Evaluation of the malignancy risk in benign breast disease using screening mammography
Keywords:Breast cancer, Bi-Rads, Lower quadrant, Histopathological
Background: Breast cancer is the most common female cancer worldwide representing nearly 25% of the population. The study was designed to find the correlation between mammographic screening and histopathology in the diagnosis of malignancy among patients breast disease.
Methods: This analytical study was done on 163 patients who came to the General Surgery Out-Patient Department, VMMC, Karaikal were screened. From this, 125 patients who were clinically diagnosed with benign breast disease were further evaluated with mammography. A detailed history, clinical examination, and investigations including mammography, histopathological examination in the operated specimen were done.
Results: In the study 10% lump in the central area, 20% in lower inner quadrant, 12% in lower outer quadrant, 22% in upper inner quadrant and 36% in upper outer quadrant. In the study, all the 100 subjects were diagnosed to have a benign lesion in mammogram, in hpe 87% were diagnosed to have benign lesion and 13% were diagnosed to have malignant lesions.
Conclusions: Even though BI-RADS 2 and 3 mammography showed the majority of benign lesions, there is an increasing trend of malignancy in higher BI-RADS criteria, on further histopathological examination. Sensitivity, positive predictive value, and diagnostic accuracy are very high for mammographic screening.
Ballard-Barbash R, Taplin SH, Yankaskas BC. Breast Cancer Surveillance Consortium:a national mammography screening and outcomes database. Am J Roentgenol. 1997;169(4):1001–8.
Bassett LW. Quality determinants of mammography: clinical image evaluation. In: Kopans DB, Mendelson EB, eds. Syllabus:a categorical course in breast imaging. Oak Brook, Ill: Radiological Society of North Am. 1995: 57- 67.
Berg WA, Campassi C, Langenberg P, Sexton MJ. Breast imaging reporting and data system:Inter- and Intraobserver variability in feature analysis and final assessment. AJR Am J Roentgenol. 2000;174:1769–77.
Berg WA, D'Orsi CJ, Jackson VP, Bassett LW, Beam CA, Lewis RS. Does training in the Breast Imaging Reporting and Data System (BI-RADS) Improve biopsy recommendations or feature analysis agreement with experienced breast imagers at mammography? Radiology. 2002;224:871–80.
Boyd NF, Guo H, Martin LJ. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356(3):227–36.
Byrne C, Schairer C, Brinton LA. Effects of mammographic density and benign breast disease on breast cancer risk (United States). Cancer Causes Control. 2001;12(2):103–10.
Carter CL, Corle DK, Micozzi MS. A prospective study of the development of breast cancer in 16,692 women with benign breast disease. Am J Epidemiol. 1988;128(3):467–77.
Cummings SR, Tice JA, Bauer S. Prevention of breast cancer in postmenopausal women:approaches to estimating and reducing risk. J Natl Cancer Inst. 2009;101(6):384–98.
D'Orsi CJ. American College of Radiology mammography lexicon:an initial attempt to standardize terminology. AJR. 1996;166:779-80.
Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985;312(3):146–51.
Elmore JG, Barton MB, Moceri VM. n-year risk of false positive screening mammograms and clinical breast examinations. NEngl J Med. 1998;338:1089-96.
Frederick BW Jr, Samuel WB, Bland KI. History of breast cancer. In: The Breast – Comprehensive management of benign and malignant disease, (3rded.). Philadelphia: WB Saunders; 2001: 220.
Hartmann LC, Sellers TA, Frost MH. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353(3):229–37.
Jackson FI. Acceptability of periodic follow-up as an alternative to biopsy for mammographically detected lesions interpreted as probably benign. Radiology. 1989;173:580-1.
Kerlikowske K, Cook AJ, Buist DS. Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use. J Clin Oncol. 2010;28(24):3830–7.
Lehman CD, Rutter CM, Eby PR, White E, Buist DS, Taplin SH. Lesion and patient characteristics associated with malignancy after a probably benign finding on community practice mammography. AJR Am J Roentgenol. 2008;190:511–5.
Liberman L, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD. The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR. 1998;171:35-40.
Ojeda FH, Nguyen J. How to improve your breast cancer program:standardized reporting using the new American College of Radiology Breast Imaging-Reporting and Data System. Indian J Radiol Imaging. 2009;19(4):266–77.
Orel SG, Kay N, Reynolds C, Sullivan DC. BI-RADS categorization as a predictor of malignancy. Radiology. 1999;211:845–50.
Page DL, Dupont WD, Rogers LW. Atypical hyperplastic lesions of the female breast: A long-term follow-up study. Cancer. 1985;55(11):2698–708.