Breast Biopsy Utilization

Ghosh, Karthik; Melton, L. Joseph; Suman, Vera J.; Grant, Clive S.; Sterioff, Sylvester; Brandt, Kathy R.; Branch, Charles D.; Sellers, Thomas A.; Hartmann, Lynn C.

doi:10.1001/archinte.165.14.1593

Cited by 32 publications

(15 citation statements)

References 28 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Atypical hyperplasia (AH) of the breast is diagnosed in approximately 40,000–50,000 US women/year, as it is found in about 4–5% of the 1,000,000 benign breast biopsies performed annually (1, 2). Women diagnosed with AH have a substantial risk of subsequent development of breast cancer, with a cumulative incidence of 30% at 25 years (3).…”

Section: Introductionmentioning

confidence: 99%

p16INK4a Expression and Breast Cancer Risk in Women with Atypical Hyperplasia

Radisky

Santisteban

Berman

et al. 2011

Cancer Prevention Research

Self Cite

View full text Add to dashboard Cite

p16, a nuclear protein encoded by the p16INK4a gene, is a regulator of cell cycle regulation. Previous studies have shown that expression of p16 in tissue biopsies of patients with ductal carcinoma in situ (DCIS) is associated with increased risk of breast cancer, particularly when considered in combination with other markers such as Ki67 and COX2. Here we evaluated how expression of p16 in breast tissue biopsies of women with atypical hyperplasia (AH), a putative precursor lesion to DCIS, is associated with subsequent development of cancer. p16 expression was assessed by immunohistochemistry in archival sections from 233 women with AH diagnosed at the Mayo Clinic. p16 expression in the atypical lesions was scored by percent of cells positive and intensity of staining. We also studied coexpression of p16, with Ki67 and COX2, biomarkers of progression in AH. Risk factor and follow-up data were obtained via study questionnaire and medical records. Forty-seven patients (20%) developed breast cancer with a median follow-up of 14.5 years. Staining of p16 was increased in older patients relative to younger patients (p=0.0025). While risk of developing breast cancer was not associated with increased p16 expression, joint overexpression of Ki67 and COX2 was found to convey stronger risk of BC in the first 10 years after diagnosis as compared to one negative marker (p<0.01). However, the addition of p16 levels did not strengthen this association. p16 overexpression, either alone or in combination with COX2 and Ki67, does not significantly stratify breast cancer risk in women with AH.

show abstract

Section: Introductionmentioning

confidence: 99%

p16INK4a Expression and Breast Cancer Risk in Women with Atypical Hyperplasia

Radisky

Santisteban

Berman

et al. 2011

Cancer Prevention Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…[42–44] Recent data suggest that the absolute risk of future breast cancer imparted after a biopsy demonstrating atypia is about 30% at 25 years, comparable to the risk associated with mantle radiation prior to age 31, a well-recognized indication for breast cancer risk reduction interventions. [33,45–47] While a prior benign breast biopsy showing atypia confers a substantial risk for the future development of breast cancer, currently utilized models to predict breast cancer risk are poorly applicable to these women, although a risk model incorporating benign breast biopsy histology recently has been published.…”

Section: Discussionmentioning

confidence: 99%

ERβ Expression and Breast Cancer Risk Prediction for Women with Atypias

Hieken

Carter

Hawse

et al. 2015

Cancer Prevention Research

Self Cite

View full text Add to dashboard Cite

Estrogen receptor beta (ERβ) is highly expressed in normal breast epithelium and a putative tumor suppressor. Atypical hyperplasia substantially increases breast cancer risk, but identification of biomarkers to further improve risk stratification is needed. We evaluated ERβ expression in breast tissues from women with atypical hyperplasia and association with subsequent breast cancer risk. ERβ expression was examined by immunohistochemistry in a well-characterized 171 women cohort with atypical hyperplasia diagnosed 1967–1991. Nuclear ERβ percent and intensity was scored in the atypia and adjacent normal lobules. An ERβ sum score (percent + intensity) was calculated and grouped as low, moderate or high. Competing risks regression was used to assess associations of ERβ expression with breast cancer risk. After 15 years median follow-up, 36 women developed breast cancer. ERβ expression was lower in atypia lobules than normal lobules, by percent staining and intensity (both p<0.001). Higher ERβ expression in the atypia or normal lobules, evaluated by percent staining, intensity or sum score, decreased the risk of subsequent breast cancer by 2 (p=0.04) and 2.5-fold (p=0.006). High normal lobule ERβ expression conferred the strongest protective effect in pre-menopausal women: the 20-year cumulative incidence of breast cancer was 0% for women

show abstract

“…In the United States over 700,000 women undergo breast biopsies per year 1, 2 . However, most women who have a breast biopsy do not have breast cancer—in fact, approximately 80% of image-guided breast biopsies are benign.…”

Section: Introductionmentioning

confidence: 99%

Pursuing optimal thresholds to recommend breast biopsy by quantifying the value of tomosynthesis

Alagöz

Vanness

et al. 2014

SPIE Proceedings

View full text Add to dashboard Cite

A 2% threshold has been traditionally used to recommend breast biopsy in mammography. We aim to characterize how the biopsy threshold varies to achieve the maximum expected utility (MEU) of tomosynthesis for breast cancer diagnosis. A cohort of 312 patients, imaged with standard full field digital mammography (FFDM) and digital breast tomosynthesis (DBT), was selected for a reader study. Fifteen readers interpreted each patient's images and estimated the probability of malignancy using two modes: FFDM versus FFDM + DBT. We generated receiver operator characteristic (ROC) curves with the probabilities for all readers combined. We found that FFDM+DBT provided improved accuracy and MEU compared with FFDM alone. When DBT was included in the diagnosis along with FFDM, the optimal biopsy threshold increased to 2.7% as compared with the 2% threshold for FFDM alone. While understanding the optimal threshold from a decision analytic standpoint will not help physicians improve their performance without additional guidance (e.g. decision support to reinforce this threshold), the discovery of this level does demonstrate the potential clinical improvements attainable with DBT. Specifically, DBT has the potential to lead to substantial improvements in breast cancer diagnosis since it could reduce the number of patients recommended for biopsy while preserving the maximal expected utility.

show abstract

Breast Biopsy Utilization

Cited by 32 publications

References 28 publications

p16INK4a Expression and Breast Cancer Risk in Women with Atypical Hyperplasia

p16INK4a Expression and Breast Cancer Risk in Women with Atypical Hyperplasia

ERβ Expression and Breast Cancer Risk Prediction for Women with Atypias

Pursuing optimal thresholds to recommend breast biopsy by quantifying the value of tomosynthesis

Contact Info

Product

Resources

About