title: Lesion and patient characteristics associated with malignancy after a probably benign finding on community practice mammography.
abstract: OBJECTIVE
  The purpose of this study was to identify patient and lesion characteristics associated with a diagnosis of breast malignancy within 3 years of having a probably benign finding (BI-RADS category 3) on a mammogram obtained in a community radiology practice.
  
  
  METHODS
  The subjects were women 30 years old and older without breast implants or previous breast cancer who received notice of a probably benign finding on a bilateral screening mammogram between January 1, 1996, and June 30, 1999, in a community-based practice. From 82,898 mammograms, we identified 129 breast lesions designated probably benign that progressed to malignancy within 3 years of an index examination (cases) and matched them to 129 lesions designated probably benign that did not progress to malignancy within 3 years (controls). A breast imaging specialist blinded to case-control status interpreted all examinations and recorded detailed lesion descriptors according to the BI-RADS lexicon.
  
  
  RESULTS
  Case lesions were more likely in patients who were older, postmenopausal, or had a strong family history of breast cancer or previous biopsy. The lesions were more likely masses with obscured, indistinct, or spiculated margins compared with control lesions (84.6% vs 66%, p = 0.03). Case lesions were more likely calcifications (29.5% vs 17.8%, p = 0.03). No cases were encountered among calcifications considered typically benign in the BI-RADS lexicon (vascular or coarse), and no controls were encountered among calcifications considered suspicious or highly suggestive of malignancy in the BI-RADS lexicon (amorphous, pleomorphic, branching, and fine linear) (p < 0.0001).
  
  
  CONCLUSIONS
  In community practice, patient and lesion mammographic characteristics can be predictive of the likelihood of a subsequent cancer diagnosis of mammographic lesions designated as probably benign. Careful evaluation of mass margins and of the morphologic features of calcifications can help distinguish a malignant lesion from a probably benign finding.
authors.affiliation: Department of Radiology, University of Washington Medical Center, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, G2-600, PO Box 19023, Seattle, WA 98109-1023, USA. lehman@u.washington.edu
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.forename: Peter R
authors.initials: PR
authors.lastname: Eby
authors.forename: Emily
authors.initials: E
authors.lastname: White
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology