Added value of second biopsy target in screen-detected widespread suspicious breast calcifications

Nathalie M Falkner, Dana Hince, Gareth Porter, Ben Dessauvagie, Sanjay Jeganathan, Max Bulsara, Glen Lo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

INTRODUCTION: There is controversy on the optimal work-up of screen-detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen-detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value.

METHODS: Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen's Kappa were calculated.

RESULTS: A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post-hoc second target biopsy cases.

CONCLUSION: While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post-hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological-pathological concordant; discordance still requires repeat sampling.

Original languageEnglish
Pages (from-to)299-306
JournalJournal of Medical Imaging and Radiation Oncology
Volume62
Issue number3
DOIs
Publication statusPublished - Jun 2018

Fingerprint

Breast
Biopsy
Mammography
Early Detection of Cancer
Observational Studies
Retrospective Studies
Breast Neoplasms

Cite this

Falkner, Nathalie M ; Hince, Dana ; Porter, Gareth ; Dessauvagie, Ben ; Jeganathan, Sanjay ; Bulsara, Max ; Lo, Glen. / Added value of second biopsy target in screen-detected widespread suspicious breast calcifications. In: Journal of Medical Imaging and Radiation Oncology. 2018 ; Vol. 62, No. 3. pp. 299-306.
@article{f731ec38e9d24a7f9842e01b0bdf2981,
title = "Added value of second biopsy target in screen-detected widespread suspicious breast calcifications",
abstract = "INTRODUCTION: There is controversy on the optimal work-up of screen-detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen-detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value.METHODS: Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen's Kappa were calculated.RESULTS: A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86{\%}) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85{\%}, 86{\%} and 92{\%} for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post-hoc second target biopsy cases.CONCLUSION: While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14{\%} there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post-hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological-pathological concordant; discordance still requires repeat sampling.",
keywords = "Journal Article",
author = "Falkner, {Nathalie M} and Dana Hince and Gareth Porter and Ben Dessauvagie and Sanjay Jeganathan and Max Bulsara and Glen Lo",
note = "{\circledC} 2018 The Royal Australian and New Zealand College of Radiologists.",
year = "2018",
month = "6",
doi = "10.1111/1754-9485.12715",
language = "English",
volume = "62",
pages = "299--306",
journal = "Journal of Medical Imaging and Radiation Oncology",
issn = "0004-8461",
publisher = "John Wiley & Sons",
number = "3",

}

Added value of second biopsy target in screen-detected widespread suspicious breast calcifications. / Falkner, Nathalie M; Hince, Dana; Porter, Gareth; Dessauvagie, Ben; Jeganathan, Sanjay; Bulsara, Max; Lo, Glen.

In: Journal of Medical Imaging and Radiation Oncology, Vol. 62, No. 3, 06.2018, p. 299-306.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Added value of second biopsy target in screen-detected widespread suspicious breast calcifications

AU - Falkner, Nathalie M

AU - Hince, Dana

AU - Porter, Gareth

AU - Dessauvagie, Ben

AU - Jeganathan, Sanjay

AU - Bulsara, Max

AU - Lo, Glen

N1 - © 2018 The Royal Australian and New Zealand College of Radiologists.

PY - 2018/6

Y1 - 2018/6

N2 - INTRODUCTION: There is controversy on the optimal work-up of screen-detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen-detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value.METHODS: Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen's Kappa were calculated.RESULTS: A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post-hoc second target biopsy cases.CONCLUSION: While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post-hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological-pathological concordant; discordance still requires repeat sampling.

AB - INTRODUCTION: There is controversy on the optimal work-up of screen-detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen-detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value.METHODS: Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen's Kappa were calculated.RESULTS: A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post-hoc second target biopsy cases.CONCLUSION: While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post-hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological-pathological concordant; discordance still requires repeat sampling.

KW - Journal Article

U2 - 10.1111/1754-9485.12715

DO - 10.1111/1754-9485.12715

M3 - Article

VL - 62

SP - 299

EP - 306

JO - Journal of Medical Imaging and Radiation Oncology

JF - Journal of Medical Imaging and Radiation Oncology

SN - 0004-8461

IS - 3

ER -