110110 b9 breast biopsy presentation for rsna
DESCRIPTION
Breast Cancer Yield after Short Interval Follow-up Compared to Return to Routine Annual Screen in Patients with Benign Stereotactic or Ultrasound-guided Biopsy ResultsTRANSCRIPT
Breast Cancer Yield a/er Short-‐Interval Follow-‐Up Compared to
Return to Rou=ne Annual Screen in Pa=ents with Benign Stereotac=c or Ultrasound Guided Biopsy Results JM Johnson, MD; AK Johnson, MD; ES O'Meara,
PhD; D Migliore8, PhD; BM Geller, EdD; P Frawley, SD Herschorn, MD; EN Hotaling, MD
RSNA 96th Scientific Assembly & Annual Meeting, November 28 – December 3, Chicago, IL.
Disclosures
• No contributors have any relevant disclosures.
Background
• Biopsy of breast lesions is increasingly being performed using ultrasound and stereotacKc guidance.
• Exact # of percutaneous breast biopsies performed annually in the US is unknown, esKmates range 500,000 -‐ 1,000,000.
• # of percutaneous breast biopsies performed in the US conKnues to increase; only 20 -‐ 33% of these biopsy samples prove to be cancer.
Accuracy
• Percutaneous breast biopsy has been shown to be a highly accurate procedure.
• With stereotac=c biopsies, reports of false-‐negaKve rates range from 2.9 –7.8%.
• With ultrasound guided core needle biopsy, reports of false-‐negaKve rates range from 0 -‐ 1.7%.
Concordance
• ConfirmaKon of lesion retrieval aYer biopsy is essenKal and can be confirmed by specimen radiography, post biopsy mammography and by correlaKon of histologic findings with imaging characterisKcs.
• Imaging–histologic discordance aYer breast biopsy occurs when histologic findings do not provide a sufficient explanaKon for imaging features.
• Imaging–histologic discordance at stereotacKc or ultrasound guided biopsy is an indica=on for re-‐biopsy.
Biopsy Follow-‐Up
• Li^le evidence to guide how to follow-‐up paKents with benign biopsies.
• Many centers recommend return for a six-‐month follow-‐up unilateral mammogram or ultrasound to ensure that there has been no change at the biopsy site.
• Other centers perform a four-‐month follow-‐up and others return paKents to annual screening.
Mo Screening ≠ Mo Be^er
• Using conservaKve esKmates, as many as 330,000 women annually receive a breast biopsy with benign pathology result.
• SIFU leads to increase healthcare uKlizaKon and increased paKent anxiety.
• There are adverse psychological and immunological impacts of biopsy that persist beyond the biopsy.
• The effects may be prolonged with the addiKon of short-‐term follow-‐up.
Purpose
• Our goal was to compare the cancer detecKon rate and nodal status, stage and tumor size following a benign stereotacKc or ultrasound guided breast biopsy between paKents with SIFU and RTAS.
DefiniKons
• SIFU and RTAS defined based on observed Kme since biopsy, not just radiologist recommendaKon or indicaKon.
• "SIFU" defined as (a) imaging 3-‐9 months aYer biopsy with (b) indicaKon "rouKne screening" or "short-‐interval follow-‐up".
• "RTAS" defined as (a) imaging 9-‐18 months aYer biopsy with (b) indicaKon "rouKne screening" or "short-‐interval follow-‐up".
Rules
• Cases with findings of atypical hyperplasia or lobular carcinoma in situ were excluded.
• If any cancer diagnosis was found to precede the benign biopsy or occurred within the following 90 days, the biopsy was excluded.
• We required 3 months of follow-‐up for cancer detecKon at post-‐biopsy imaging.
• We examined biopsies that resulted from both screening and diagnosKc evaluaKons.
Rules 2 • Only core biopsies with ultrasound or stereotacKc guidance were evaluated.
• Any cases in which there was a repeat biopsy within 3 months or before follow-‐up imaging were excluded due to the likelihood of represenKng discordant radiology-‐pathology results.
• Diagnosis of ipsilateral invasive cancer or DCIS within 3 months of the 1st follow-‐up imaging exam and tumor characterisKcs were determined through linkage with pathology databases and tumor registries.
