Pathology Evaluation of Reduction Mammaplasty Specimens and Subsequent Diagnosis of Malignant Breast Disease: A Claims‐Based Analysis

Abstract

Background This study aimed to measure the use of pathology evaluation of breast specimens among patients undergoing reduction mammaplasty and assess rates of new diagnoses of breast disease and associated cost. Methods We analyzed the Truven MarketScan Databases from 2009 to 2015 to identify adult female patients undergoing reduction mammaplasty for macromastia. We recorded patient age, rates of obtaining pathology evaluation, new diagnoses of benign or malignant breast disease after pathology evaluation, and total cost for the surgery encounter. Results Among 17,738 macromastia patients undergoing reduction mammaplasty, 91.3% (n = 16,193) received pathology evaluation. Pathology evaluation rates were clinically similar across age groups \70 years (90.8-92.1%) and slightly lower for patients C70 (85.0%). Among 6987 patients less than 40 years who received pathology evaluation, 0.06% (n = 4) were subsequently diagnosed with malignant breast disease within 3 months, compared to 0.23% in the entire cohort (n = 37/16,193). Pathology claims resulted in an added $307 (SD 251) on average for the breast reduction surgery encounters. Conclusions Breast tissue after reduction mammaplasty is routinely submitted for pathology evaluation, without consideration of age-based risk for breast cancer. Routine pathology evaluation of breast tissue in patients in lower risk age groups (less than 40 years) required an additional $536,000 on average to detect a single occult breast cancer compared to an added $85,600 to detect a new malignancy in patients 40 years and older. Clinicians and policy makers should consider whether routine pathology evaluation of breast tissue should be individualized based on risk factors for breast cancer.

The rate of incidental atypical and malignant breast lesions in reduction mammoplasty specimens

“…The cancer rate in patients with no history of breast cancer in previous studies ranged from 0 to 1% 12–26 . Similar to those studies, the cancer rate in our study was 0.36%.…”

“…in 2012 suggested gross‐only evaluation for patients aged <30 years 11,26 . However, previous studies, including ours, reported many cancer cases in patients aged between 30 and 35 years 5,19,23–25 . In our study, we did not observe any cancer cases in patients aged <30 years.…”

“…In our study, the rate of AMBL in patients with no history of breast cancer was 3.3%. The previous studies that included only patients with no history of breast cancer reported the rate of AMBL to be between 1.5 and 14% 5,7–26 . The wide range of reported rates of AMBL in different studies can be attributed to different pathological assessment methods of RM specimens between institutions.…”

“…In our study, we did not observe any cancer cases in patients aged <30 years. Reviewing the previous studies revealed only four patients aged <30 years with incidental cancer in more than 60 000 RM cases 23–25 . Tang et al .…”

“…In this context, previous studies that analysed RM specimens showed a higher rate of incidental breast cancer in patients with a history of breast cancer compared to patients with no history of breast cancer 5–11 . The rate of incidental atypical and malignant breast lesions (AMBL) in patients with no history of breast cancer ranged from 1.5 to 14% 5,7–26 . One of the most common findings in all these studies was the older age of patients with AMBL compared to patients with no AMBL.…”