Previous Benign Biopsy Research Articles

Prostate Cancer Mortality Among Elderly Men After Discontinuing Organised Screening: Long-term Results from the European Randomized Study of Screening for Prostate Cancer Rotterdam

BackgroundThe optimal timing for discontinuing screening of prostate cancer (PCa) in elderly men is currently not known and remains debated. ObjectiveTo assess prostate cancer–specific mortality (PCSM) in elderly men who previously underwent prostate-specific antigen (PSA)-based screening and to identify those who may benefit from continued screening. Design, setting, and participantsA total of 7052 men, who participated in the screening arm of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer and were aged 70–74 yr at their last screening visit after undergoing a maximum of three screening rounds without being diagnosed with PCa, were included. Outcome measurements and statistical analysisThe cumulative incidence of PCSM by the age of 85 yr was assessed. Additionally, a competing risk regression was performed to assess the potential predictors of PCSM. Results and limitationsThe median follow-up was 16 yr. The cumulative incidence of PCSM by the age of 85 yr was 0.54% (95% confidence interval [CI]: 0.40–0.70) in all men, 0.11% (95% CI: 0.05–0.27) in men with PSA <2 ng/ml, 0.85% (95% CI: 0.47–1.5) in men with PSA 2–3 ng/ml, and 6.8% (95% CI: 3.1–15) in men with PSA ≥6.5 ng/ml and no previous benign biopsy. PSA (subdistribution hazard ratio [sHR]: 2.0; 95% CI: 1.7–2.3), previous benign prostate biopsy (sHR: 0.41; 95% CI: 0.23–0.72), and hypertension (sHR: 0.48; 95% CI: 0.25–0.91) were significantly associated with PCSM. ConclusionsMen aged 70–74 yr who have previously undergone PSA-based screening without receiving a PCa diagnosis have a very low risk of dying from PCa by the age of 85 yr. These data suggest that screening may be discontinued in men with PSA <3.0 ng/ml or previous benign prostate biopsies. Those with higher PSA levels and no prior biopsies may consider continued screening if life expectancy exceeds 10 yr. Patient summaryThis study shows that men who participated in a prostate cancer screening trial have a very low risk of dying from prostate cancer if they have not been diagnosed with prostate cancer by the age of 74 yr.

Effect of Benign Biopsy Findings on an Artificial Intelligence–Based Cancer Detector in Screening Mammography: Retrospective Case-Control Study

Background Artificial intelligence (AI)–based cancer detectors (CAD) for mammography are starting to be used for breast cancer screening in radiology departments. It is important to understand how AI CAD systems react to benign lesions, especially those that have been subjected to biopsy. Objective Our goal was to corroborate the hypothesis that women with previous benign biopsy and cytology assessments would subsequently present increased AI CAD abnormality scores even though they remained healthy. Methods This is a retrospective study applying a commercial AI CAD system (Insight MMG, version 1.1.4.3; Lunit Inc) to a cancer-enriched mammography screening data set of 10,889 women (median age 56, range 40-74 years). The AI CAD generated a continuous prediction score for tumor suspicion between 0.00 and 1.00, where 1.00 represented the highest level of suspicion. A binary read (flagged or not flagged) was defined on the basis of a predetermined cutoff threshold (0.40). The flagged median and proportion of AI scores were calculated for women who were healthy, those who had a benign biopsy finding, and those who were diagnosed with breast cancer. For women with a benign biopsy finding, the interval between mammography and the biopsy was used for stratification of AI scores. The effect of increasing age was examined using subgroup analysis and regression modeling. Results Of a total of 10,889 women, 234 had a benign biopsy finding before or after screening. The proportions of flagged healthy women were 3.5%, 11%, and 84% for healthy women without a benign biopsy finding, those with a benign biopsy finding, and women with breast cancer, respectively (P&lt;.001). For the 8307 women with complete information, radiologist 1, radiologist 2, and the AI CAD system flagged 8.5%, 6.8%, and 8.5% of examinations of women who had a prior benign biopsy finding. The AI score correlated only with increasing age of the women in the cancer group (P=.01). Conclusions Compared to healthy women without a biopsy, the examined AI CAD system flagged a much larger proportion of women who had or would have a benign biopsy finding based on a radiologist’s decision. However, the flagging rate was not higher than that for radiologists. Further research should be focused on training the AI CAD system taking prior biopsy information into account.

