Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium

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• 作者：Tehillah S. Menes ; Robert Rosenberg ; Steven Balch ; Shabnam Jaffer ; Karla Kerlikowske ; Diana L. Miglioretti
• 关键词：High-risk breast lesions ; Atypical ductal hyperplasia ; Atypical lobular hyperplasia ; Lobular neoplasia ; Papillary lesions ; Upgrade
• 刊名：The American Journal of Surgery
• 出版年：January, 2014
• 年：2014
• 卷：207
• 期：1
• 页码：24-31
• 全文大小：255 K

文摘

Background

Upgrade rates of high-risk breast lesions after screening mammography were examined.

Methods

The Breast Cancer Surveillance Consortium registry was used to identify all Breast Imaging Reporting and Data System category 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women.

Results

High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (n = 685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia, and 2% in papillary lesions). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, and those associated with lobular neoplasia were mostly (56%) invasive. During a further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery.

Conclusions

Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on Breast Imaging Reporting and Data System category 4 mammograms among asymptomatic women do not justify surgical excision.