Mammographically occult breast cancer: A pathologic and radiologic study

Holland, Roland; Hendriks, Jan H. C. L.; Mravunac, M.

doi:10.1002/1097-0142(19831115)52:10<1810::aid-cncr2820521009>3.0.co;2-f

Cited by 118 publications

(48 citation statements)

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“…Patients were younger compared with all other breast cancer patients (Burns et al, 1979;Cahill et al, 1981). Here the limits of modern mammography have been reached since in dense breast parenchyma these types of breast cancers probably cannot be visualised (Holland et al, 1983).…”

Section: Discussionmentioning

confidence: 75%

The occurrence of interval cancers in the Nijmegen screening programme

Peeters

Verbeek²,

Hendriks³

et al. 1989

Br J Cancer

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Summary Since January 1975 a population-based screening programme for the early detection of breast cancer has been carried out in the city of Nijmegen. During five interscreening periods of 2 years each a total of 158 so-called interval cancers were diagnosed. Careful revision of all screening and diagnostic mammograms was executed. Of all interval cancers 26% were 'missed' at the previous screening examination (due to technical or observer error), 16% were radiographically occult at the time of diagnosis and 58% were 'true' interval cancers. Interval cancers were regarded as 'true' when an obvious lesion was observed on the diagnostic mammogram while no suspect signs were seen on the previous screening mammogram. The prevalence of 'missed' cancers did not decline in the course of the screening programme. Radiographically occult tumours were localised, mostly in Wolfe's P2/DY breast parenchyma (83%), 33% were lobular invasive and 25% ductal non-invasive. 'True' interval cancer cases (58%) showed the same overall survival as control breast cancer patients, diagnosed in a non-screening situation. Shortening the screening interval would reduce interval cancer rates and probably further decrease breast cancer mortality in a screened population. However, from the present series of interval cancers 63% would not have been prevented by an annual screening examination. As regards women under age 50 annual screening would still leave 66% of all interval cancers in this age group undetected. Probably more benefit will be gained by searching for new imaging techniques to reduce numbers of 'missed' cancers and to detect lobular invasive and ductal non-invasive cancers in dense breast parenchyma.Within any screening programme for the early detection of breast cancer, women are diagnosed as having so-called interval cancer. These cancers surface among negative screenees before the next scheduled examination would have taken place. Of all breast cancers in a screened population about 20-35% are diagnosed within 2 years after the last screening examination (Verbeek, 1985;Tabar et al., 1987;Moskowitz, 1986;de Waard et al., 1984;Lundgren, 1979). The survival of patients with interval cancers turned out to be just as bad as the survival of patients diagnosed outside screening programmes (Holmberg et al., 1986;Shapiro et al., 1982). This finding would seem to suggest that shortening the screening interval to, say, one year might further decrease breast cancer mortality in a population offered a screening programme. The aim of the present study was to search for more evidence validating such recommendations. It was evaluated whether the number of 'missed' cancers decreased during the 12-year observation period. Interval cancers were compared with breast cancers, detected at one of the five screening rounds, in terms of such radiological and prognostic aspects as Wolfe classification, mammographical tumour size, age at the previous examination, quetelet index, oestrogen receptor positivity and axillary lymph node involvement. To eva...

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Section: Discussionmentioning

confidence: 75%

The occurrence of interval cancers in the Nijmegen screening programme

Peeters

Verbeek²,

Hendriks³

et al. 1989

Br J Cancer

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“…However, as in situ breast carcinoma (in situ BC) is rarely symptomatic and the sensitivity of mammography in detecting malignancy is limited despite improved techniques (Holland et al, 1983), much uncertainty exists concerning these lesions.Histopathologic examination of the breast is a reliable method for detection of clinically and radiologically occult malignant and atypical lesions but extensive sampling is mandatory to detect these small lesions. The few autopsy studies using this technique have been carried out mainly on elderly women (Alpers & Wellings, 1985;Kramer & Rush, 1973;Nielsen et al, 1984).…”

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confidence: 99%

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confidence: 99%

“…The available information stems mainly from studies using mammography for mass screening (Andersen, 1981; Moskowitz, 1981;Tabiar et al, 1985), and from clinically based series of self-selected women (Betsill et al, 1978;Fisher et al, 1986;Moskowitz, 1983;Page et al, 1978;Page et al, 1982). However, as in situ breast carcinoma (in situ BC) is rarely symptomatic and the sensitivity of mammography in detecting malignancy is limited despite improved techniques (Holland et al, 1983), much uncertainty exists concerning these lesions.…”

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confidence: 99%

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Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies

Nielsen

Thomsen²,

Primdahl³

et al. 1987

Br J Cancer

379

162

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(Andersen, 1981;Moskowitz, 1981; Tabiar et al., 1985), and from clinically based series of self-selected women (Betsill et al., 1978;Fisher et al., 1986;Moskowitz, 1983;Page et al., 1978;Page et al., 1982). However, as in situ breast carcinoma (in situ BC) is rarely symptomatic and the sensitivity of mammography in detecting malignancy is limited despite improved techniques (Holland et al., 1983), much uncertainty exists concerning these lesions.Histopathologic examination of the breast is a reliable method for detection of clinically and radiologically occult malignant and atypical lesions but extensive sampling is mandatory to detect these small lesions. The few autopsy studies using this technique have been carried out mainly on elderly women (Alpers & Wellings, 1985;Kramer & Rush, 1973;Nielsen et al., 1984).To obtain an estimate of the frequency and characteristics of clinically occult malignant and atypical lesions in younger Danish women, a series of medicolegal cases seemed to be a suitable sample. The results of an extensive histopathologic breast tissue examination and correlative specimen radiography in such a group of women are presented in this paper. Materials and methodsThe study group consisted of a series of 110 consecutive medicolegal autopsies on (Danmarks Statistik, 1985). During the sampling period about 10% of all deaths within the area underwent medicolegal examination and of these about 25% were subjected to autopsy.During the medicolegal autopsy, bilateral total mastectomy with partial axillary dissection (Cady, 1973) was performed in all cases, except for one woman who had undergone previous mastectomy for IBC and consequently only had a contralateral mastectomy.Each fresh breast specimen was weighed and radiographed intact in a single frontal projection in a Faxitron (model 43805N) using Kodak industrial M film. With the nipple as the center point, the specimen was then divided into the four quadrants and cut systematically from the deep fascia to the outer surface in 5 mm-thick slices. Each of these were radiographed and thereafter fixed in formalin. The slices were examined grossly after fixation and the relative proportion of glandular and fatty breast tissue was evaluated in 10% estimates. All tissue including fatty tissue was processed routinely for paraffin embedding. Axillary lymph nodes were also radiographed and processed for microscopic examination.The total number of paraffin blocks was 60,335 with each block containing -1.3 g of breast tissue. The average number of paraffin blocks from each breast specimen was 275 (range 57-683). The average number of lymph nodes from each woman was 21 (range 0-50). Sections for microscopic examination were cut from each paraffin block and stained with hematoxylin and eosin. In cases with suspicion of or with manifest in situ BC and atypical ductal hyperplasia (ADH), additional serial sections were prepared. The PAS-alcian stain was used to support the differentiation between LCIS and DCIS, based on the presence of intracytoplasmic lumi...

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“…In 6 of the 16 cases the mammographically detected lesion was not included in biopsy specimen. This can be explained by the lack of routine specimen X-ray of biopsies (Holland et al, 1985) in the early years of the screening programme or by poor radiologic localisation due to small diameter and/or deep situation of the tumour and/ or density of the breast. Some time lapsed before radiological tests and clinical examination were carried out.…”

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confidence: 99%