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Performance of a clinical and imaging-based multivariate model as decision support tool to help save unnecessary surgeries for high-risk breast lesions

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions.

Methods

In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our institution between July 1, 2014-July 1, 2017. Lesions were categorized high-risk-I (HR-I = atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ and atypical papillary lesion) and II (HR-II = Flat epithelial atypia, radial scar, benign papilloma). Patient risk factors, lesion features, detection and biopsy modality, excision and cancer upgrade rates were collected. Reference standard for upgrade was either excision or at least 2-year imaging follow-up. Multiple logistic regression analysis was performed to develop a multivariate model using HRL type, lesion and biopsy needle size for surgical cancer upgrade with performance assessed using ROC analysis.

Results

Of 699 HRL in 652 patients, 525(75%) had reference standard available, and 48/525(9.1%) showed cancer at surgical excision. Excision (84.5% vs 51.1%) and upgrade (17.6%vs1.8%) rates were higher in HR-I compared to HR-II (p < 0.01). In HR-I, small needle size < 12G vs ≥ 12G [32.1% vs 13.2%, p < 0.01] and less cores [< 6 vs ≥ 6, 28.6%vs13.7%, p = 0.01] were significantly associated with higher cancer upgrades. Our multivariate model had an AUC = 0.87, saving 28.1% of benign surgeries with 100% sensitivity, based on HRL subtype, lesion size(mm, continuous), needle size (< 12G vs ≥ 12G) and biopsy modality (US vs MRI vs stereotactic)

Conclusion

Our multivariate model using lesion size, needle size and patient age had a high diagnostic performance in decreasing unnecessary surgeries and shows promise as a decision support tool.

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Abbreviations

HRL:

High-risk breast lesions

HR-I:

High-risk I group

HR-II:

High-risk II group

ADH:

Atypical ductal hyperplasia

ALH:

Atypical lobular hyperplasia

LCIS:

Lobular carcinoma in situ (LCIS)

FEA:

Flat epithelial atypia

RS:

Radial scar

DCIS:

Ductal Carcinoma in Situ

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Authors and Affiliations

  1. Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Dogan S. Polat, Jennifer G. Schopp, Firouzeh Arjmandi, Jessica Porembka, Yin Xi & Basak E. Dogan

  2. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Venetia Sarode

  3. Department of Surgery, Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Deborah Farr

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Appendix

Appendix

See Table

Table 5 Association of patient history, mammographic density, lesion detection mode, size, biopsy parameters and high-risk lesion types with surgical excision in 699 lesions in 620 women
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5,

Table 6 Clinicopathological features of 48 cancers identified in 47 women at surgical excision
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6,

Table 7 Features of radial scar, flat epithelial atypia and benign papilloma (HR-II) lesions that upgraded to breast cancer (n = 5)
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7,

Table 8 Association of patient characteristics, lesion and biopsy parameters with cancer upgrade (including DCIS) in 245 excised *HR-I lesions identified in 221 women with reference standards
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8,

Table 9 Diagnostic performance of multivariate regression models with differing end points to detect cancer in training data set(525 high-risk lesions diagnosed in 487 women)
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9,

Table 10 Surgery rates for cancers and benign lesions based on sensitivities and specificities of Model A
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10.

See Fig. 

Fig. 2
figure 2

High-risk lesions eligible for analysis identified in 727 women

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2.

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Polat, D.S., Schopp, J.G., Arjmandi, F. et al. Performance of a clinical and imaging-based multivariate model as decision support tool to help save unnecessary surgeries for high-risk breast lesions. Breast Cancer Res Treat 185, 479–494 (2021). https://doi.org/10.1007/s10549-020-05947-1

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