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood.

This study aimed to explore the benefits of theranostic robot-assisted radical prostatectomy (T-RARP) for clinically highly suspicious prostate cancer (PCa) without proven biopsies. Between February 2016 and December 2020, we included men with clinically highly suspicious PCa in this study. They were assessed to have possible localized PCa without any initial treatments, and were categorized into previous benign biopsies or without biopsies. Furthermore, another group of malignant biopsies with RARP in the same time frame was adopted as the control group. The endpoints were to compare the oncological outcome and functional outcome between malignant biopsies with RARP and T-RARP. p < 0.05 was considered to be significant. We included 164 men with proven malignant biopsies treated with RARP as the control group. For T-RARP, we included 192 men. Among them, 129 were preoperatively benign biopsies, and 63 had no biopsies before T-RARP. Approximately 75% of men in the T-RARP group had malignant pathology in their final reports, and the other 25% had benign pathology. T-RARP provides several oncological advantages, such as a higher initial pathological T stage, lower Gleason grade, and lower odds of positive surgical margins. However, the biochemical recurrence rates were not significantly decreased. From our cohort, T-RARP (odds ratio with 95% confidence interval; erectile recovery: 3.19 (1.84-5.52), p < 0.001; continence recovery: 2.25 (1.46-3.48), p < 0.001) could result in better recovery of functional outcomes than malignant biopsies with RARP. For clinically highly suspicious PCa, T-RARP was able to detect around 75% of PCa cases and preserved their functional outcomes maximally. However, in 25% of men with benign pathology, approximately 6% would have incontinence and 10% would have erectile impairment. This part should be sufficiently informed of the potential groups considering T-RARP.

Effect of information on prostate biopsy history on biopsy outcomes in the era of MRI-targeted biopsies

PurposeTo describe the predictive value of information on previous benign biopsy for the outcome of MRI-targeted biopsies.MethodsAn exploratory analysis was conducted using data from a prospective, multicenter, paired diagnostic study of 532 men undergoing diagnostics for prostate cancer during 2016–2017. All men underwent 1.5 T MRI; systematic prostate biopsies; and MRI-targeted biopsies to MRI lesions with Prostate Imaging Reporting and Data System version 2, PI-RADS ≥ 3. The main outcome was numbers of detected prostate cancer characterized by grade group (GG) where GG ≥ 2 defined clinically significant cancer (csPCa).ResultsMen with previous biopsies had significantly more often negative MRI (26% vs. 17%, p < 0.05) compared to men without previous biopsies. Men with previous biopsies showed higher rates of benign biopsies (41% vs. 26%, p < 0.05) and lower rates of GG2 (17% vs. 30%, p < 0.05) and GG ≥ 3 (5% vs. 10%, p < 0.05) cancer. Biopsy-naïve men had higher proportions of highly suspicious MRI lesions (PIRADS 5; p < 0.05) and a higher proportion of significant cancer in those lesions (p = 0.05). In multivariate regression analysis, a previous benign prostate biopsy was associated with less than half the odds of csPCa (OR 0.38; 95% CI 0.20–0.71).ConclusionIn this large prospective multicenter trial, we showed that men with a previous prostate biopsy had higher proportions of MRIs without lesions and lower proportion of highly suspicious lesions than biopsy-naïve men. Further, biopsy-naïve men showed higher detection of clinically significant cancer when using MRI-targeted biopsies. Also, in the era of MRI-targeted biopsy strategies, biopsy history should be carefully considered in biopsy decisions.Trial registrationNCT02788825 (ClinicalTrials.gov). Date of registration June 2, 2016.

