Lesion and patient characteristics associated with malignancy after a probably benign finding on community practice mammography.

OBJECTIVE The purpose of this study was to identify patient and lesion characteristics associated with a diagnosis of breast malignancy within 3 years of having a probably benign finding (BI-RADS category 3) on a mammogram obtained in a community radiology practice. MATERIALS AND METHODS The subjects were women 30 years old and older without breast implants or previous breast cancer who received notice of a probably benign finding on a bilateral screening mammogram between January 1, 1996, and June 30, 1999, in a community-based practice. From 82,898 mammograms, we identified 129 breast lesions designated probably benign that progressed to malignancy within 3 years of an index examination (cases) and matched them to 129 lesions designated probably benign that did not progress to malignancy within 3 years (controls). A breast imaging specialist blinded to case-control status interpreted all examinations and recorded detailed lesion descriptors according to the BI-RADS lexicon. RESULTS Case lesions were more likely in patients who were older, postmenopausal, or had a strong family history of breast cancer or previous biopsy. The lesions were more likely masses with obscured, indistinct, or spiculated margins compared with control lesions (84.6% vs 66%, p = 0.03). Case lesions were more likely calcifications (29.5% vs 17.8%, p = 0.03). No cases were encountered among calcifications considered typically benign in the BI-RADS lexicon (vascular or coarse), and no controls were encountered among calcifications considered suspicious or highly suggestive of malignancy in the BI-RADS lexicon (amorphous, pleomorphic, branching, and fine linear) (p < 0.0001). CONCLUSION In community practice, patient and lesion mammographic characteristics can be predictive of the likelihood of a subsequent cancer diagnosis of mammographic lesions designated as probably benign. Careful evaluation of mass margins and of the morphologic features of calcifications can help distinguish a malignant lesion from a probably benign finding.

[1]  Jo M. Kendrick,et al.  Quality Determinants of Mammography, Clinical Practice Guideline , 1995 .

[2]  J. Robbins,et al.  Frequency and predictive value of a mammographic recommendation for short-interval follow-up. , 2003, Journal of the National Cancer Institute.

[3]  E. Sickles.  Probably benign breast lesions: when should follow-up be recommended and what is the optimal follow-up protocol? , 1999, Radiology.

[4]  E. Sickles.  Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. , 1991, Radiology.

[5]  Emily White,et al.  Use of the American College of Radiology BI-RADS guidelines by community radiologists: concordance of assessments and recommendations assigned to screening mammograms. , 2002, AJR. American journal of roentgenology.

[6]  X. Varas,et al.  Nonpalpable, probably benign lesions: role of follow-up mammography. , 1992, Radiology.

[7]  D. Salas,et al.  Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. , 2001, Radiology.

[8]  M. Nadel,et al.  Coding mammograms using the classification "probably benign finding--short interval follow-up suggested". , 1999, AJR. American journal of roentgenology.

[9]  M. Manos,et al.  Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up? , 2005, Journal of the National Cancer Institute.

[10]  K. Kerlikowske,et al.  Improving the concordance of mammography assessment and management recommendations. , 2006, Radiology.

[11]  M A Helvie,et al.  Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield. , 1991, Radiology.

[12]  Emily White,et al.  Evaluating Organized Breast Cancer Screening Implementation , 2004, Cancer Epidemiology Biomarkers & Prevention.

[13]  K. Kerlikowske,et al.  Performance of Screening Mammography among Women with and without a First-Degree Relative with Breast Cancer , 2000, Annals of Internal Medicine.

[14]  X. Varas,et al.  Revisiting the mammographic follow-up of BI-RADS category 3 lesions. , 2002, AJR. American journal of roentgenology.

[15]  J. Baker,et al.  Malignant lesions initially subjected to short-term mammographic follow-up. , 2002, Radiology.

[16]  A R Feinstein,et al.  The impact of clinical history on mammographic interpretations. , 1997, JAMA.

[17]  A. Wilson,et al.  Short-term recall for 'probably benign' mammographic lesions detected in a three yearly screening programme. , 1994, Clinical radiology.

[18]  David Page,et al.  Validation of Results from Knowledge Discovery: Mass Density as a Predictor of Breast Cancer , 2009, Journal of Digital Imaging.