Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening
M E El-Sayed, E A Rakha, J Reed, A H S Lee, A J Evans, I O Ellis
Histopathology 2008, 53, 650–657

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Approximately 20% of needle core biopsy of screen-detected breast lesions classified as B3 are malignant on excision, and the likelihood of malignancy varies substantially between different histological subtypes

Lobular neoplasia: Core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features
Viviana Londero, Chiara Zuiani, Anna Linda, Elena Vianello, Alessandro Furlan, Massimo Bazzocchi
The Breast 17 (2008) 623 - 630

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Purpose: to assess the positive predictive value (PPV) for malignancy of core needle biopsy (CNB) demonstrating lobular neoplasia.
Underestimation of malignancy was more likely in cases of LCIS, US-guided CNB, and lesions that were large and suspicious on imaging.

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications
Ki Seok Choo, Hee Suk Kwak, Young Tae Bae, Jee-Yeon Lee, Seung Ju Lee, Hyoung Il Seo, Su Bong Nam
The Breast 17 (2008) 611 - 616

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Purpose: to introduce and evaluate the usefulness of the combination of wire localization and ultrasound (US)-guided, vacuum-assisted breast biopsy (VAB) to histologically diagnose mammographically detected clustered microcalcifications in the absence of sonographic and clinically palpable masses. Appears to be an accurate and useful method for diagnosing mammographically detected, clustered microcalcifications

Pain during vacuum-assisted breast biopsy: Are there any predictors?

Pain during vacuum-assisted breast biopsy: Are there any predictors?
George C. Zografos, Flora Zagouri, Theodoros N. Sergentanis, Afrodite Nonni, Philip Domeyer, Dimitra Koulocheri, Ioannis Flessas, Effrosyni Panopoulou, Dimosthenis Chrysikos, John Bramis
The Breast 17 (2008) 592e595

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Pain can be reduced by increased experience of the operator (shorter procedure times) and the avoidance of the luteal phase - timing is everything!

Lower recurrence risk through mammographic screening reduces breast cancer treatment costs

Lower recurrence risk through mammographic screening reduces breast cancer treatment costs
Lea Kauhava, Pirjo Immonen-Räihä, Ilmo Parvinen, Kaija Holli, Liisa Pylkkänen, Anne Kaljonen, Hans Helenius, Pauliina Kronqvist, Pekka J. Klemi
The Breast 17 (2008) 550–554

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The high risk and high costs of breast cancer recurrence are reasons why interventions should be developed that can prevent or delay disease recurrence and reduce the costs of breast cancer care. The present study showed that screening saves costs by early detection of breast cancer with reduced risk of recurrence

Management of lesions of uncertain malignant potential on breast core needle histology: an alternative to surgery in selected cases

Management of lesions of uncertain malignant potential on breast core needle histology: an alternative to surgery in selected cases
S.L. Tennant, A. Evans, L.J. Hamilton, J. James, A.H.S. Lee, Z. Hodi, I.O. Ellis, E.A. Rakha, A.R.M. Wilson
The Breast 17 (2008) 546–549

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Something we all aspire to do - not overtreat borderline lesions which could possibly be followed, after adequate Vacuum Assisted Biopsy. This is a sensible way to go, with adequate multidiscipinary discussion of the case, and close follow up

Management of lesions of uncertain malignant potential on breast core needle histology: Vacuum-assisted excision as an alternative to surgical excisio

Management of lesions of uncertain malignant potential on breast core needle histology: Vacuum-assisted excision as an alternative to surgical excision (EDITORIAL)
The Breast 17 (2008) 543–544

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Editorial comment on the Nottingham paper

Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: Initial observations

Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: Initial observations
He Liu, Yu-Xin Jiang, Ji-Bin Liu, Qing-Li Zhu, Qiang Sun
The Breast 17 (2008) 532 - 539

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The aim of the paper was to evaluate the usefulness of contrast-enhanced ultrasound using the microvascular imaging technique in the diagnosis of breast lesions. Conventional and contrast-enhanced ultrasound using the microvascular imaging technique were performed after administration of SonoVue. The peripheral enhancement pattern was suggestive of malignancy, with a sensitivity of 39.5%, specificity of 98.3%, PPV of 94.4%, NPV of 69.4%, and accuracy of 73.8%. Homogeneous, regional, and heterogeneous enhancement patterns did not show meaningful diagnostic information

