Is the Mammotome excision of indeterminate impalpable lesions found incidentally on mammography best practice?

Mammotome excision of indeterminate (B3) impalpable lesions combined with annual mammographic follow-up can be regarded as routine practice.

This quantitative study retrospectively reviewed consecutive Mammotome procedures from January 2003 to July 2005. B3 outcomes were analysed by category combined with follow-up for any evidence of histological upgrade to carcinoma.

Out of a total of 120 consecutive Mammotome procedures, 61 (58%) had a B3 outcome. The B3 category subdivided into: 37% (n = 23) atypical ductal hyperplasia, 37% (n = 23) as radial scars, with the remaining 26% (n = 15) in a mixed category containing mucoceles, lobular carcinoma in situ, and papillomata. A total of 42.6% (n = 26) of the B3 category underwent annual mammographic follow-up with no signs of recurrence, 41% (n = 25) proceeded to 3-yearly NHSBSP routine recall follow-up, and 9.8% (n = 6) proceeded to surgical follow-up with two patients being up-graded to carcinoma. Four patients were lost to follow-up. The incidence of carcinoma in the B3 category ranged between 3.6% and 6.3%.

Trends demonstrated that Mammotome excision for B3 lesions combined with annual mammographic follow-up can be safe practice providing each case is discussed within a multidisciplinary setting with regard to atypia, past history and concordance of imaging and results.