axillary lymph node and right upper outer quadrant breast microcalcifications confirmed the presence of breast metastases at both sites from primary peritoneal serous carcinoma. This case highlights the importance of histopathological correlation of any breast and axillary abnormalities in patient with primary extramammary malignancy. Imaging features of metastatic lesions to the breast are also reviewed.

Evaluation of the Incorporation of Recurrence Score into the American Joint Committee on Cancer Eighth Edition Staging System in Patients with T1-2N0M0, Estrogen Receptor-Positive, Human Epidermal Growth Receptor 2-Negative Invasive Breast Cancer: A Population-Based Analysis

BACKGROUND

The current study aimed to evaluate the predictive performance of the American Joint Committee on Cancer eighth edition staging system in patients with invasive breast cancer based on the Surveillance, Epidemiology, and End Results database.

SUBJECTS, MATERIALS, AND METHODS

Patients diagnosed with T1-2N0M0, estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer from 2010 to 2014 were retrospectively recruited in this analysis. Patients were reassigned to different stages according to the anatomic staging system (AS), prognostic staging system (PS), and prognostic and genomic staging criteria downstaging patients with recurrence score (RS) lower than 11 (PGS_RS11). Cox models were conducted for multivariate analyses, and likelihood ratio (LR) χ², Akaike information criterion (AIC), and Harrell's concordance index (C-index) were calculated for the comparison of different staging systems. Additionally, adjustments were made to generate prognostic and genomic staging criteria downstaging patients with RS lower than 18 (PGS_RS18) and RS lower than 25 (PGS_RS25).

RESULTS

PGS_RS11 was an independent predictor for breast cancer-specific survival, as were PS and AS. Adjusted for age and ethnicity, PGS_RS11 (AIC = 2,322.763, C-index = 0.7482, LR χ² = 113.17) showed superiority in predicting survival outcomes and discriminating patients compared with AS (AIC = 2,369.132, C-index = 0.6986, LR χ² = 60.80) but didn't outperform PS (AIC = 2,320.992, C-index = 0.7487, LR χ² = 114.94). The predictive and discriminative ability of PGS_RS18 was the best (AIC = 2297.434, C-index = 0.7828, LR χ² = 138.50) when compared with PS and PGS_RS11.

CONCLUSION

PGS_RS11 was superior to AS but comparable with PS in predicting prognosis. Further validations and refinements are needed for the better incorporation of RS into staging systems.

IMPLICATIONS FOR PRACTICE

Staging systems are of critical importance in informing prognosis and guiding treatment. This study's objective was to evaluate the newly proposed staging system in the American Joint Committee on Cancer eighth edition staging manual, which combined biological and genomic information with the traditional TNM classification for the first time to determine tumor stages of breast cancer. The superiority of the prognostic and genomic staging system was validated in our cohort and possibly could encourage the utility of genomic assays in clinical practice for staging assessment and prognosis prediction.

A population-based analysis of pediatric breast cancer

PURPOSE

The purpose of this study was to evaluate trends in demographics and outcomes of pediatric breast cancer in a United States population-based cohort.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant breast tumors between 1973 and 2014. Analysis was performed using Stata Statistical Software version 13.1. Associations between categorical variables were made using X² test. Log-rank test was used for univariate survival analysis. Kaplan-Meier analysis investigated five-year survival rates across several variables. Adjusted analysis was performed using a Cox Proportional-Hazards regression.

RESULTS

134 patients with breast malignancies were identified. Carcinoma was the most prevalent histology (48.5%), followed by fibroepithelial tumors (FETs) (35.1%), and sarcoma (14.2%). FETs were twice as common in black compared to nonblack patients (56.3% vs. 29.0%, p < 0.01). Analyzing histology by stage revealed that 100% of FETs were early stage disease (p < 0.0001). 46.7% of the tumors tested were ER/PR negative, more than twice as many compared to the published adult estimate of 20.0%. Unadjusted survival analysis revealed worse survival for patients with adenocarcinoma/sarcomas, advanced stage, and high grade disease, without a survival difference between races.

