Fourteen‐gauge needle core biopsy of mammographically evident radial scars

Cawson, Jennifer; Malara, F; Kavanagh, Anne; Hill, Prue; Balasubramanium, Gnani; Henderson, M. Todd

doi:10.1002/cncr.11070

Cited by 99 publications

(79 citation statements)

References 37 publications

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“…10,13,[27][28][29] When we excluded cases associated with epithelial atypia (PPV ¼ 39%) from the analysis, the PPV of RS/CSL was 9%, similar to that reported in our previous study (9%). 4 These findings in addition to the fact that most of the malignant lesions detected after a diagnosis of RS/CSL were low grade (80%) and often of pure tubular morphology (55%) may support consideration of nonsurgical management, such as removal by vacuum assisted biopsy, in selected cases.…”

supporting

confidence: 86%

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Rakha

Lee

Jenkins

et al. 2011

Intl Journal of Cancer

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In the setting of breast cancer screening, 5-9% of needle core biopsies are diagnosed as lesions of uncertain malignant potential (B3). The management of these lesions is potentially problematic as the data on their outcome remains limited. In our study, we aim to assess the outcome of screen-detected lesions diagnosed as B3 in a large series to validate previous studies and to characterize the malignant lesions detected after a B3 diagnosis. Therefore, the results of 1,025 needle core biopsies of women screened over a 7-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) in two different regions in the UK with B3 diagnoses who underwent surgical excision were reviewed and compared to the final excision histology. Final histology showed that 25% of cases were malignant (17% ductal carcinoma in situ and 8% invasive). Predictors of malignancy included calcification on imaging and epithelial atypia on needle core biopsy particularly atypical ductal hyperplasia [positive predictive value 50%]. Pure flat epithelial atypia showed the lowest positive predictive value amongst all epithelial atypia groups (21%). The positive predictive value was low for complex sclerosing lesions (9%) and papillary lesions (13%) without epithelial atypia. Malignant tumors detected after B3 diagnosis showed favorable histological features, the majority were in situ, and most belonged to the low grade breast neoplasia family that is associated with indolent behavior. The underlying radiological abnormality was calcification in 44% of cases and the imaging classification was malignant/suspicious in 38%. In conclusion, our results further emphasize the heterogeneity of B3 lesions and that the likelihood of malignancy varies substantially between different histological subtypes. Malignancy is particularly associated with epithelial atypia suggesting the use of two categories of with and without epithelial atypia. Radiological findings provided useful information regarding the nature and outcome of B3 lesions.

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confidence: 86%

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Rakha

Lee

Jenkins

et al. 2011

Intl Journal of Cancer

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“…In an overview of this topic, Jacobs et al (2002) reported that knowledge and consensus on the management of these lesions are hindered by the very small number of subjects in most studies, and also by selection bias for subjects managed with excision biopsy (Jacobs et al, 2002). Whereas acknowledging that a few studies have included more cases per specific B3 lesion (Cawson et al, 2003;Shah et al, 2006), we believe that our study addresses the first issue in providing the largest consecutive study of B3 cases. As for the latter issue, and while selection to surgery was not entirely avoided, the vast majority of subjects had excision in our series.…”

Section: Discussionmentioning

confidence: 91%

Borderline breast core needle histology: predictive values for malignancy in lesions of uncertain malignant potential (B3)

et al. 2007

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Breast core needle biopsy (CNB) is an accurate test but may result in borderline histology (lesions of uncertain malignant potential or B3). This is an evaluation of the largest series (to date) of B3 histology, which focusses on estimating positive predictive values (PPV) for malignancy. We identified all B3 CNBs over a 10-year period in a single institution (N ¼ 372) from a series of 4035 consecutive needle biopsies. We describe the imaging findings, and report excision histology outcomes (N ¼ 279) and category-specific PPV for B3 lesions using two approaches including estimates based on subjects who had either excision or follow-up (N ¼ 328). B3 represented 9.2% of all CNB results. Excision histology was benign in 181 (64.9%) and malignant in 98 (35.1%) subjects (61 ductal carcinoma in situ, 37 invasive carcinoma). Positive predictive value for malignancy (based on excision histology) was 35.1% (95% CI: 29.5 -40.7) and PPV (based on excision or review) was 29.9% (95% CI: 24.9 -34.8). Lesion-specific PPV (estimates in parentheses for excision or follow-up) was atypical ductal hyperplasia 44.7% (40.6%); lobular intraepithelial neoplasia 60.9% (58.3%); papillary lesion 22.7% (15.9%); radial scar 16.7% (12.3%); phyllodes tumour 12.5% (12.5%); and B3 not specified 20.0%. Approximately one-third of CNB results classified as B3 are malignant on excision, and the likelihood of malignancy varies substantially between specific lesion groups. Whereas cases may be selectively managed without surgery, the majority warrant excision biopsy based on our estimates. Research is needed to improve differentiation between malignant and benign diseases in B3 lesions using diagnostic or predictive methods.

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“…5 However, it has also been suggested that pure radial scars diagnosed by needle core biopsy do not require excision and can be managed safely by mammographic surveillance. 6 There are mammographic features suggestive of radial scars (for example, the Tabar and Dean criteria; Table 2). 2 However, only 68% of radial scars present as a typical mammographic lesion and less than 50% display all the Tabar and Dean criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Of the six invasive cancers identified on excision biopsy, four were thought to be pure radial scars on needle core biopsy (67%). In addition there were 22 lesions (18%) with associated atypia -ADH (13), ALH (6) and both ADH and ALH (3) -and, finally, three cases (2.5%) with LCIS. Only 81 lesions were deemed to be pure radial scars on final histological assessment, giving an overall false negative rate of 12% for needle core biopsy.…”

Section: A Review Of Needle Core Biopsy Diagnosed Radial Scars In Thementioning

confidence: 98%

A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme

Osborn

Wilton

Stevens

et al. 2011

annals

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INTRODUCTION Radial scars are benign breast lesions; their appearance on mammography may, however, mimic carcinoma. Needle core biopsy is performed for pre-operative diagnosis and, currently in Wales, all lesions with benign biopsy results are surgically excised. We have reviewed all cases of needle core biopsy-diagnosed radial scars from the Welsh breast screening programme, Breast Test Wales (BTW), and investigated the outcome of radial scars based on histology from surgical excision in order to evaluate the appropriateness of the current management of these lesions in Wales. PATIENTS AND METHODS All needle core biopsy diagnosed radial scars were identified from the BTW screening database from the start of screening in 1989 until the end of 2007. RESULTS A total of 118 patients were diagnosed with radial scars on needle core biopsy; two patients had bilateral radial scars. Median patient age was 54 years (range, 49-68 years). Ninety-five lesions (79%) were thought to be pure radial scars on needle core biopsy; however, only 81 pure radial scars were identified on excision biopsy histology. Carcinoma was present in seven patients and ductal carcinoma in situ in nine patients at excision biopsy. In two patients, the cancers occurred in lesions reported as pure radial scars on needle core biopsy. Twenty-two lesions showed atypical ductal or lobular hyperplasia (ADH/ALH) or both on excision biopsy; 14 of these lesions were classed as pure radial scars by needle core biopsy. CONCLUSIONS All core biopsy diagnosed radial scars, presenting as screen detected abnormalities, should be excised due to their association with premalignant and malignant conditions.

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Fourteen‐gauge needle core biopsy of mammographically evident radial scars

Cited by 99 publications

References 37 publications

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Borderline breast core needle histology: predictive values for malignancy in lesions of uncertain malignant potential (B3)

A review of needle core biopsy diagnosed radial scars in the Welsh Breast Screening Programme

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