Radiological and histological features of mammography screen-detected lesions having undergone benign surgical excision

Aim

The development of modern image breast-guided biopsy techniques including core biopsy and vacuum-assisted core biopsy has improved the nonoperative diagnosis for most screening mammography-detected lesions, leading to a decrease in benign surgery. The aim is to describe the radiology and histology of benign screen-detected lesions requiring surgical excision in our practice.

Method

From April 1998 to March 2003, 155,621 women were screened in the South East London Breast Screening Programme, 8836 women were assessed (5.7%), and 182 benign lesions were surgically removed (0.1% of women screened). Radiological and histological features were recorded on a database.

Results

The primary histological diagnosis was: fibrocystic change (FCC) (26%), radial scar/complex sclerosing lesion (CSL) (24%), fibroadenoma (FA) (14%), papilloma (11%), atypical ductal hyperplasia (ADH) (7%), and miscellaneous other (15%).

The mammography features of benign lesions excised were well-defined mass (38%), microcalcifications (28%), stellate distortion (28%), asymmetry density (3%), and 4% other signs.

The commonest histology for each mammography sign was: microcalcifications, FCC (40%), papilloma (11%), FA (9%), ADH (8%), CSL (6%); well-defined mass, FA (28%), FCC (25%), papilloma (18%), CSL (10%); and architectural distortion, CSL/radial scar (78%), only 16% in FCC with 6% in FA.

Conclusion

This study confirms that modern breast biopsy techniques decrease the need for surgery for benign lesions, particularly microcalcifications due to FCC. A further decrease in the need for surgical biopsy may be anticipated as techniques improve and data showing the effectiveness of nonoperative diagnosis of such as CSL/radial scar and papilloma become available.