Abstract
The aim of breast cancer screening is to decrease the number of deaths from breast cancer by detecting and treating cancers when they are small, when there is a low risk of metastatic spread and when treatment is most likely to be effective. The detection of small breast cancers continues to present challenges to mammography film readers and is dependent on specialist film reader training, ongoing audit and reader performance monitoring and high-quality digital images obtained with modern mammography equipment. In the UK screening programme, all screening mammograms are independently double read by trained film readers, and systematic audit of screening detected cancers demonstrates that 9 % of screen-detected cancers are detected by one reader only. Analysis of the mammographic features of such discordant read cancers is important in enabling film readers to be aware of the mammographic features which may be missed. Over 70 % of such cancers are small (less than 15 mm diameter), and the mammographic features include irregular and spiculate masses and clusters of microcalcification. Readers may fail to detect such lesions either on the craniocaudal or medial lateral oblique view, and histological analysis of the cancers shows no significant difference in distribution of tumour type compared to non-discordant read tumours.
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References
Quality assurance guidelines for breast cancer screening radiology second edition NHSBSP Publication No 59 March 2011 Editors Robin Wilson and Joyce Liston. NHS Cancer Screening Programmes
Quality assurance guidelines for breast cancer screening assessment third edition NHSBSP Publication No 49 June 2010 Editors Joyce Liston and Robin Wilson NHS Cancer Screening Programmes
Hackshaw AK, Wald NJ, Michell MJ, Field S, Wilson AR (2000) An investigation into why two-view mammography is better than one-view in breast cancer screening. Clin Radiol 15:454–458. doi:10.1053/crad.2000.0448
Cornford EJ et al (2005) The pathological and radiological features of screen-detected breast cancers diagnosed following arbitration of discordant double reading opinions. Clin Radiol 15:1182–1187. doi:10.1016/j.crad.2005.06.003
El-Sayed ME, Rakha EA, Reed J, Lee AH, Evans AJ, Ellis IO (2008) Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Histopathology 53(6):650–657
Quality assurance guidelines for surgeons in breast cancer screening. 2009. (Surgical guidelines for the management of breast cancer. Association of Breast Surgery at BASO. EJSO 2009; S1-S22). Edited by Mark Sibbering, Roger Watkins, John Winstanley and Julietta Patnick
Huber S, Wagner M, Medl M, Czembirek H (2003) Benign breast lesions: minimally invasive vacuum-assisted biopsy with 11-gauge needles—patient acceptance and effect on follow-up imaging findings. Radiology 226:783–790
Rakha EA, Lee AH, Jenkins JA, Murphy AE, Hamilton LJ, Ellis IO (2011) Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Int J Cancer 129(6):1417–1424
Buckley ES, Webster F, Hiller JE, Roder DM, Farshid G (2014) A systematic review of surgical biopsy for LCIS found at core needle biopsy – do we have the answer yet?. Eur J Surg Oncol 40(2):168–175
Hussain M, Cunnick GH (2011) Management of lobular carcinoma in-situ and atypical lobular hyperplasia of the breast – a review. Eur J Surg Oncol 37(4):279–289
Hwang H, Barke LD, Mendelson EB, Susnik B (2008) Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary. Mod Pathol 21(10):1208–1216
Verschuur-Maes AH, van Deurzen CH, Monninkhof EM, van Diest PJ (2012) Columnar cell lesions on breast needle biopsies: is surgical excision necessary? A systematic review. Ann Surg 255(2):259–265
Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA Jr, Finkelstein SI, Shepard MJ (1999) Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 210(3):799–805
Brenner RJ, Jackman RJ, Parker SH, Evans WP 3rd, Philpotts L, Deutch BM, Lechner MC, Lehrer D, Sylvan P, Hunt R, Adler SJ, Forcier N (2002) Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol 179(5):1179–1184
Eiada R, Chong J, Kulkarni S, Goldberg F, Muradali D (2012) Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol 198(2):264–271
Page DL, Salhany KE, Jensen RA, Dupont WD (1996) Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer 78:258–266
Rakha EA, Shaaban AM, Haider SA, Jenkins J, Menon S, Johnson C, Yamaguchi R, Murphy A, Liston J, Cornford E, Hamilton L, James J, Ellis IO, Lee AHS (2013) Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology 62:894–898
Rakha EA, Ho BC, Naik V, Sen S, Hamilton LJ, Hodi Z, Ellis IO, Lee AH (2011) Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia. Histopathology 58(4):626–632
Green S, Khalkhali I, Azizollahi E, Venegas R, Jalil Y, Dauphine C (2011) Excisional biopsy of borderline lesions after large bore vacuum-assisted core needle biopsy – is it necessary? Am Surg 77(10):1358–1360
Bianchi S, Caini S, Renne G, Cassano E, Ambrogetti D, Cattani MG, Saguatti G, Chiaramondia M, Bellotti E, Bottiglieri R, Ancona A, Piubello Q, Montemezzi S, Ficarra G, Mauri C, Zito FA, Ventrella V, Baccini P, Calabrese M, Palli D (2011) Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. VANCB Study Group. Breast 20(3):264–270
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Michell, M.J. (2016). Current Challenges in Mammography Screening and Diagnostic Assessment. In: Hodler, J., Kubik-Huch, R., von Schulthess, G. (eds) Diseases of the Brain, Head and Neck, Spine 2016-2019. Springer, Cham. https://doi.org/10.1007/978-3-319-30081-8_36
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