Evaluation of abnormal mammography results and palpable breast abnormalities

Article Abstract:

Background: Because approximately 1 in 10 women with a breast lump or abnormal mammography result will have breast cancer, a series of decisions must be taken by a primary care practitioner to exclude or establish a diagnosis of breast cancer among these women. Purpose: To determine the most accurate and least invasive means to evaluation an abnormal mammography result and a palpable breast abnormality. Data Source: MEDLINE search (January 1966 to March 2003) for articles and reviews describing the accuracy of clinical examination, biopsy procedures, and radiographic examination for patients with abnormal mammography results or palpable breast abnormalities. Study Selection: The authors reviewed abstracts and selected articles that provided relevant primary data. Studies were included if 1) mammography, fine-needle aspiration biopsy, or core-needle biopsy was performed before a definitive diagnosis was obtained; 2) the study sample included 100 or more women; and 3) breast cancer status was determined from histopathology review of excisional biopsy specimens, from linkage with a state cancer registry or the Surveillance, Epidemiology, and End Results program, or from clinical follow-up of 95% or more of the study sample. Data Extraction: One investigator abstracted results. Methods were evaluated for major potential biases, but methodologic scoring was not performed. Data Synthesis: Likelihood ratios for first screening mammography were 0.1 for the Breast Imaging Reporting and Data System (BI-RADS) assessment category "negative or benign finding," 1.2 for "probably benign finding," 7 for "need additional imaging evaluation," 125 for "suspicious abnormality," and 2200 for "highly suggestive of malignancy." For fine-needle aspiration biopsy of a palpable lump performed by formally trained physicians, the likelihood ratio was infinity for an assessment of "malignant," 2.6 for "atypical/suspicious," and 0.02 for "benign." When diagnostic mammography was used to evaluate a palpable lump or nonpalpable breast abnormality, the positive likelihood ratios were 5.6 and 9.4, and the negative likelihood ratios were 0.15 and 0.19, respectively. Conclusions: Women whose screening mammography results are interpreted as "suspicious abnormality" or "highly suggestive of malignancy" have a high risk for breast cancer and should undergo core-needle biopsy or needle localization with surgical biopsy. Women whose screening mammography results are interpreted as "need additional imaging evaluation" have a moderate risk for breast cancer and should undergo diagnostic mammography or ultrasonography to decide whether a nonpalpable breast lesion should be biopsied. Women whose screening mammography results are interpreted as "probably benign finding" have a low risk for breast cancer and can undergo follow-up mammography in 6 months. Either fine-needle aspiration biopsy or ultrasonography is recommended as the first diagnostic test of a palpable breast abnormality to distinguish simple cysts from solid masses. Fine-needle aspiration biopsy also allows characterization of a solid mass. Diagnostic mammography does not help determine whether a palpable breast mass should be biopsied and should not affect the decision to perform a biopsy.

Author Abstract

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Endovaginal Ultrasound to Exclude Endometrial Cancer and Other Endometrial Abnormalities

Article Abstract:

Endovaginal ultrasound (EVUS) examination is highly effective at detecting endometrial thickening, which may indicate endometrial disease or cancer in postmenopausal women with vaginal bleeding. The endometrium is the lining of the uterus. Researchers reviewed 35 research studies assessing 5,892 women with vaginal bleeding after menopause. Endometrial thickening identified by EVUS was diagnosed in 96% of women with endometrial cancer and 92% of women with other endometrial disease. Only 8% of healthy women, and 23% of healthy women taking hormone replacement, had endometrial thickening.

Evaluation, Medical examination, Postmenopausal women, Endometrium, Vagina, Diagnosis, Ultrasonic, Diagnostic ultrasonography, Vaginal bleeding

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Comparison of screening mammography in the United States and the United Kingdom

Article Abstract:

More women are recalled for a second mammogram in the US compared to the UK and more US women are subjected to unnecessary breast biopsies, according to a study of 5.5 million mammograms taken in the US and UK over a three-year period. However, the number of women who were diagnosed with breast cancer was similar in both countries. This indicates that US doctors are not diagnosing more breast cancer even though they are more aggressive in recalling women for a second mammogram and doing a breast biopsy to confirm breast cancer.

United Kingdom, United States, Demographic aspects, Medical screening, Health screening

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