Contemporary indications for diagnostic open biopsy in women assessed for screen-detected breast lesions: A ten-year, single institution series of 814 consecutive cases

• Published in: Breast cancer research and treatment 2017-02, Vol.162 (1), p.49-58
• Main Authors: Farshid, Gelareh, Gill, P. Grantley
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy; Biopsy - methods; Biopsy, Large-Core Needle; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - epidemiology; Cancer research; Clinical Decision-Making; Clinical Trial; Early Detection of Cancer - methods; Female; Health aspects; Humans; Mammography; Mass Screening; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Oncology; Women
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-016-4087-2

Purpose In contemporary practice, 5% of women with non-malignant needle biopsies of screen-detected lesions still require diagnostic open biopsy (OBx). Our aims are to (i) capture a snapshot of the contemporary indications for OBx in screen-detected lesions; (ii) determine upgrade rates to malignancy (DCIS or invasive cancer); (iii) identify indications with sufficiently low upgrades to justify avoidance of OBx and (iv) propose plausible non-surgical alternatives. Methods Between Jan 2005 and Dec 2014, women assessed for a screen-detected lesion and recommended for OBx are included. We retrieved patient, imaging, biopsy and final pathology or follow-up data. Results 814 lesions, mean diameter 16.7 mm, microcalcifications in 353 (43.4%) cases, lesions other than calcifications in 461 (56.6%), mean patient age 58.4 yrs, are included. Surgery was performed in 98.2% cases. Imaging follow-up (1–6.5 yrs) is available in 13 of 15 remaining cases. 27 indications for OBx were identified, with a prevalence of 0.3–13.9%. Borderline lesions (BL) comprised 64% of OBx indications, amongst which atypical ductal hyperplasia was the most prevalent at 13.9%, followed by papillary lesions, radial scars, flat epithelial atypia and lobular neoplasia. Imaging factors contributed 26.3% of OBx. In 9.8% of cases, NCB was not performed due to client, technical or cytologic factors. Overall, 261(32.1%) lesions were malignant at OBx. Upgrade rates varied from 0 to 100%, depending on the specific indication for OBx. Conclusions Surgical biopsy remains a valuable method of last resort for breast cancer diagnosis but strategies to limit benign breast surgery merit attention as a public health issue.