Performance of a clinical and imaging-based multivariate model as decision support tool to help save unnecessary surgeries for high-risk breast lesions

Purpose To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions. Methods In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our i...

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Bibliographic Details
Published in:Breast cancer research and treatment 2021-01, Vol.185 (2), p.479-494
Main Authors: Polat, Dogan S., Schopp, Jennifer G., Arjmandi, Firouzeh, Porembka, Jessica, Sarode, Venetia, Farr, Deborah, Xi, Yin, Dogan, Basak E.
Format: Article
Language:English
Subjects:
Biopsy
Breast
Breast cancer
Cancer
Cancer research
Epidemiology
Hyperplasia
Lesions
Magnetic resonance imaging
Medicine
Medicine & Public Health
Oncology
Papilloma
Patients
Risk factors
Surgery
Tumors
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Summary:Purpose To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions. Methods In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our institution between July 1, 2014-July 1, 2017. Lesions were categorized high-risk-I (HR-I = atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ and atypical papillary lesion) and II (HR-II = Flat epithelial atypia, radial scar, benign papilloma). Patient risk factors, lesion features, detection and biopsy modality, excision and cancer upgrade rates were collected. Reference standard for upgrade was either excision or at least 2-year imaging follow-up. Multiple logistic regression analysis was performed to develop a multivariate model using HRL type, lesion and biopsy needle size for surgical cancer upgrade with performance assessed using ROC analysis. Results Of 699 HRL in 652 patients, 525(75%) had reference standard available, and 48/525(9.1%) showed cancer at surgical excision. Excision (84.5% vs 51.1%) and upgrade (17.6%vs1.8%) rates were higher in HR-I compared to HR-II ( p  
ISSN:0167-6806
1573-7217
DOI:10.1007/s10549-020-05947-1