PD43-02 MULTICENTRE COMPARISON OF TARGET AND SYSTEMATIC BIOPSIES USING MAGNETIC RESONANCE AND ULTRASOUND IMAGE-FUSION GUIDED TRANSPERINEAL PROSTATE BIOPSY IN PATIENTS WITH A PREVIOUS NEGATIVE BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI1 Apr 2017PD43-02 MULTICENTRE COMPARISON OF TARGET AND SYSTEMATIC BIOPSIES USING MAGNETIC RESONANCE AND ULTRASOUND IMAGE-FUSION GUIDED TRANSPERINEAL PROSTATE BIOPSY IN PATIENTS WITH A PREVIOUS NEGATIVE BIOPSY Claudia Kesch, Nienke Lynn Hansen, Tristan Barett, Jan Philipp Radtke, David Bonekamp, Heinz-Peter Schlemmer, Anne Warren, Kathrin Wieczorek, Markus Hohenfellner, Christoph Kastner, and Boris Hadaschik Claudia KeschClaudia Kesch More articles by this author , Nienke Lynn HansenNienke Lynn Hansen More articles by this author , Tristan BarettTristan Barett More articles by this author , Jan Philipp RadtkeJan Philipp Radtke More articles by this author , David BonekampDavid Bonekamp More articles by this author , Heinz-Peter SchlemmerHeinz-Peter Schlemmer More articles by this author , Anne WarrenAnne Warren More articles by this author , Kathrin WieczorekKathrin Wieczorek More articles by this author , Markus HohenfellnerMarkus Hohenfellner More articles by this author , Christoph KastnerChristoph Kastner More articles by this author , and Boris HadaschikBoris Hadaschik More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1907AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance (MRI) and transrectal ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal US guided biopsies in two high-volume centres. METHODS Two centre, prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided target and systematic saturation biopsy from 2012 to 2015. MRI was reported according to PIRADS Version 1. Detection of Gleason score (GS) 7-10 cancer (PCa) on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar test. AUCs were calculated for PIRADS, PSA-Density and the combination of the both. RESULTS Median PSA was 9.0 (IQR 6.7-13.4) ng/ml. PIRADS 3-5 MRI lesions were reported in 343 (70%) patients. GS 7-10 PCa was detected in 149 (31%). PPV for detecting GS 7-10 PCa was 0.20 (+/-0.07) for PIRADS 3, 0.32 (+/-0.09) for PIRADS 4, and 0.70 (+/-0.08) for PIRADS 5. NPV of PIRADS 1-2 was 0.92 (+/-0.04) for GS 7-10 and 0.99 (+/-0.02) for GS 4+3 or higher cancer. Systematic biopsies alone found 125/138 (91%) GS 7-10 cancers. In patients with suspicious lesions (PIRADS 4-5) on MRI, systematic biopsies would not have detected 12/113 significant PCa (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PIRADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of GS 7-10, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA-density improved the AUC of PIRADS from 0.822 to 0.846. CONCLUSIONS In patients with high probability MRI lesions, combined targeted and systematic MRI/TRUS image-fusion biopsy is still required, however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA-density and a negative MRI read by experienced radiologists. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e818 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Claudia Kesch More articles by this author Nienke Lynn Hansen More articles by this author Tristan Barett More articles by this author Jan Philipp Radtke More articles by this author David Bonekamp More articles by this author Heinz-Peter Schlemmer More articles by this author Anne Warren More articles by this author Kathrin Wieczorek More articles by this author Markus Hohenfellner More articles by this author Christoph Kastner More articles by this author Boris Hadaschik More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy.

To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres. A two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7-10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test. The median (interquartile range) PSA level was 9.0 (6.7-13.4) ng/mL. PI-RADS 3-5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7-10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7-10 prostate cancer was 0.20 (±0.07) for PI-RADS 3, 0.32 (±0.09) for PI-RADS 4, and 0.70 (±0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1-2 was 0.92 (±0.04) for Gleason score 7-10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7-10 cancers. In patients with suspicious lesions (PI-RADS 4-5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7-10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846. In patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7-10 cancer still required combined targeted and systematic MRI/US image-fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.