CONCLUSION

Breast cancer remains a rare malignancy among pediatric patients. Although black patients were found to have more noncarcinomatous tumors with less advanced disease, this did not confer a survival advantage.

TYPE OF STUDY

Retrospective cohort study.

LEVEL OF EVIDENCE

Level III.

Primary breast lymphoma: A mimic of inflammatory breast cancer

•

Primary breast lymphoma (PBL) is a rare disease accounting for 0.04–0.5% of all breast malignancies.

•

The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma.

•

Sometimes, PBL presentation is suggestive of Inflammatory breast cancer.

•

Diagnosis depends on adequate tissue sampling for histology examination and immunophenotyping.

•

The therapeutic management of PBL is controversial and is not clearly established, but many studies support that it is not a surgical disease and can be treated successfully with combined chemotherapy and radiotherapy.

•

Imaging is a useful method to monitor a patient’s response to therapy.

Introduction

Primary breast lymphoma (PBL) is a rare disease accounting for 0.04–0.5% of all breast malignancies.

Presentation of case

This article reports a clinical case of a 81-year-old woman with a history of right breast erythema and edema associated to breast pain, with over two weeks duration. Physical examination demonstrated mammary asymmetry and inflammatory signs with orange peel skin. She had the right upper limb swollen and palpable axillar and supraclavicular lymph nodes. The principal suspicion was an inflammatory breast cancer. Imaging was unspecific. Core needle biopsy of an axillary lymph node and of the breast mass identified morphological and immunophenotypic features consistent with diagnosis of primary non-Hodgkin DLBCL. Patient was guided by Hematology.

Discussion

The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma. Sometimes, PBL presentation is suggestive of Inflammatory breast cancer. Diagnosis depends on adequate tissue sampling for histology examination and immunophenotyping. The therapeutic management of PBL is controversial and is not clearly established, but many studies support that it is not a surgical disease and can be treated successfully with combined chemotherapy and radiotherapy.

Conclusion

Breast lymphoma must be considered in the differential diagnosis of a breast lump, even in the presence of cutaneous inflammatory changes. PBL can be treated successfully with combined therapy.

Do All Women With Abnormal Sonographic Axillary Lymph Nodes Need a Biopsy?

PURPOSE

With the increased use of breast ultrasound for different indications, sonographically abnormal axillary lymph nodes are not a rare finding. We examined clinical and imaging characteristics in correlation with pathological reports of the sonographic guided biopsies to assess the yield of needle biopsy of these nodes.

METHODS

Clinical, imaging and pathology data were collected for 171 consecutive patients who underwent sonographic guided needle biopsy of an abnormal lymph node between 2008 and 2013. Malignancy rates were examined for different clinical settings: palpable axillary mass, previous history of breast cancer, findings suggestive of a systemic disease, and those with a breast finding of low suspicion or an incidental abnormal axillary lymph node. Patients with newly diagnosed breast cancer were excluded.

RESULTS

Twelve patients (7%) were found to have a malignancy on their axillary lymph node biopsy. Malignancy rates increased with age, and varied with clinical presentation: Axillary mass (8, 26%); history of breast cancer (2, 11%); systemic disease (0%) and breast finding of low suspicion or incidental abnormal lymph node on screening (1, 1%). Low rates of malignancy were found when the cortex was <6 mm (1, 0.8%). The most important imaging finding associated with malignancy was lack of a preserved hilum, in which case almost a third (10, 29%) of the biopsies were malignant. Only 1 of 89 women with a breast finding of low suspicion or an incidental abnormal axillary lymph node was found to have malignancy. In this case the lymph node had no hilum.

CONCLUSIONS

In women without breast cancer, a highly suspicious breast mass or an axillary mass, more stringent criteria should be used when evaluating an abnormal axillary lymph node on sonography, as the malignancy rates are very low (1%).

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

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.