Breast screening: Axillary lymph node status of interval cancers by interval year

Breast screening: Axillary lymph node status of interval cancers by interval year
Lauro Bucchi, Donella Puliti, Alessandra Ravaioli, Laura Cortesi, Vincenzo De Lisi, Fabio Falcini, Stefano Ferretti, Alfonso Frigerio, Lucia Mangone, Marco Petrella, Chiara Petrucci, Priscilla Sassoli de Bianchi, Adele Traina, Rosario Tumino, Roberto Zanetti, Manuel Zorzi, Eugenio Paci
The Breast 17 (2008) 477 - 483

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We can confirm the hypothesis that there exists a relationship between the time since last negative screen and the biological aggressiveness of interval-surfacing cancers. The second interval year, but not the first, was associated with an excess risk of lymph node metastases that was independent from tumour size and grade. The results of this study improve the understanding of the screening process, particularly the interplay between mammography sensitivity and the natural history of breast cancer.

Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy?

Jenny K. Hoang, Prue Hill and Jennifer N. Cawson
The Breast 17, Issue 3, June 2008, Pages 282-288

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In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy. Underestimates for malignancy occurred in 14 of 29 cases with granular calcification form (OR 7.9, 95% confidence interval (CI) 1.5–41) and 6 of 8 cases with segmental/linear branching distribution (OR 9.0, 95%CI 1.6–52). No malignancy was found at surgical excision in 16 cases with fine, rounded calcification.

In conclusion, detailed assessment of calcification distribution and form gave helpful predictors for malignancy. Lesions with fine rounded calcification were always benign.

Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy?

Won-Ho Kil, Eun Yoon Cho, Jung Han Kim, Seok-Jin Nam and Jung-Hyun Yang
The Breast 17, Issue 3, June 2008, Pages 258-262

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Debate continues regarding the use of surgical excision in benign papillary lesions initially diagnosed at core biopsy. The objective of this study is to propose management guidelines for benign papillary breast lesions initially diagnosed at core biopsy. Between January 2003 and January 2006, 76 lesions were identified as benign papillary lesions at initial core needle biopsy (n=68) or vacuum biopsy (n=8). After surgical excision, six of the 68 benign papillary lesions initially diagnosed at core needle biopsy were confirmed as malignant papillary neoplasms, giving a false-negative rate of core needle biopsy of 8.8%. Three of the eight atypical papillomas initially diagnosed at core needle biopsy were confirmed as papillary cancer in final pathology, giving a false-negative rate of 37.5%. In the analysis of the difference between benign papillary lesions and atypia or malignant papillary lesions, malignant papillary lesions were located more peripherally (p=0.005) than benign lesions and were larger (>1.5 cm, p=0.017).

It is concluded that atypical papillomas at initial core biopsy or large, clinically peripherally located papillomas (>1.5 cm) need additional surgical excision.

Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography—A clinical approach

S.M. Tan, H.S. Teh, J.F. Kent Mancer and W.T. Poh
The Breast 17, Issue 3, June 2008, Pages 252-257

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Ultrasound elastography using the extended combined auto-correlation method of tissue elasticity allows for real-time strain image visualisation using a free-hand probe with concurrent conventional B mode imaging. Four hundred and fifteen consecutive women with 550 breast lesions confirmed on B mode ultrasound were assessed with elastography using the elasticity score. There were 119 malignant and 431 benign lesions. The elastography sensitivity was 78.0%, specificity was 98.5% and overall accuracy was 93.8%. The median score for malignancy was 5 and that for benign lesions was 2.

There was good correlation with B mode BIRADS category. 98.6% of lesions with an elasticity score of 2 or below (95%CI=96.8–99.4) were benign. BIRADS 3 lesions with an elasticity score of 2 or below may be re-classified as BIRADS 2 lesions. We found that 15.3% of BIRADS 2 and 3 lesions with an elasticity score of 3 were malignant. Real-time ultrasound elastography is user-friendly with a high accuracy rate, thereby improving B mode ultrasound assessment.