Association between Breast Parenchymal Complexity and False-Positive Recall From Digital Mammography Versus Breast Tomosynthesis: Preliminary Investigation in the ACRIN PA 4006 Trial

We investigate associations between measures of mammographic parenchymal complexity and false-positive (FP) recall from screening with digital mammography (DM) versus digital breast tomosynthesis (DBT). We retrospectively analyzed data from 541 women recruited by the American College of Radiology Imaging Network 4006 trial, designed to evaluate callback and detection rates from screening with DM versus combined DM and DBT. Of these, 68 and 56 were FPs based on DM alone versus the combined DM/DBT readings, respectively. Mammographic complexity was quantified with computerized texture analysis and percent density. Logistic regression was performed to evaluate associations between extracted features and FP recall, after adjusting for age and number of previous benign biopsies. Odds ratios and area under the curve (AUC) of the receiver operating characteristic were used to assess association strength. For DM, age, previous benign biopsies and texture features of correlation, inverse difference moment, sum average, and sum variance were deemed as significant predictors (P <.05) of FP recall, with an AUC = 0.77. For DBT, age was the only significant predictor of FP recall with AUC = 0.64. Using exploratory receiver operating characteristic thresholds for which no true-positives would be missed, a potential FP reduction of 23.5% and 8.9% was demonstrated, respectively, for DM alone versus DM/DBT. Measures of breast complexity measured on 2D digital mammograms are indicative of the likelihood for FP recall from screening with DM, and could help identify women who could benefit from supplemental screening, including DBT.

Factors Associated With Rates of False-Positive and False-Negative Results From Digital Mammography Screening: An Analysis of Registry Data

Women screened with digital mammography may receive false-positive and false-negative results and subsequent imaging and biopsies. How these outcomes vary by age, time since the last screening, and individual risk factors is unclear. To determine factors associated with false-positive and false-negative digital mammography results, additional imaging, and biopsies among a general population of women screened for breast cancer. Analysis of registry data. Participating facilities at 5 U.S. Breast Cancer Surveillance Consortium breast imaging registries with linkages to pathology databases and tumor registries. 405,191 women aged 40 to 89 years screened with digital mammography between 2003 and 2011. A total of 2963 were diagnosed with invasive cancer or ductal carcinoma in situ within 12 months of screening. Rates of false-positive and false-negative results and recommendations for additional imaging and biopsies from a single screening round; comparisons by age, time since the last screening, and risk factors. Rates of false-positive results (121.2 per 1000 women [95% CI, 105.6 to 138.7]) and recommendations for additional imaging (124.9 per 1000 women [CI, 109.3 to 142.3]) were highest among women aged 40 to 49 years and decreased with increasing age. Rates of false-negative results (1.0 to 1.5 per 1000 women) and recommendations for biopsy (15.6 to 17.5 per 1000 women) did not differ greatly by age. Results did not differ by time since the last screening. False-positive rates were higher for women with risk factors, particularly family history of breast cancer; previous benign breast biopsy result; high breast density; and, for younger women, low body mass index. Confounding by variation in patient-level characteristics and outcomes across registries and regions may have been present. Some factors, such as numbers of first- and second-degree relatives with breast cancer and diagnoses associated with previous benign biopsy results, were not examined. False-positive mammography results and additional imaging are common, particularly for younger women and those with risk factors, whereas biopsies occur less often. Rates of false-negative results are low. Agency for Healthcare Research and Quality and National Cancer Institute.

Impact of risk factors on different interval cancer subtypes in a population-based breast cancer screening programme.

