The significance of circumscribed malignant mammographic masses in the surveillance of BRCA 1/2 gene mutation carriers.
Breast cancers in gene mutation carriers may escape mammographic detection because of rapid growth and tumor expansion. Therefore, they may mimic benign lesions on the mammogram. Twenty-nine BRCA 1/2 mutation carriers under surveillance developed 31 breast cancers between 1994 and 2001 at a mean age of 44.2 years. Controls were 63 women with 67 breast cancers in the same period at a mean age of 53.8 years, also under surveillance because of a life time risk of at least 15%. In 26% of the carriers vs. 48% of the controls, mammography was the method that first suspected a malignancy. Seven radiologists performed a retrospective review of the original mammograms to establish technical assessment, with special attention for circumscribed lesions and estimated probability of malignancy. In the mutation carriers seven (23%) circumscribed non-calcified mammographic masses were found and three in the controls (4.5%) P=0.01. These masses were proven to be malignant. In both groups around 70% of these fast-growing circumscribed lesions were detected by the patients. The masses were situated in breasts with a good interpretable breast pattern. BRCA 1/2 mutation carriers had a significantly higher percentage of circumscribed non-calcified mammographic masses that proved to be malignant. These mammographic lesions in women at high risk should be described as at least Birads 0 and worked-up with ultrasound and needle biopsy.
Kaas
R
R
Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek ziekenhuis, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. r.kaas@nki.nl
Kroger
R
R
Hendriks
J H C L
JH
Besnard
A P E
AP
Koops
W
W
Pameijer
F A
FA
Prevoo
W
W
Loo
C E
CE
Muller
S H
SH
D000328:Adult; D000368:Aged; D001706:Biopsy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006580:Genetic Carrier Screening; D006801:Humans; D008297:Male; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D011159:Population Surveillance; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013679:Technology, Radiologic; D016217:Ultrasonography, Mammary