TY - JOUR
T1 - Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study
AU - Luiten, Jacky D.
AU - Korte, Bram
AU - Voogd, Adri C.
AU - Vreuls, Willem
AU - Luiten, Ernest J. T.
AU - Strobbe, Luc J.
AU - Rutten, Matthieu J. C. M.
AU - Plaisier, Menno L.
AU - Lohle, Paul N.
AU - Hooijen, Marianne J. H.
AU - Tjan-Heijnen, Vivianne C. G.
AU - Duijm, Lucien E. M.
N1 - Publisher Copyright:
© 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC
PY - 2019/11/15
Y1 - 2019/11/15
N2 - 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.
AB - 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.
KW - high-risk lesions
KW - risk-associated lesions
KW - surgical excision
KW - diagnostics
KW - mammographic screening
KW - CARCINOMA IN-SITU
KW - VACUUM-ASSISTED BIOPSY
KW - INTRADUCTAL PAPILLOMAS
KW - ATYPIA
KW - UPGRADE
KW - SURVEILLANCE
KW - INSTITUTION
KW - SENSITIVITY
KW - CONCORDANT
KW - MANAGEMENT
U2 - 10.1002/ijc.32353
DO - 10.1002/ijc.32353
M3 - Article
C2 - 31001821
SN - 0020-7136
VL - 145
SP - 2720
EP - 2727
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 10
ER -