Lesions of uncertain malignant potential (B3) on core biopsy in the NHS Breast Screening Programme: is the screening round relevant?

Hunt, Richard; Steel, J; Porter, G.; Holgate, C.; Watkins, R M

doi:10.1308/003588412x13171221498460

Cited by 10 publications

(10 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…93 These rates are again consistent with the rate observed among UK NHS breast-screening programme participants, whereby 70% of diagnostic biopsies resulted in benign diagnoses. 94 The proportion of benign diagnoses is even greater when taking into account diagnostic work-ups carried out by means of additional imaging and clinical examination. Data from the BCSC registries demonstrated that of 4082 patients prescribed to diagnostic follow-up by means of imaging, clinical follow-up or biopsy following mammographic screening, only 316 cases were diagnosed as invasive cancer or DCIS.…”

Section: Risk-benefit Analysis Diagnostic Follow-upmentioning

confidence: 99%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

View full text Add to dashboard Cite

The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.

show abstract

Section: Risk-benefit Analysis Diagnostic Follow-upmentioning

confidence: 99%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

View full text Add to dashboard Cite

show abstract

“…Most of the studies in the literature discuss the outcome of B3 lesions following a stereotactic biopsy because they usually manifest as microcalcifications or architectural distortions recognized on mammography or digital breast tomosynthesis during breast screening …”

Section: Introductionmentioning

confidence: 99%

A new risk stratification score for the management of ultrasound-detected B3 breast lesions

et al. 2018

View full text Add to dashboard Cite

To develop a predictive scoring system for ultrasound-detected B3 lesions at ultrasound-guided core needle biopsy (US-CNB). A total of 2724 consecutive US-CNBs performed in our Institution (January 2011 to December 2014) were retrospectively reviewed. Inclusion criteria were as follows: (a) histopathological examination of the entire lesion or (b) availability of radiologic follow-up (FUP) ≥24 months. Patient- and lesion-related variables-patients' age, lesion consistency, lesion size, vascularization, BI-RADS category, and US-CNB result-were analyzed. Positive predictive values (PPVs) for malignancy were calculated correlating US-CNB results with excision histology or FUP. A scoring system for underlying malignancy was developed using risk factors weighting. A total of 102 B3 lesions were included: 27 atypical ductal hyperplasia (26.5%), 5 lobular intraepithelial neoplasia (4.9%), 32 radial scar (31.4%), 37 papillary lesions (36.3%), and 1 fibroepithelial lesion (0.9%). Surgery was performed on 71/102 (69.6%) lesions, and 22/71 were malignant; the remaining 31/102 lesions (30.4%) were unchanged at FUP. The overall PPV for malignancy was 21.6%. Patients' age (odds ratio [OR] = 3.63, P = 0.008), lesion consistency (OR = 5.96, P = 0.001), BI-RADS category (OR = 17.52, P < 0.001), and CNB result (OR = 3.6, P = 0.008) were associated with a higher risk of malignancy underestimation and selected as risk factors in the score definition. Two risk groups were identified: low (0-2 points) and high risk (3-5 points), with significantly different risk of malignancy underestimation (8.0% vs 59.3%, P < 0.001). The proposed score helps to predict the risk of malignancy underestimation and choose the management of B3 lesions at US-CNB.

show abstract

“…In the context of public health care, the financial and planning costs might be an obstacle to implement such a short-term follow-up. In the Netherlands, approximately 1 million women join the breast screening program every year, and in Australia and England 1.5 million 27 and 2 million, 28 respectively. Between 1% and 15% of all patients attending breast cancer screening programs worldwide are recalled for further assessment, 29 – 32 and pure calcifications classified as B3 account for approximately 8% of all patient recalls.…”

Section: Discussionmentioning

confidence: 99%

“…In light of these figures, the Dutch National Breast screening program has abandoned the use of B3 for calcifications; instead, B3 lesions are directly classified as B4 and all of them should undergo further investigation. 28 , 37 , 38 The most recent edition of the BI-RADS suggests avoiding the use of the B3 category in large population screening programs. 10 …”

Section: Discussionmentioning

confidence: 99%

Simplifying Breast Imaging Reporting and Data System classification of mammograms with pure suspicious calcifications

et al. 2017

View full text Add to dashboard Cite

ObjectivesTo investigate the risk of malignancy following stereotactic breast biopsy of calcifications classified as Breast Imaging Reporting and Data System (BI-RADS) 3, 4, and 5.MethodsThe study included women with pure calcifications (not associated with masses or architectural distortions) who underwent stereotactic breast biopsy at the Dutch Cancer Institute between January 2011 and October 2013. Suspicious calcifications (Breast Imaging Reporting and Data System 3, 4, or 5) detected on mammography were biopsied. All lesions were assessed by breast radiologists and classified according to the BI-RADS lexicon.ResultsOverall, 473 patients underwent 497 stereotactic breast biopsies. Sixty-six percent (326/497) of calcifications were classified B4, 30% (148/497) B3, and 4% (23/497) B5. Of the 226 (45%) malignant lesions, there were 182 pure ductal carcinoma in situ, 22 mixed ductal carcinoma in situ and invasive carcinomas (ductal or lobular), 21 pure invasive carcinomas, and one angiosarcoma. Malignancy was found in 32% (95% confidence interval [CI] 0.24 to 0.39) of B3, 49% (95% CI 0.43 to 0.54) of B4, and 83% (95% CI 0.61 to 0.95) of B5 calcifications.ConclusionsConsidering the high predictive value for malignancy in B3 calcifications, we propose that these lesions should be classified as suspicious (B4), especially in a screening setting.

show abstract

Lesions of uncertain malignant potential (B3) on core biopsy in the NHS Breast Screening Programme: is the screening round relevant?

Cited by 10 publications

References 10 publications

Is the false-positive rate in mammography in North America too high?

Is the false-positive rate in mammography in North America too high?

A new risk stratification score for the management of ultrasound-detected B3 breast lesions

Simplifying Breast Imaging Reporting and Data System classification of mammograms with pure suspicious calcifications

Contact Info

Product

Resources

About