Lisa Hamilton

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

In the setting of breast cancer screening, 5–9% of needle core biopsies are diagnosed as lesions of uncertain malignant potential (B3). The management of these lesions is potentially problematic as the data on their outcome remains limited. In our study, we aim to assess the outcome of screen‐detected lesions diagnosed as B3 in a large series to validate previous studies and to characterize the malignant lesions detected after a B3 diagnosis. Therefore, the results of 1,025 needle core biopsies of women screened over a 7‐year period (1999–2006) in two different regions in the UK with B3 diagnoses who underwent surgical excision were reviewed and compared to the final excision histology. Final histology showed that 25% of cases were malignant (17% ductal carcinoma in situ and 8% invasive). Predictors of malignancy included calcification on imaging and epithelial atypia on needle core biopsy particularly atypical ductal hyperplasia [positive predictive value 50%]. Pure flat epithelial atypia showed the lowest positive predictive value amongst all epithelial atypia groups (21%). The positive predictive value was low for complex sclerosing lesions (9%) and papillary lesions (13%) without epithelial atypia. Malignant tumors detected after B3 diagnosis showed favorable histological features, the majority were in situ, and most belonged to the low grade breast neoplasia family that is associated with indolent behavior. The underlying radiological abnormality was calcification in 44% of cases and the imaging classification was malignant/suspicious in 38%. In conclusion, our results further emphasize the heterogeneity of B3 lesions and that the likelihood of malignancy varies substantially between different histological subtypes. Malignancy is particularly associated with epithelial atypia suggesting the use of two categories of with and without epithelial atypia. Radiological findings provided useful information regarding the nature and outcome of B3 lesions.

Accuracy of GE digital breast tomosynthesis versus supplementary mammographic views for diagnosis of screen-detected soft tissue breast lesions

Objective: To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. Methods: Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. Results: The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views—the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review—AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. Conclusion: The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. Advances in knowledge: The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities.

Outcome of pure mucocele‐like lesions diagnosed on breast core biopsy

Current guidelines recommend that mucocele‐like lesions (MLL) of the breast diagnosed on needle core biopsy (NCB) should be categorized as a lesion of uncertain malignant potential (B3). However, data on the outcome of MLL diagnosed on NCB remains limited due to the rarity of this lesion. The aim of this study was to assess the outcome of pure MLL without atypia diagnosed on NCB using a large series of cases and a review of the literature to provide evidence that can guide management.

Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas

AIM To establish the efficacy, complications, and patient satisfaction for vacuum-assisted biopsy (VAB) excision of fibroadenomas. MATERIALS AND METHODS All patients referred for VAB of benign lesions from 11 December 2002 to 30 November 2006 were identified prospectively, and the following data were recorded: age, histology, lesion size, and completeness of excision. A questionnaire was sent at least a year after the procedure to assess pain, complications, residual palpable lesions, and cosmetic result. RESULTS One hundred and thirty-four patients were referred for VAB, 81 had fibroadenomas. Fifty-nine percent replied to the questionnaire. Fifty-four percent of patients reported no pain during the procedure, 8% rated their pain at > or =3/10. Thirty-two percent had no pain the week after the procedure, 55% had pain > or =3/10. Seventy-nine percent had no palpable mass at the site of the original lesion. Ninety-four percent would recommend the procedure to others and would prefer further VAB to surgery. Bruising was common, one patient required aspiration of a haematoma. Six percent developed infections, all resolved with antibiotic therapy. Eighty-five percent of patients were completely satisfied with the cosmetic result. Interval ultrasound was performed in 36 patients. A palpable mass was present in 11%, a non-palpable mass in 19%, and no mass in 70%. CONCLUSION VAB excision is well-tolerated, safe, and popular with a high initial success rate for fibroadenomas. Bruising and pain are common the week after the procedure.

Accuracy of GE digital breast tomosynthesis vs supplementary mammographic views for diagnosis of screen-detected soft-tissue breast lesions

OBJECTIVE To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. METHODS Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. RESULTS The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views-the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review-AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. CONCLUSION The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. ADVANCES IN KNOWLEDGE The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities.

Contrast-enhanced spectral mammography: what is the 'added value' in a symptomatic setting? Initial findings from a UK centre

Contrast-enhanced spectral mammography (CESM) is a new technology. Dual energy acquisitions during one exposure yield two sets of images: a low energy (LE) set, equivalent to standard full field digital mammography (FFDM); and a recombined set displaying contrast uptake. In our symptomatic breast service, specific patients, including those with a P4/5 clinical abnormality are offered CESM instead of FFDM. Despite encouraging data from Europe and the USA, there are, until now, no UK data to support its use in this setting.