Methods
Results
• Total of 19,598 benign biopsies among 18,367 women were idenKfied. – Post-‐biopsy imaging
• SIFU 7397 • RTAS 3604 • Other 8597
Demographics SIFU (N = 7397) RTAS (N = 3604)
CharacterisKc % %
Age
<40 6 5.5
40-‐49 34 35.3
50-‐59 31.8 31.7
60-‐69 16.6 16
70-‐79 9.3 9
≥80 2.3 2.5
Race/ethnicity
White, non-‐hispanic 90.5 89
Black, non-‐hispanic 3.6 4.1
Asian/Pacific Islander 2 2.7
Demographics
SIFU (N = 7397) RTAS (N = 3604)
CharacterisKc % %
BMI (kg/m2)
<25 43 43.5
25 to <30 28.8 29
30 to <35 16.8 16.6
≥35 11.4 11
Current HRT 17.4 17.5
Family history of breast cancer 17.2 19.4
No breast symptoms, by self-‐report 78 91.6
Demographics
SIFU (N = 7397) RTAS (N = 3604)
CharacterisKc % %
Mammographic (BI-‐RADS) breast density -‐ -‐
Almost enKrely fat 4.8 4.7
Sca^ered fibroglandular densiKes 38.8 35.9
Heterogeneously dense 49.2 50.2
Extremely dense 7.2 9.3
Pre-‐biopsy imaging was for rou=ne screening 76 77.6
Breast Cancer w/in 3 months aYer post-‐biopsy imaging
SIFU RTAS
N benign biopsies 7397 3604
Incident ipsilateral breast cancer cases diagnoses w/in 3 months a/er post-‐biopsy imaging, N
40 18
Rate per 1000 imaging exams (95% CI) 5.4 (3.9, 7.4) 5.0 (3.0, 7.9)
Invasive cancer (nonmissing), N 26 (40) 12 (18)
Percent (95% CI) 65% (48%, 79%) 67% (41%, 87%)
Breast Cancer w/in 3 months aYer post-‐biopsy imaging
SIFU RTAS
Among invasive cancers
Node posi=ve (non missing), N 7 (23) 3 (10)
Percent (95% CI) 30% (13%, 53%) 30% (7%, 76%)
Late stage (III or IV) (non missing), N 4 (22) 3 (10)
Percent (95% CI) 18% (5%, 40%) 30% (7%, 65%)
Large size (≥20 mm) (non missing), N 4 (22) 3 (11)
Percent (95% CI) 18% (5%, 40%) 27% (6%, 61%)
Conclusion
• Our results do not show a staKsKcally significant difference in the rate of ipsilateral cancer detecKon between SIFU and RTAS following a benign breast biopsy.
• Rates of invasive cancer and posiKve nodal status also did not achieve staKsKcal significance between the groups.
Conclusion 2
• Having a benign breast biopsy is a posiKve risk factor for breast cancer (Breast Cancer Risk Assessment Tool and Gail Model).
• Despite the posiKve relaKve risk factor associated with a biopsy, the ideal method of follow-‐up for women with benign concordant breast biopsies has not been studied.
• Our results suggest that the pracKce of SIFU following a benign biopsy may not offer significant advantage over RTAS considering the cost and Kme involved.
Strengths
• Large sample of both paKents and radiologists which is representaKve of diverse US pracKces.
• To our knowledge, this is the first study to assess the outcome differences between SIFU and RTAS following a benign concordant breast biopsy.
• PaKent, radiologic, and cancer data within the BCSC provides an opportunity to examine follow-‐up outcomes in a large data set collected in a common format.
Weaknesses
• Small # of cancers detected precludes sub-‐groups analysis for difference in outcome between groups (i.e., older versus younger, white versus non-‐white, HRT vs. no HRT, etc.).
• RetrospecKve nature has inherent weaknesses including possibility of incorrectly filed data and missing data points.
• Predominance of White, non-‐Hispanic paKents (~85%) in our data set limits generalizability of our data to non-‐Whites.
Clinical Relevance
• These results suggest that the pracKce of SIFU following a benign biopsy may not offer significant advantage over RTAS considering the cost and Kme involved.
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