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Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study.

Authors
  • Luiten, Jacky D1, 2
  • Korte, Bram3
  • Voogd, Adri C4, 5
  • Vreuls, Willem6
  • Luiten, Ernest J T7
  • Strobbe, Luc J8
  • Rutten, Matthieu J C M9
  • Plaisier, Menno L10
  • Lohle, Paul N11
  • Hooijen, Marianne J H12
  • Tjan-Heijnen, Vivianne C G2, 13
  • Duijm, Lucien E M14, 15
  • 1 Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands. , (Netherlands)
  • 2 School for Oncology and Developmental Biology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands. , (Netherlands)
  • 3 Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. , (Netherlands)
  • 4 Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands. , (Netherlands)
  • 5 Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands. , (Netherlands)
  • 6 Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. , (Netherlands)
  • 7 Department of Surgical Oncology, Amphia Hospital, Breda, The Netherlands. , (Netherlands)
  • 8 Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. , (Netherlands)
  • 9 Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. , (Netherlands)
  • 10 Department of Radiology, Maxima Medical Centre, Veldhoven, The Netherlands. , (Netherlands)
  • 11 Department of Radiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands. , (Netherlands)
  • 12 Department of Radiology, St Anna Hospital, Geldrop, The Netherlands. , (Netherlands)
  • 13 Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands. , (Netherlands)
  • 14 Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. , (Netherlands)
  • 15 Dutch Expert Centre for Screening, Nijmegen, The Netherlands. , (Netherlands)
Type
Published Article
Journal
International Journal of Cancer
Publisher
Wiley (John Wiley & Sons)
Publication Date
Nov 15, 2019
Volume
145
Issue
10
Pages
2720–2727
Identifiers
DOI: 10.1002/ijc.32353
PMID: 31001821
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high-risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6-year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high-risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high-risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high-risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high-risk lesions at CNB tripled in a 6-year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome. © 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

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