Screening-mammography-detected lesions undergoing benign surgical excision: review of mammography features and preoperative needle biopsy results

Introduction

The aim of assessment of screen-detected lesions is to achieve a definitive diagnosis and thereby avoid diagnostic surgery.

Aim

To analyse the needle biopsy results and mammography features of cases undergoing surgical excision for benign screen-detected lesions.

Methods

A total of 155,621 women were screened by SouthEast London Breast screening programme from April 1998 to March 2003; 8836 (5.7%) were assessed. The study group consisted of 182 lesions that were benign on final surgical histology (0.1% of women screened). Needle biopsy results and mammography features were recorded on a database.

Results

Final surgical histology of the lesion: fibrocystic change (26%), radial scar (24%), fibroadenoma (14%), papilloma (11%) and atypical ductal hyperplasia (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.

All 182 cases underwent biopsy, either ultrasound 14 G core biopsy or stereo 14 G core biopsy or 11 G vacuum biopsy. Core needle biopsy results: 13% (24/182) had inadequate, 27% (50/182) benign, 42% (76/182) suspicious, 18% (32/182) no biopsy performed; 21% (39/182) underwent cytology. Out of the 39 cytology aspirates performed: 41% (16/39) suspicious, 28% (11/39) benign, 31% (12/39) inadequate.

Discussion

The most common benign lesions requiring surgical excision are mass and microcalcifications due to fibrocystic change and distortion due to radial scar. Forty-two per cent (76/182) of core biopsy results showed atypia/ suspicious findings. More accurate nonoperative diagnosis obtained by excising large volume biopsy techniques such as vacuum biopsy should decrease the need for surgical excision in these cases.