Biopsy of occult breast lesions: analysis of 1261 abnormalities

Article Abstract:

One of the most important developments during the last 20 years is the use of mammography (X-ray) of the breast to detect cancer long before it would be apparent during a physical examination. An analysis of biopsies to confirm 1,261 mammographic abnormalities from 1,160 patients is provided in an effort to evaluate several aspects of the procedure's value. Positive predictive value (PPV) was defined as the percentage of women with mammographic results rated as 'suspicious, biopsy recommended' who were subsequently diagnosed as having cancer. Of these, 626 masses (49.6 percent of all abnormalities) and 635 (50.4 percent) calcified lesions were found. Two hundred thirty-seven (18.7 percent) were malignant, of which 107 were calcifications and 130 were masses. The mammograms had either been taken and interpreted at the hospital where the authors practiced (22.2 percent), or at other hospitals, and the PPVs for biopsy recommendations were different, with a higher PPV for those performed at the authors' hospital (26.1 percent versus 16.7 percent for those done elsewhere). The PPV for women 50 and older was 25.8 percent, while that for younger women was 11.7 percent, indicating the procedure is a more accurate predictor of cancer in older women. A discussion of factors that could influence a decision to biopsy a suspicious mammogram is presented. One implication of these findings which show different PPVs at different institutions is that second opinions about proposed biopsies are well warranted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Cancer, Cancer diagnosis, Radiography, Breast biopsy

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Lobular carcinoma in situ: mammographic-pathologic correlation of results of needle-directed biopsy

Article Abstract:

Lobular carcinoma in situ (LCIS) is a noninvasive cancer of the breast lobules that is characterized by cellular changes similar to those found with invasive cancer. Women with LCIS are at an increased risk for developing invasive breast cancer, although it is unclear if LCIS itself can become invasive or is merely an indicator for an increased risk. It is also unclear what, if any, abnormalities on a mammogram are indicative of LCIS. To examine this latter issue, mammograms and pathologic data from 41 women who were found to have LCIS unassociated with malignant disease at biopsy were reviewed. Mammographic abnormalities that led to biopsy included clustered microcalcifications in 31 patients (76 percent), calcified masses in four patients (10 percent), noncalcified masses in three patients (7 percent), a mass with adjacent calcifications in two patients and asymmetric opacity in one patient. Biopsy results showed the microcalcifications were not associated with LCIS in 24 cases, and in the remaining cases, they existed in both LCIS tissue and benign tissue. In the other cases, the mammographic abnormalities were found at biopsy to be in benign tissue, although some overlap with LCIS was seen in a few cases. These results indicated that LCIS in all cases was detected incidentally to the reason for the biopsy and that LCIS does not seem to have characteristic mammographic features. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Abnormalities, Carcinoma in situ, Biopsy, Needle, Needle biopsy

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