Benign breast lesions at risk of developing cancer—A challenging problem in breast cancer screening programs

Abstract

BACKGROUND:Cytology and core‐needle biopsies are not always sufficient to exclude malignancy in benign breast lesions (BBL) that are at risk of developing cancer, and open biopsy often is mandatory. In screening programs, open biopsies performed for lesions that are at risk of developing malignancy are considered benign. The authors of this report evaluated the impact of the screen‐detected BBL at risk of developing cancer that were counted in the quota of benign breast open biopsies in the Breast Cancer Screening Program of Verona.METHODS:Benign open biopsies were subdivided into 4 groups according to their risk of developing cancer: Histo1, normal histology; Histo2, ‘pure’ BBL (fibroadenoma, fibrocystic disease, mastitis, adenosis); Histo3, BBL with a low risk of developing cancer (radial scar, papilloma, papillomatosis, phyllodes tumor, mucocele‐like lesion); and Histo4, BBL with a high risk of developing cancer (atypical columnar cell hyperplasia, atypical ductal hyperplasia, atypical lobular hyperplasia).RESULTS:Of 510 open biopsies, 83 biopsies were benign, and the ratio of benign to malignant biopsies was 1:5. Histo1 was observed in 4.8% of all benign open biopsies, Histo2 was observed in 37.4%, Histo3 was observed in 31.3%, and Histo4 was observed 26.5%.CONCLUSIONS:BBL at risk of developing cancer may be numerous in screening programs. It is inappropriate to include BBL at risk of developing cancer in the overall benign open biopsy rate. The authors propose separating pure BBL from lesions at higher risk of developing cancer. To date, there is no evidence to support the premise that detecting high‐risk proliferative lesions leads to benefits in terms of reduced mortality; however, these lesions need to be counted separately for future evaluations. Cancer 2009. © 2008 American Cancer Society.

Fine‐needle aspiration cytology as the first pathological diagnostic modality in breast lesions: A comparison with core needle biopsy

“…37 The false-negative rate in the combined FNAC and CNB group is 0%, and other parameters are also higher than in the FNAC or CNB group alone. 37 The false-negative rate in the combined FNAC and CNB group is 0%, and other parameters are also higher than in the FNAC or CNB group alone.…”

“…37 The false-negative rate in the combined FNAC and CNB group is 0%, and other parameters are also higher than in the FNAC or CNB group alone. 33,34,37 Lesion size is a major factor in quality assurance in both FNAC and CNB. 31,32 However, FNAC has many advantages over CNB, including safety, low cost, ease of performance, and less pain; therefore, FNAC should be the first pathological modality.…”

Risk of breast cancer and family history of other cancers in first-degree relatives in Chinese women: a case control study

“…Of these 823 controls, 311 (intraductal papilloma) were classified as benign breast disease with a low risk of developing breast cancer, and only 13 (atypical hyperplasia) were classified as benign breast disease with a high risk of developing breast cancer [26]. …”

B3 breast lesions determined by vacuum-assisted biopsy: how to reduce the frequency of benign excision biopsies

“…È opinione condivisa da molti autori che al riscontro microistologico di lesione B3 debba far seguito l'approfondimento chirurgico, allo scopo di ottenere la più affidabile conferma istologica sul tessuto mammario residuo [7][8][9][10][11]. La soverchia prudenza espressa da tale atteggiamento rischia tuttavia di esporre ad un eccesso di interventi chirurgici che potrebbero risultare non necessari, dal momento che il valore predittivo positivo (VPP) di malignità per i B3 si situa nel range del 30% [12][13][14][15]. Va peraltro sottolineato come le varie lesioni B3 abbiano VPP di malignità assai diversi tra di loro e variabili con le sottocategorie.…”

“…Many authors agree that a microhistological finding of B3 lesion should prompt surgical excision aimed at obtaining the most reliable histological confirmation on the remaining breast tissue [7][8][9][10][11]. Such an overcautious approach could, however, lead to an excess of unnecessary surgical procedures, given that the positive predictive value (PPV) of malignancy for B3 lesions is in the order of 30% [12][13][14][15]. It should be emphasised that B3 lesions have very different PPV for malignancy, which vary according to the individual lesion and to the lesion subcategory.…”