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Am J Surg. 2014 Jan;207(1):24-31. doi: 10.1016/j.amjsurg.2013.05.014. Epub 2013 Oct 7.

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

Author information

1
Department of Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239 Tel Aviv, Israel. Electronic address: tehillahm@lvmc.gov.il.
2
Radiology Associates of Albuquerque, Albuquerque, NM, USA; Department of Radiology, University of New Mexico, Albuquerque, NM, USA.
3
Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
4
Department of Pathology, The Mount Sinai Medical Center, New York, NY, USA.
5
Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
6
Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA; Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.

Abstract

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.

KEYWORDS:

Atypical ductal hyperplasia; Atypical lobular hyperplasia; High-risk breast lesions; Lobular neoplasia; Papillary lesions; Upgrade

PMID:
24112677
PMCID:
PMC3865063
DOI:
10.1016/j.amjsurg.2013.05.014
[Indexed for MEDLINE]
Free PMC Article
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