Tehillah S Menes1, Robert Rosenberg2, Steven Balch3, Shabnam Jaffer4, Karla Kerlikowske5, Diana L Miglioretti6. 1. Department of Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239 Tel Aviv, Israel. Electronic address: tehillahm@lvmc.gov.il. 2. Radiology Associates of Albuquerque, Albuquerque, NM, USA; Department of Radiology, University of New Mexico, Albuquerque, NM, USA. 3. Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA. 4. Department of Pathology, The Mount Sinai Medical Center, New York, NY, USA. 5. Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. 6. Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA; Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
Abstract
BACKGROUND: Upgrade rates of high-risk breast lesions after screening mammography were examined. METHODS: The Breast Cancer Surveillance Consortium registry was used to identify all Breast Imaging Reporting and Data System category 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women. RESULTS: High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (n = 685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia, and 2% in papillary lesions). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, and those associated with lobular neoplasia were mostly (56%) invasive. During a further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery. CONCLUSIONS: Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on Breast Imaging Reporting and Data System category 4 mammograms among asymptomatic women do not justify surgical excision.
BACKGROUND: Upgrade rates of high-risk breast lesions after screening mammography were examined. METHODS: The Breast Cancer Surveillance Consortium registry was used to identify all Breast Imaging Reporting and Data System category 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women. RESULTS: High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (n = 685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia, and 2% in papillary lesions). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, and those associated with lobular neoplasia were mostly (56%) invasive. During a further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery. CONCLUSIONS: Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on Breast Imaging Reporting and Data System category 4 mammograms among asymptomatic women do not justify surgical excision.
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