BackgroundInterval cancers are primary breast cancers diagnosed in women after a negative screening test and before the next screening invitation. Our aim was to evaluate risk factors for interval cancer and their subtypes and to compare the risk factors identified with those associated with incident screen-detected cancers.MethodsWe analyzed data from 645,764 women participating in the Spanish breast cancer screening program from 2000–2006 and followed-up until 2009. A total of 5,309 screen-detected and 1,653 interval cancers were diagnosed. Among the latter, 1,012 could be classified on the basis of findings in screening and diagnostic mammograms, consisting of 489 true interval cancers (48.2%), 235 false-negatives (23.2%), 172 minimal-signs (17.2%) and 114 occult tumors (11.3%). Information on the screening protocol and women's characteristics were obtained from the screening program registry. Cause-specific Cox regression models were used to estimate the hazard ratios (HR) of risks factors for interval cancer and incident screen-detected cancer. A multinomial regression model, using screen-detected tumors as a reference group, was used to assess the effect of breast density and other factors on the occurrence of interval cancer subtypes.ResultsA previous false-positive was the main risk factor for interval cancer (HR = 2.71, 95%CI: 2.28–3.23); this risk was higher for false-negatives (HR = 8.79, 95%CI: 6.24–12.40) than for true interval cancer (HR = 2.26, 95%CI: 1.59–3.21). A family history of breast cancer was associated with true intervals (HR = 2.11, 95%CI: 1.60–2.78), previous benign biopsy with a false-negatives (HR = 1.83, 95%CI: 1.23–2.71). High breast density was mainly associated with occult tumors (RRR = 4.92, 95%CI: 2.58–9.38), followed by true intervals (RRR = 1.67, 95%CI: 1.18–2.36) and false-negatives (RRR = 1.58, 95%CI: 1.00–2.49).ConclusionThe role of women's characteristics differs among interval cancer subtypes. This information could be useful to improve effectiveness of breast cancer screening programmes and to better classify subgroups of women with different risks of developing cancer.

Breast cancer detection risk in screening mammography after a false-positive result

Background: False-positives are a major concern in breast cancer screening. However, false-positives have been little evaluated as a prognostic factor for cancer detection. Our aim was to evaluate the association of false-positive results with the cancer detection risk in subsequent screening participations over a 17-year period. Methods: This is a retrospective cohort study of 762,506 women aged 45–69 years, with at least two screening participations, who underwent 2,594,146 screening mammograms from 1990 to 2006. Multilevel discrete-time hazard models were used to estimate the adjusted odds ratios (OR) of breast cancer detection in subsequent screening participations in women with false-positive results. Results: False-positives involving a fine-needle aspiration cytology or a biopsy had a higher cancer detection risk than those involving additional imaging procedures alone (OR=2.69; 95%CI: 2.28–3.16 and OR=1.81; 95%CI: 1.70–1.94, respectively). The risk of cancer detection increased substantially if women with cytology or biopsy had a familial history of breast cancer (OR=4.64; 95%CI: 3.23–6.66). Other factors associated with an increased cancer detection risk were age 65–69 years (OR=1.84; 95%CI: 1.67–2.03), non-attendance at the previous screening invitation (OR=1.26; 95%CI: 1.11–1.43), and having undergone a previous benign biopsy outside the screening program (OR=1.24; 95%CI: 1.13–1.35). Conclusion: Women with a false-positive test have an increased risk of cancer detection in subsequent screening participations, especially those with a false-positive result involving cytology or biopsy. Understanding the factors behind this association could provide valuable information to increase the effectiveness of breast cancer screening.