Surveillance mammography after breast conservation therapy in Hong Kong: Effectiveness and feasibility of risk-adapted approach

T.K. Yau, H. Sze, I.S. Soong, W. Wong, K. Chan, A. Chang, K.Y. Lau and A. Lee
The Breast 17, 2, April 2008, Pages 132-137

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Annual surveillance mammography is commonly recommended after breast conservation therapy (BCT). We retrospectively reviewed its effectiveness on 511 invasive and non-invasive breast cancers treated with BCT between 1994 and 2003. The median follow-up was 5.9 years. The 5-year actuarial ipsilateral breast tumour recurrence (IBTR) rate was 4.5% and contralateral breast cancer (CBC) rate was 2.0% (representing eight times increase in risk). IBTR of 43% and 62% CBC were first detected by surveillance mammography. The IBTR detection rates per 1000 mammograms were 5.2 for patients (n=349) with one or more IBTR risk factors (age 45, positive/close margins or histological grade 3) and 0.6 for patients (n=162) without. No survival difference was observed between different modes of IBTR detection (p=0.342).

In conclusion, a risk-adapted approach of limiting ipsilateral surveillance to patients with IBTR risk is possible but its implementation will be complicated by the continued need of contralateral surveillance.

Borderline breast lesions diagnosed at core needle biopsy: Can magnetic resonance mammography rule out associated malignancy? Preliminary results base

Anna Linda, Chiara Zuiani, Massimo Bazzocchi, Alessandro Furlan and Viviana Londero
The Breast 17, 2, April 2008, Pages 125-131

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The purpose of this study is to assess whether magnetic resonance mammography (MRM) can exclude associated malignancy in case of diagnosis of borderline breast lesions (B3) at core needle biopsy (CNB). Retrospective analysis of MRM findings of 79 borderline breast lesions (26 benign papillomas, 29 radial sclerosing lesions, 6 atypical ductal hyperplasias, 18 lobular neoplasias) diagnosed at CNB was performed.

Lesions were classified as “non-suspicious” or “suspicious” according to Fischer score. These findings were compared to the results of histological analysis of the excisional specimens. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of MRM in predicting the presence of malignancy were calculated. Out of 24 (30.4%) lesions classified as “suspicious”, 8 (33.3%) proved to be malignant and 16 (66.7%) benign. Among the 55 (69.6%) “non-suspicious” lesions, only 1 (1.8%) was malignant (low-grade ductal carcinoma in situ), while the remaining 54 (98.2%) proved to be benign. MRM sensitivity, specificity, PPV, and NPV were 88.9%, 77.1%, 33.3%, and 98.2%, respectively.

When a borderline lesion is diagnosed on CNB, in case of mild or no enhancement at MRM, follow-up rather than excisional biopsy might be prompted.

Performance of radiographers in mammogram interpretation: A systematic review

F.J.H.M. van den Biggelaar, P.J. Nelemans and K. Flobbe
The Breast Volume 17, Issue 1, February 2008, Pages 85-90
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This systematic literature review focuses on the performance of radiographers (also referring to technologists and physician assistants) compared with radiologists in the interpretation of mammograms; the effect of training; and the question whether there are any studies evaluating the effects of involving radiographers in the interpretation of diagnostic mammograms in daily clinical practice on the sensitivity and specificity of cancer detection in breast imaging.

Six studies met the inclusion criteria (primary aim of the study has to be the evaluation of the performance of radiographers, sensitivity and specificity have to be reported or calculable and there has to be a sufficient gold standard). The results showed that, in a screening setting, radiographers scored higher false positive rates with a similar sensitivity in the detection of malignancies, compared with radiologists. Furthermore, results suggested that training could improve their performance. No studies were reported assessing the performance of radiographers interpreting diagnostic mammograms in a consecutive patient population in a daily clinical setting.

This indicates a need for a well-designed diagnostic study using an adequate gold standard, in order to evaluate the feasibility of deploying radiographers in the interpretation of diagnostic mammograms in a clinical setting.

Pain in different methods of breast biopsy: Emphasis on vacuum-assisted breast biopsy

Flora Zagouri, Theodoros N. Sergentanis, Antonia Gounaris, Dimitra Koulocheri, Afroditi Nonni, Philip Domeyer, Constantine Fotiadis, John Bramis and George C. Zografos
The Breast Volume 17, Issue 1, February 2008, Pages 71-75
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This study examines pain (visual analog scale 0–10) in women undergoing breast biopsy. Two hundred and twenty-seven patients with a palpable lesion underwent FNA (21 G, n=85), core biopsy (14 G, n=86) or open biopsy under local anesthesia (n=56). One hundred and twenty-six women presented with a non-palpable lesion, and underwent vacuum-assisted breast biopsy (VABB, 11 G) under mammographic guidance, prone position (n=72) or hook-wire localization followed by open surgery (n=54).

