High-Risk Lesions at MRI-Guided Breast Biopsy: Frequency and Rate of Underestimation

Lourenço, Ana P.; Khalil, Hanan; Sanford, Matthew F.; Donegan, Linda

doi:10.2214/ajr.13.11905

Cited by 49 publications

(40 citation statements)

References 36 publications

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“…In this study, the upgrade rate from atypical lesions to cancer due to a finding on BSGI was 21.4% (3/14). This is comparable to existing data demonstrating upgrade rates of 20%-23% for MRI-detected atypia (33,34). These findings suggest that surgical excision should be recommended for all atypical, highrisk lesions found on BSGI.…”

Section: Treatment and Outcome Of Atypical High-risk Lesionssupporting

confidence: 85%

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

et al. 2016

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Breast-specific γ-imaging (BSGI) is a physiologic imaging modality that can detect subcentimeter and mammographically occult breast cancer, with a sensitivity and specificity comparable to MRI. The purpose of this study was to determine the incremental increase in breast cancer detection when BSGI is used as an adjunct to mammography in women at increased risk for breast cancer. Methods: All patients undergoing BSGI from April 2010 through January 2014 were retrospectively reviewed. Eligible patients were identified as women at increased risk for breast cancer and whose most recent mammogram was benign. Examinations exhibiting focally increased radiotracer uptake were considered positive. Incremental increase in cancer detection was calculated as the percentage of mammographically occult BSGI-detected breast cancer and the number of mammographically occult breast cancers detected per 1,000 women screened. Results: Included in this study were 849 patients in whom 14 BSGI examinations detected mammographically occult breast cancer. Patients ranged in age from 26 to 83 y, with a mean age of 57 y. Eleven of 14 cancers were detected in women with dense breasts. The addition of BSGI to the annual breast screen of asymptomatic women at increased risk for breast cancer yields 16.5 cancers per 1,000 women screened. When high-risk lesions and cancers were combined, BSGI detected 33.0 high-risk lesions and cancers per 1,000 women screened. Conclusion: BSGI is a reliable adjunct modality to screening mammography that increases breast cancer detection by 1.7% (14/849) in women at increased risk for breast cancer, comparable to results reported for breast MRI. BSGI is beneficial in breast cancer detection in women at increased risk, particularly in those with dense breasts. Br east cancer is the second most common cancer in American women (1). X-ray mammography remains the standard of breast cancer screening and is an effective imaging tool that reduces mortality from breast cancer (2). However, it is an imperfect tool, with an overall reported sensitivity of 85%, which decreases to 68% in women with dense breasts (3,4). In prospective trials among women at high risk for breast cancer due to a familial or genetic predisposition, mammography demonstrated a 30%-40% sensitivity (5). Because of the limitations of mammography, supplemental imaging modalities, including MRI, whole-breast screening ultrasound, and breast-specific g-imaging (BSGI), are becoming increasingly important for women at increased risk, with the goal of detecting early-stage breast cancer.Breast MRI is a physiologic imaging modality recommended as a supplemental screening tool to mammography for high-risk women ($20%-25% lifetime risk) (6). MRI has demonstrated an incremental detection rate of 9.5 cancers per 1,000 high-risk women screened (7) and variable sensitivity and specificity ranging from 71% to 92% and 54% to 86%, respectively (8-10). However, MRI is costly, time-consuming for radiologists to interpret, poorly tolerated by some patients due to claus...

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Section: Treatment and Outcome Of Atypical High-risk Lesionssupporting

confidence: 85%

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

et al. 2016

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“…Even with complete removal of malignant microcalcifications by VAB, underestimation rates up to 17 % are documented [26–29]. The highest underestimation rates (22–65 %) are published for ultrasound-guided 14G CNB [21, 22, 25, 30–34] while ultrasound-guided VABs have much lower rates of underestimation (0–22 %) [33, 35]. Grady et al found no underestimation in lesions completely removed by 8 G ultrasound-guided VAB [35].…”

Section: Resultsmentioning

confidence: 99%

“…The highest underestimation rates (22–65 %) are published for ultrasound-guided 14G CNB [21, 22, 25, 30–34] while ultrasound-guided VABs have much lower rates of underestimation (0–22 %) [33, 35]. Grady et al found no underestimation in lesions completely removed by 8 G ultrasound-guided VAB [35]. For MRI-guided VAB only two studies exist regarding underestimation of ADH showing underestimation rates of 32 and 38 %, respectively [36, 37].…”

Section: Resultsmentioning

confidence: 99%

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Rageth

O’Flynn

Comstock

et al. 2016

Breast Cancer Res Treat

191

149

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The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

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“…This finding was in agreement with the existing data, lending additional support to the idea that MRI characteristics are not predictive of upstaging to malignancy. [6][7][8][9][13][14][15] Finally, all upstaged lesions in our study were in patients with a history of breast cancer. Although not statistically significant, this characteristic is likely related to the small sample size and our specific population at a tertiary cancer center.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging-Guided Core Needle Breast Biopsies Resulting in High-Risk Histopathologic Findings: Upstage Frequency and Lesion Characteristics

Weinfurtner

Patel

Laronga

et al. 2015

Clinical Breast Cancer

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High-Risk Lesions at MRI-Guided Breast Biopsy: Frequency and Rate of Underestimation

Abstract: MRI-guided breast biopsy yielded high-risk lesions in 21.5% of cases, and the underestimation rate was 23.2%. No patient or lesion characteristics correlated with underestimation rate.

Cited by 49 publications

References 36 publications

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Magnetic Resonance Imaging-Guided Core Needle Breast Biopsies Resulting in High-Risk Histopathologic Findings: Upstage Frequency and Lesion Characteristics

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