To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Likely Benign Breast Lesions Require Biopsy in High-Risk Patients: Presented at ASBD URL: http://www.pslgroup.com/dg/21F80E.htm Doctor's Guide April 15, 2008
By Kristina Rebelo SAN DIEGO -- April 15, 2008 -- Patients who have a high Gail score or prior breast-cancer diagnosis and a breast lesion termed "likely benign" should still be offered a tissue diagnosis for that lesion rather than follow-up with repeat imaging in 6 months, according to research released on April 11 here at the 32nd Annual Symposium of the American Society of Breast Disease (ASBD 2008). "We're looking at high risk versus low risk -- and the outcomes," said Hanadi Bu-Ali, MD, FICS, Akron General Medical Center, Akron, Ohio, and the Aultman Health Foundation, Canton, Ohio. Dr. Bu-Ali's study intended to decipher the rate of malignancy according to the predicted risk for breast cancer by the Gail model in patients who had Breast Imaging Reporting and Data System (BIRADS)-3 lesions on mammogram or ultrasound and who subsequently underwent a biopsy. The BIRADS rankings are from 1 to 5, with BIRADS-3 lesions defined as "likely benign, with a 2% or less risk of malignancy." To date, the standard recommendation for a BIRADS-3 lesion has been early follow-up, usually at 6-month intervals. Records of 414 patients from five imaging sites who had a BIRADS-3 lesion on mammogram or ultrasound and subsequently underwent a percutaneous core biopsy between 1999 and 2006 were reviewed by the study authors. The presenting imaging abnormalities were as follows: mass in 216 patients (52.2%), microcalcifications in 101 patients (24.4%), density in 62 patients (15%), nodule in 18 patients (4.3%), and complex cyst in 12 patients (2.9%). The diagnostic modality was primarily ultrasound (64% of cases). It was not possible to calculate the Gail score in 75 of the patients due to a history of prior breast cancer, and one additional patient was excluded because of missing information for Gail-score calculation. In the remaining 338 patients without prior breast cancer, the modified Gail score was used to calculate the 5-year and lifetime risks for breast cancer. (Another nine patients with available Gail scores had inadequate tissue sampling and were also eventually excluded.) Of the 338 patients (mean age, 51.9 years), 83% had a 5-year risk greater than 1.7%, and 57% had a Gail score greater than 3.4%. Pathology results were divided into four categories: benign non-proliferative (68.6%), benign proliferative without atypia (13.7%), benign proliferative with atypia (8.4%), and cancer including ductal carcinoma in situ (9.6%). "There was no statistically significant correlation between radiologic modality and pathologic outcome. There was also no significant correlation between the modified Gail score and pathology category," the authors noted. These results led the researchers to conclude that it is more likely to find cancer or atypical hyperplasia in patients with a BIRADS-3 lesion and a high Gail score (>3.4%) or prior breast cancer diagnosis. Hence, it would be appropriate to offer tissue diagnosis to these patients rather than following them with repeat imaging studies at 6-month intervals. BIRADS was created by the American College of Radiology with the objective of improving communication of breast-imaging results and providing for outcome monitoring to improve the quality of patient care. [Presentation title: Do We Need to Biopsy BIRADS 3 Lesions in Selected High-Risk Patients? Poster F-30.] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.