Minimal Invasive Biopsy Results of ”Uncertain Malignant Potential” in Digital Mammography Screening: High Prevalence but also High Predictive Value for Malignancy

Zusammenfassung

Ziel: Aus der Abklärungsdiagnostik des digitalen Mammografie-Screenings wurden die Rate, das histologische Spektrum und der positive Vorhersagewert (PPV) hinsichtlich Malignität von Brustläsionen minimalinvasiver Biopsien „unklaren malignen Potenzials (B3)” untersucht. Material und Methoden: Konsekutive Untersuchungen von 37 178 Teilnehmerinnen einer digitalen Einheit des deutschen Screeningprogramms wurden eingeschlossen. Ergebnisse: Die B 3-Rate war 15,1 % (148 / 979). Es lagen folgende Häufigkeiten der B 3-Subtypen vor: atypische epitheliale Proliferationen vom duktalen Typ (AEPDT) 35,1 % (52 / 148), radiäre Narben (RS) 28,4 % (42 / 148), papilläre Läsionen (PAP) 20,3 % (30 / 148), Carcinoma lobulare in situ 8,8 % (13 / 148), flache epitheliale Atypien 5,4 % (8 / 148), mukozelenartige Läsionen 2,0 % (3 / 148). Der PPV für Malignität in der sekundären chirurgischen Exzision betrug insgesamt 0,28 (25 / 91); dabei ist der PPV 0,40 (19 / 47) für die AEPDT, 0,20 (5 / 25) für die RS, 0,08 (1 / 12) für PAP. Schlussfolgerung: Trotz einer höheren B 3-Rate von Brustläsionen mit „unklarem malignem Potenzial” minimalinvasiver Biopsien im digitalen Mammografie-Screening ist die Rate benigner chirurgischer Exzisionen im Vergleich zum analogen Screening nicht unverhältnismäßig erhöht. In Kombination mit einem konsequenten interdisziplinären Management resultiert eine erhöhte Brustkrebsentdeckungsrate pro Screeningteilnehmerin mit offener Biopsie.

Abstract

Purpose: To evaluate the rate, the histological spectrum and the positive predictive value (PPV) for malignancy of minimally invasive biopsies with ”uncertain malignant potential (B3)” in digital mammography screening. Methods and Materials: Consecutive data of 37 178 participants of one digital unit of the German screening program were included. Results: The B 3 rate was 15.1 % (148 / 979). The frequencies of lesion subtypes were as follows: atypical epithelial proliferation of ductal type (AEPDT) 35.1 % (52 / 148), radial scar (RS) 28.4 % (42 / 148), papillary lesions (PAP) 20.3 % (30 / 148), lobular carcinoma in situ 8.8 % (13 / 148), flat epithelial atypia 5.4 % (8 / 148), and mucocele-like lesions 2.0 % (3 / 148). The PPV for malignancy in surgical excisions was overall 0.28 (25 / 91); in detail 0.40 (19 / 47) for AEPDT, 0.20 (5 / 25) for RS, 0.08 (1 / 12) for PAP. Conclusion: Despite a higher B 3 rate of minimally invasive biopsies with ”uncertain malignant potential” in digital screening, the benign surgical biopsy rate is not disproportionally increased compared with analog screening programs. Together with defined management protocols, this results in an increased cancer detection rate per screening participant with surgical excision.

Key words

breast - biopsy - mammography screening - digital mammography - histology - predictive value

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