Trends in frequency and outcome of high‐risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study

Abstract

Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high‐risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6‐year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high‐risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high‐risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high‐risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high‐risk lesions at CNB tripled in a 6‐year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome.

Patient reported cosmetic outcome after vacuum assisted excision of benign breast lesions: a cross-sectional study

“…Even more females are diagnosed with benign breast lesions, [1][2][3][4] although exact prevalence data are lacking. Surgical excision of all highrisk lesions is performed in 2.5% of all recalled females after screening, 5 and over 70% of these excised lesions are benign lesions. 5 This does not even include females referred from the general physician with palpable lesions.…”

“…Surgical excision of all highrisk lesions is performed in 2.5% of all recalled females after screening, 5 and over 70% of these excised lesions are benign lesions. 5 This does not even include females referred from the general physician with palpable lesions. Benign or high-risk lesion are excised if: (1) the lesion is symptomatic or (2) when there is the need for additional tissue for diagnostic purposes.…”

“…Benign or high-risk lesion are excised if: (1) the lesion is symptomatic or (2) when there is the need for additional tissue for diagnostic purposes. [5][6][7][8] Surgical excision is still the most performed procedure for benign or high-risk breast lesions in the Netherlands. However, vacuum-assisted excision (VAE) offers an alternative therapy for benign and highrisk lesions and surgery can then be avoided.…”

Are Columnar Cell Lesions the Earliest Non-Obligate Precursor in the Low-Grade Breast Neoplasia Pathway?

“…In part due to the implementation of widespread screening mammography, CCLs have been increasingly recognized in stereotactic core needle biopsies (CNB) performed for the assessment of calcifications [ 2 , 3 , 4 , 5 ]. CCLs have been postulated to represent the earliest non-obligate precursor of low-grade invasive breast carcinomas as they share molecular alterations and often coexist with entities in the low-grade breast neoplasia pathway, including atypical ductal hyperplasia (ADH), lobular neoplasia (LN), low-grade ductal carcinoma in situ (DCIS) and tubular carcinoma [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Hospital costs and cosmetic outcome of benign and high-risk breast lesions managed by vacuum assisted excision versus surgical excision

“…Excision of these lesions is only indicated if it is symptomatic or for diagnostic purposes. [5][6][7][8] Surgical excision (SE) is still the most performed procedure for benign or high-risk breast lesions in the Netherlands. However, previous studies have shown that vacuum-assisted excision (VAE) is an alternative non-surgical treatment option for most of these lesions.…”