2205 PCA3 TEST AS AN ADJUNCT IN DIAGNOSIS OF PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Early diagnosis of prostate cancer is conventionally done with serum prostate specific antigen (PSA) test and digital rectal examination, but these tests lack specificity. Many men worldwide undergo repeated, sometimes unnecessary prostate biopsies due to suspicious or rising PSA levels. A urine test PCA3 is gaining popularity, predominantly in the field of managing patients with suspicious PSA and previous benign biopsies. In this multinational study we assessed the performance of the PCA3 urine test in patients who were candidates for prostate biopsies due to high or rising PSA’s. METHODS: The PCA3 scores were determined in urine samples in these men A PCA3 scores of 35 or higher were considered higher probability of cancer. Subsequent biopsy was performed as per current best practice and at the discretion of the urologist in concert with the patient. To retrospectively assess the performance of PCA3, we used multiple logistic regression analysis and receiver operating characteristic (ROC) curves were constructed to evaluate PCA3 as a prognostic factor compared with PSA and evaluated the influence of PCA3 testing on the decision making. RESULTS: 401 patients had PCA3 score available. The most common indication was rising or high PSA after previous negative biopsies -in 256 patients (63.8%), followed by the finding of high grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) on previous biopsy in 101 patients (25.2%). Forty four subjects (11%) did not undergo prostate biopsy prior to PCA3 testing. PCA3 scores were significantly lower in patients without malignancy using a cutoff score of 35 (OR 2.99 (95%CI) (1.42, 6.30), p 0.004). On ROC curve analysis PCA3 area under the curve of 0.722 was significantly greater than PSA (0.4837). Sensitivity and specificity of PCA3 score using the 35 cutoff were 63.6% and 63.0%, respectively. When a cutoff score of 20 was used, the sensitivity and specificity of PCA3 score were 86.4% and 41.3%, respectively. The PCA3 test influenced the clinical course of the patient in 73.5% of cases. The follow-up PSA values in patients who did not perform biopsy after PCA3 testing had, without exception, remained stable or dropped (7.86 vs. 6.22, p 0.003) with follow-up of at least 6 months. CONCLUSIONS: In this multinational study we demonstrate that urine PCA3 score test out-performs PSA in decision making in men facing possibility of repeat prostate biopsy. We recommend that the PCA3 results should be integrated with other relevant data and rather be used in continuous fashion, and not with certain cutoff value.

Projecting Individualized Absolute Invasive Breast Cancer Risk in Asian and Pacific Islander American Women

The Breast Cancer Risk Assessment Tool (BCRAT) of the National Cancer Institute is widely used for estimating absolute risk of invasive breast cancer. However, the absolute risk estimates for Asian and Pacific Islander American (APA) women are based on data from white women. We developed a model for projecting absolute invasive breast cancer risk in APA women and compared its projections to those from BCRAT. Data from 589 women with breast cancer (case patients) and 952 women without breast cancer (control subjects) in the Asian American Breast Cancer Study were used to compute relative and attributable risks based on the age at menarche, number of affected mothers, sisters, and daughters, and number of previous benign biopsies. Absolute risks were obtained by combining this information with ethnicity-specific data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and with US ethnicity-specific mortality data to create the Asian American Breast Cancer Study model (AABCS model). Independent data from APA women in the Women's Health Initiative (WHI) were used to check the calibration and discriminatory accuracy of the AABCS model. The AABCS model estimated absolute risk separately for Chinese, Japanese, Filipino, Hawaiian, Other Pacific Islander, and Other Asian women. Relative and attributable risks for APA women were comparable to those in BCRAT, but the AABCS model usually estimated lower-risk projections than BCRAT in Chinese and Filipino, but not in Hawaiian women, and not in every age and ethnic subgroup. The AABCS model underestimated absolute risk by 17% (95% confidence interval = 1% to 38%) in independent data from WHI, but APA women in the WHI had incidence rates approximately 18% higher than those estimated from the SEER program. The AABCS model was calibrated to ethnicity-specific incidence rates from the SEER program for projecting absolute invasive breast cancer risk and is preferable to BCRAT for counseling APA women.

Projecting Individualized Absolute Invasive Breast Cancer Risk in African American Women

