Abstract
A recent national audit of the West of London Breast Screening Service showed an increased rate of benign biopsy. This may be related to the increasing rate of wide bore needle (WBN) biopsies graded as B3 (indeterminate). Common B3 pathologies include atypical ductal hyperplasia (ADH), columnar cell change with hyperplasia or atypia (CCC) and intraduct papilloma (IP). Previous studies have shown an association of these lesions with malignancy [1,2]. Our practise is to recommend excision biopsy of these B3 lesions. We retrospectively audited surgical excision biopsies of B3 lesions between April 2004 and April 2005, recording mammogram findings, patient demographics, WBN and surgical excision pathological diagnoses. Twenty-five women age 50–70 (mean age 58) had excision biopsy of their B3 lesions; 64% were microcalcifications, 28% masses and the remainder distortions. The 14G core biopsy pathology included 38% ADH, 16% atypical lobular hyperplasia, 16% CCC and 12% IP. The surgical excision pathology available in 14 of these women showed ductal carcinoma in situ in seven and invasive ductal carcinoma in situ in three, justifying our practise. We discuss how the surgical pathology correlates with that of the WBN.
Highlights
Axillary lymph node dissection has been standard practice for staging invasive breast cancer
Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography
Full field digital mammography (FFDM) had a higher detection rate for ductal carcinoma in situ (DCIS) but no difference was observed for invasive tumours
Summary
Axillary lymph node dissection has been standard practice for staging invasive breast cancer. Aim To assess the feasibility of surgeons performing breast US in symptomatic breast clinics either as an adjunct to triple assessment or on their own for diagnostic and therapeutic purposes. The performance of individual units is monitored to ensure all women have access to an excellent service Aim This project aims to demonstrate how the Liverpool Breast Unit addressed failure to meet the national quality standard for the benign. Method A retrospective review of the records of patients who had undergone benign biopsy (2001–2002) was conducted to establish reasons for surgical referral and suggest corrective measures to enable the unit to meet the standard in the future. Columnar cell change (CCC) is diagnosed on core biopsies performed for indeterminate microcalcification. Method Mammograms of 33 cases with established CCC on core biopsy were reviewed and the radiological features, follow-up imaging and surgical excision histology (if performed) were collated. The results were completed when all units were undergoing assimilation onto the new banding procedures
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