The techniques sampling non-palpable lesions were the most painful: hook-wire (9.15±0.74) and VABB (4.35±1.70). Larger needle diameter was associated with more intense pain. Concerning VABB, an S-shape curve of pain (third-order pattern) was documented. A second dose of lidocaine just before the rapid increase phase was then adopted (n=61), and reduced the total/maximum pain. In conclusion, although VABB is less painful than hook-wire, the pain experienced in VABB is significant; however, it can be attenuated by a second dose of lidocaine.

Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography

Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: Distribution according to patient history of breast cancer and lesion size
Anna Linda, Chiara Zuiani, Viviana Londero and Massimo Bazzocchi
The Breast Volume 17, Issue 1, February 2008, Pages 51-57

The purpose of the study was to evaluate the outcome of initially only magnetic resonance mammography (MRM)-detected breast lesions as a function of radiologic features, history of breast cancer and lesion size.
Radiologic features, history of breast cancer and large diameter are associated with high likelihood of malignancy in case of initially only MRM-detected lesions. Nevertheless, biopsy might be spared just for MRI BI-RADS 3 lesions in patients without history of breast carcinoma.

The acceptance and feasibility of breast cancer screening in the East

Ava Kwong, Polly S.Y. Cheung, Ada Y.W. Wong, Gloria T.Y. Hung, Gladys Lo, Marion Tsao, Edith W.K. Chan, Ting Wong and Michael Ma
The Breast Volume 17, Issue 1, February 2008, Pages 42-50
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4PHJGMR-1&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=6b73ef38c616738fb79e6473b687d629

An overall malignancy detection rate of 2.3 per 1000 screens and a recall rate of 9.2% were found. Despite culture differences and differences in breast characteristics (denser and smaller breasts), breast screening is feasible and acceptable in the East

Quantitative assessment of mammographic density and breast cancer risk for Japanese women

Yasuyuki Kotsuma, Yasuhiro Tamaki, Toshihiro Nishimura, Masayoshi Tsubai, Satsuki Ueda, Kenzo Shimazu, Seung Jin Kim, Yasuo Miyoshi, Yoshio Tanji, Tetsuya Taguchi and Shinzaburo Noguchi
The Breast Volume 17, Issue 1, February 2008, Pages 27-35
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4PGH4B3-1&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=778797e49bafc65100bb6b6aa186d2f7

We conducted a case-control study to examine the relationship between breast density (BD) on mammography and breast cancer risk for postmenopausal Japanese women. The mammograms (205 cases and 223 controls) were classified by two doctors employing Wolfe's classification and used to measure BD with original computer software. A weak relationship between breast cancer risk and the parenchymal pattern of Wolfe's classification was found. The BD measured with the computer software, however, showed a significant relationship with breast cancer risk.

Atypical ductal hyperplasia: A way to minimize underestimation in vacuum-assisted breast biopsy?

Flora Zagouri, Theodoros N. Sergentanis, Dimitra Koulocheri, Aphrodite Nonni, John Bramis and George C. Zografos
The Breast Volume 17, Issue 1, February 2008, Page 6
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4RV5S14-1&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=cbdb6cda71a63b774631bde5c69d6618

The underestimation rate of atypical ductal hyperplasia (ADH) diagnosed via vacuum-assisted breast biopsy (VABB) is a crucial issue in the common clinical practice. Bedei et al. examined the underestimation of ADH diagnosis by VABB.
Independently, our research team has evaluated putative ways of minimizing underestimation rate in pre-invasive breast lesions.

Ectopic breast cancer without breast parenchyma

Letter -
N. Toman, A. Buschmann and T. Muehlberger
The Breast Volume 17, Issue 1, February 2008, Pages 3-4
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-4PRHKS2-2&_user=4430&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=50a6cdbd3ec67454f0fe1e0426839fdf

Primary breast cancer of aberrant breast tissue is virtually never diagnosed preoperatively. Once the diagnosis of breast tissue has been established through the detection of hormone receptors, its origin as a metastatic lesion from classical breast cancer has to be ruled out. There are no specific therapeutic guidelines for these rare tumors; however, the interdisciplinary adjustment of treatment to the recommendations for orthotopic breast cancer seems reasonable and effective