title: Surgical outcomes of borderline breast lesions detected by needle biopsy in a breast screening program.
abstract: BACKGROUND
  The Australian Capital Territory and South East New South Wales branch of BreastScreen Australia (BreastScreen ACT&SENSW) performs over 20,000 screening mammograms annually. This study describes the outcome of surgical biopsies of the breast performed as a result of a borderline lesion being identified after screening mammography and subsequent workup.A secondary aim was to identify any parameters, such as a family history of breast cancer, or radiological findings that may indicate which borderline lesions are likely to be upgraded to malignancy after surgery.
  
  
  METHODS
  From a period of just over eight years, all patients of BreastScreen ACT&SENSW who were diagnosed with a borderline breast lesion were identified. These women had undergone needle biopsy in Breastscreen ACT&SENSW and either atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), atypical lobular hyperplasia (ALH), radial scar/complex sclerosing lesion, papillary lesion, mucocoele-like lesion (MLL) or lobular carcinoma in situ (LCIS) was found. Final outcomes for each type of borderline lesion after referral for surgical biopsy were recorded and analysed. Results of the surgical biopsy were compared to the type of needle biopsy and its result, radiological findings and family history status.
  
  
  RESULTS
  Of the 94 surgical biopsies performed due to the presence of a borderline breast lesion, 20% showed benign pathology, 55% remained as borderline lesions, 17% showed non-invasive malignancy and 7% showed invasive malignancy. VALCS biopsy was the most common needle biopsy method used to identify the lesions in this study (76%). Malignant outcomes resulted from 24% of the surgical biopsies, with the most common malignant lesion being non-comedo ductal carcinoma in situ (DCIS). The most common borderline lesion for which women underwent surgical biopsy was ADH (38%). Of these women, 22% were confirmed as ADH on surgical biopsy and 47% with a malignancy.
  
  
  CONCLUSIONS
  Further research is required to determine whether characteristics of the mammographic lesion (particularly calcification patterns), the area targeted for biopsy and number of core samples retrieved, can indicate a closer correlation with eventual pathology. This study identified no findings in the diagnostic assessment that could exclude women with borderline lesions from surgical biopsy.
authors.affiliation: Australian National University, Medical School, The Canberra Hospital, Woden, ACT, Australia. karen.flegg@anu.edu.au
authors.forename: Karen M
authors.initials: KM
authors.lastname: Flegg
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Flaherty
authors.forename: Anne M
authors.initials: AM
authors.lastname: Bicknell
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Jain
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D009517:New South Wales; D016896:Treatment Outcome
references.citation: Hum Pathol. 2003 Mar;34(3):234-9
references.pmid: 12673557
references.citation: N Engl J Med. 1999 Feb 11;340(6):430-6
references.pmid: 9971867
references.citation: Am J Surg Pathol. 2007 Mar;31(3):417-26
references.pmid: 17325484
references.citation: Eur J Radiol. 2005 Apr;54(1):62-71
references.pmid: 15797294
references.citation: AJR Am J Roentgenol. 2006 Oct;187(4):949-54
references.pmid: 16985141
references.citation: Cancer. 2003 Jan 15;97(2):345-51
references.pmid: 12518358
references.citation: Am J Surg Pathol. 2002 Sep;26(9):1095-110
references.pmid: 12218567
references.citation: Cancer. 2007 Jan 15;109(2):180-7
references.pmid: 17154175
references.citation: Arch Surg. 2000 Jun;135(6):700-3
references.pmid: 10843367
references.citation: Br J Cancer. 2007 Apr 23;96(8):1253-7
references.pmid: 17438578
references.citation: Pathology. 2002 Oct;34(5):410-6
references.pmid: 12408338
references.citation: Am J Surg. 2006 Oct;192(4):534-7
references.pmid: 16978969
references.citation: Hum Pathol. 2007 Jan;38(1):35-41
references.pmid: 17095049
references.citation: Am J Surg Pathol. 2005 Apr;29(4):534-43
references.pmid: 15767810
references.citation: Ann Surg Oncol. 2007 Feb;14(2):704-11
references.pmid: 17151788
references.citation: Histopathology. 2004 Aug;45(2):148-54
references.pmid: 15279633
references.citation: Radiology. 1999 Mar;210(3):799-805
references.pmid: 10207484
references.citation: Histopathology. 2007 Apr;50(5):607-14
references.pmid: 17394497
references.citation: Radiology. 2004 Jun;231(3):813-9
references.pmid: 15105449
references.citation: Adv Anat Pathol. 2003 May;10(3):113-24
references.pmid: 12717115
references.citation: Breast. 2002 Jun;11(3):215-20
references.pmid: 14965670