title: Minimal invasive biopsy results of "uncertain malignant potential" in digital mammography screening: high prevalence but also high predictive value for malignancy.
abstract: OBJECTIVE
  To evaluate the rate, the histological spectrum and the positive predictive value (PPV) for malignancy of minimally invasive biopsies with "uncertain malignant potential (B3)" in digital mammography screening.
  
  
  METHODS
  Consecutive data of 37,178 participants of one digital unit of the German screening program were included.
  
  
  RESULTS
  The B 3 rate was 15.1 % (148 / 979). The frequencies of lesion subtypes were as follows: atypical epithelial proliferation of ductal type (AEPDT) 35.1 % (52 / 148), radial scar (RS) 28.4 % (42 / 148), papillary lesions (PAP) 20.3 % (30 / 148), lobular carcinoma in situ 8.8 % (13 / 148), flat epithelial atypia 5.4 % (8 / 148), and mucocele-like lesions 2.0 % (3 / 148). The PPV for malignancy in surgical excisions was overall 0.28 (25 / 91); in detail 0.40 (19 / 47) for AEPDT, 0.20 (5 / 25) for RS, 0.08 (1 / 12) for PAP.
  
  
  CONCLUSIONS
  Despite a higher B 3 rate of minimally invasive biopsies with "uncertain malignant potential" in digital screening, the benign surgical biopsy rate is not disproportionally increased compared with analog screening programs. Together with defined management protocols, this results in an increased cancer detection rate per screening participant with surgical excision.
authors.affiliation: Institut für Klinische Radiologie, Universitätsklinikum Münster. weigels@uni-muenster.de
authors.forename: S
authors.initials: S
authors.lastname: Weigel
authors.forename: T
authors.initials: T
authors.lastname: Decker
authors.forename: E
authors.initials: E
authors.lastname: Korsching
authors.forename: C
authors.initials: C
authors.lastname: Biesheuvel
authors.forename: A
authors.initials: A
authors.lastname: Wöstmann
authors.forename: W
authors.initials: W
authors.lastname: Böcker
authors.forename: D
authors.initials: D
authors.lastname: Hungermann
authors.forename: K
authors.initials: K
authors.lastname: Roterberg
authors.forename: J
authors.initials: J
authors.lastname: Tio
authors.forename: W
authors.initials: W
authors.lastname: Heindel
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D002114:Calcinosis / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010212:Papilloma / Q000473:pathology*; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity