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Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography,a multiinstitutional study |
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| Authors: | Jacky D. Luiten Bram Korte Adri C. Voogd Willem Vreuls Ernest J.T. Luiten Luc J. Strobbe Matthieu J.C.M. Rutten Menno L. Plaisier Paul N. Lohle Marianne J.H. Hooijen Vivianne C.G. Tjan-Heijnen Lucien E.M. Duijm |
| Affiliation: | 1. Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands;2. Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands;3. Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands;4. Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands;5. Department of Surgical Oncology, Amphia Hospital, Breda, The Netherlands;6. Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands;7. Department of Radiology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands;8. Department of Radiology, Maxima Medical Centre, Veldhoven, The Netherlands;9. Department of Radiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands;10. Department of Radiology, St Anna Hospital, Geldrop, The Netherlands;11. School for Oncology and Developmental Biology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands;12. Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands Dutch Expert Centre for Screening, Nijmegen, The Netherlands |
| 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. |
| Keywords: | high-risk lesions risk-associated lesions surgical excision diagnostics mammographic screening |