The Breast Cancer Risk Assessment Tool of the National Cancer Institute (NCI) is widely used for counseling and determining eligibility for breast cancer prevention trials, although its validity for projecting risk in African American women is uncertain. We developed a model for projecting absolute risk of invasive breast cancer in African American women and compared its projections with those from the Breast Cancer Risk Assessment Tool. Data from 1607 African American women with invasive breast cancer and 1647 African American control subjects in the Women's Contraceptive and Reproductive Experiences (CARE) Study were used to compute relative and attributable risks that were based on age at menarche, number of affected mother or sisters, and number of previous benign biopsy examinations. Absolute risks were obtained by combining this information with data on invasive breast cancer incidence in African American women from the NCI's Surveillance, Epidemiology and End Results Program and with national mortality data. Eligibility screening data from the Study of Tamoxifen and Raloxifene (STAR) trial were used to determine how the new model would affect eligibility, and independent data from the Women's Health Initiative (WHI) were used to assess how well numbers of invasive breast cancers predicted by the new model agreed with observed cancers. Tables and graphs for estimating relative risks and projecting absolute invasive breast cancer risk with confidence intervals were developed for African American women. Relative risks for family history and number of biopsies and attributable risks estimated from the CARE population were lower than those from the Breast Cancer Risk Assessment Tool, as was the discriminatory accuracy (i.e., concordance). Using eligibility screening data from the STAR trial, we estimated that 30.3% of African American women would have had 5-year invasive breast cancer risks of at least 1.66% by use of the CARE model, compared with only 14.5% by use of the Breast Cancer Risk Assessment Tool. The numbers of cancers predicted by the CARE model agreed well with observed numbers of cancers (i.e., it was well calibrated) in data from the WHI, except that it underestimated risk in African American women with breast biopsy examinations. The CARE model usually gave higher risk estimates for African American women than the Breast Cancer Risk Assessment Tool and is recommended for counseling African American women regarding their risk of breast cancer.

Pathologic features of breast cancers in women with previous benign breast disease.

To compare pathologic features of the cancers arising after different types of benign breast disease (BBD), we reviewed the invasive breast cancer slides of 169 women with a previous benign biopsy result. Lesions were categorized previously as nonproliferative, proliferative without atypia, or atypical hyperplasia. Pathologic features of the cancers were evaluated without knowledge of the previous BBD category. Estrogen and progesterone receptor immunohistochemistry was performed on available tissue blocks. The median times between a benign result and cancer were 100, 124, and 92 months for women with nonproliferative lesions, proliferative lesions without atypia, and atypical hyperplasia, respectively. Cancers in the 3 groups did not differ significantly in tumor size, axillary lymph node status, or histologic grade, and there was no significant difference in the distribution of histologic types of breast cancer. Lymphatic vessel invasion, extensive intraductal component, and hormone receptor status did not differ among BBD categories. The pathologic features of breast cancers that develop in women with a previous benign biopsy result do not vary according to the histologic category of the previous BBD.

Fortgeschrittener Unterbauchtumor mit Aszites in der Schwangerschaft bei Gorlin-Goltz-Syndrom

Bei einer 19jährigen Erstgravida mit Gorlin-Goltz-Syndrom, einer seltenen erblichen Erkrankung (1:57000), die gehäuft rnit benignen, selten auch mit malionen Ovarialtumoren einhergeht, wurde in der 8. SSW retrouterin ein solider, stark vaskularisierter Tumor von knapp 10 cm Durchmesser festgestellt. Sonographisch gesteuerte Stanzbiopsien in der 9. SSW ergaben fibromuskuläres Gewebe. In den folgenden Wochen zeigte der Tumor rasche Wachstumstendenz und führte ab der 26, SSW bei subjektivem Wohlbefinden zu massivem Aszites. Pleuraergüssen und einem rechtsseitigen Harnstau II.-III.°. Trotz des benignen Biopsiebefundes und einer Punktionszytologie des Aszites ohne Nachweis maligner Zellen bestand in Anbetracht der raschen Größenzunahme, der ausgeprägten Ergußbildung und exzessiv angestiegener CA 12-5 Werte über 4000 U/ml der dringende Verdacht auf ein Malignom. Unter Abwägung mütterlicher und kindlicher Risiken wurde nach medikamentöser Lungenreifung mit Betamethason in der 29. SSW der elektive Kaiserschnitt per Längsschnittlaparotomie vorgenommen. mit Darm und Uterus verwachsene, ca. 20 cm große Tumor operativ entfernt. Histologisch ergab sich ein zellreiches, wahrscheinlich vom rechten Ovar ausgehendes Leiomyom mit größeren fibromatösen Anteilen. Anhand des Falles wird das diadächtigen Unterbauchtumoren in der Schwangerschaft diskutiert.