News | August 05, 2013

Study Suggests Some Women with Abnormal Breast Lesions May be Able to Avoid Surgery

August 5, 2013 — Surgery is not always necessary for women with a type of breast tissue abnormality associated with a higher risk of cancer, according to a new study published online in the journal Radiology. Researchers said that periodic imaging and clinical exams are effective in these patients when radiology and pathology findings are benign and concordant, or in agreement.

Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are abnormal breast lesions that occasionally appear as incidental findings in breast biopsies. Women with ALH or LCIS have a four to 10 times higher risk of developing breast cancer, according to Michael A. Cohen, M.D., FACR, professor of radiology at the Emory University School of Medicine in Atlanta. As a result, it is often recommended that ALH and LCIS diagnosed on image-guided core biopsy be removed surgically. “Because of the possibility of upgrade to cancer, the bulk of the published literature says that the prudent thing to do is excise ALH and LCIS,” Cohen said.

But new research from Cohen, Kristen Atkins, M.D., and colleagues may alter that thinking. Atkins is a pathologist and associate professor at the University of Virginia in Charlottesville. At one time, Cohen and Atkins were colleagues there and had many discussions about balancing the risk of cancer in ALH and LCIS patients with the costs and potential complications of surgery.

“From a pathology perspective, ALH and LCIS are often very tiny lesions, so we wondered why they were getting excised,” Atkins said. “These surgeries may involve general anesthesia and possible disfigurement.”

The researchers studied 10 years of pathology and radiology data to look for a correlation between the number of ALH and LCIS cases that were upgraded to cancer after surgery or follow-up and the concordance between the radiologist and pathologist. The research yielded 50 cases from 49 women aged 40 to 73 years. Radiologist and pathologist findings were concordant in 43 of the 50 cases. None of the benign concordant cases were subsequently upgraded to cancer, strongly suggesting that observation in these patients would have been a viable alternative to surgery. Of the seven discordant cases, two were upgraded to ductal carcinoma in situ (DCIS) an early-stage, noninvasive form of breast cancer.

Cohen repeated the study after moving to Emory and found the same results. “When there’s no discordance between the radiologist and pathologist after thorough radiology-pathology correlation, there’s no upgrade from ALH or LCIS to cancer in our study,” Cohen said. “These findings show that some women can avoid surgery, and that yearly mammograms along with MRI [magnetic resonance imaging] or ultrasound as second-line screening tools may suffice.”

The researchers suggested their findings will help physicians and patients make informed decisions about ALH and LCIS.

For more information: http://radiology.rsna.org

Related Content

Transpara Deep Learning Software Matches Experienced Radiologists in Mammogram Reading
News | Computer-Aided Detection Software | January 12, 2018
Deep learning and artificial intelligence improves the efficiency and accuracy of reading mammograms, according to...
Fat Distribution in Women and Men Provides Clues to Heart Attack Risk
News | Women's Health | January 11, 2018
January 11, 2018 – It’s not the amount of fat in your body but where it is stored that may increase your risk for hea
Women Prefer Getting Mammograms Every Year
News | Mammography | January 09, 2018
Women prefer to get their mammograms every year, instead of every two years, according to a new study presented at the...
Planmed Clarity 2-D Digital Mammography System Receives FDA Approval
Technology | Mammography | January 08, 2018
The U.S. Food and Drug Administration (FDA) issued an approval letter for the Planmed Clarity 2-D full-field digital...
Overweight Women May Need More Frequent Mammograms
News | Mammography | January 04, 2018
Women with higher body mass index (BMI) face an increased risk of not detecting their breast tumor until it has become...
About 25 percent of screening patients and 60 percent of diagnostic patients do not have prior mammograms available for comparison at the time of their examinations due to the lack of interoperability or other restrictions preventing clinicians from accessing prior exams.

About 25 percent of screening patients and 60 percent of diagnostic patients do not have prior mammograms available for comparison at the time of their examinations due to the lack of interoperability or other restrictions preventing clinicians from accessing prior exams.

Feature | Breast Imaging | January 02, 2018 | Kathryn Pearson Peyton, M.D.
Sixty million women undergo regular screening mammography in the United States, but even in the digital age, it is di
Imagio Opto-Acoustic Breast Imaging System Helps Differentiate Tumor Subtypes
News | Oncology Diagnostics | January 02, 2018
Seno Medical Instruments Inc. (Seno Medical) recently reported data from their clinical study demonstrating that its...
Study Finds Link Between Breast Cancer Treatments and Cellular Aging Markers
News | Women's Health | January 02, 2018
January 2, 2018 — A new study found women who had received chemotherapy and/or...
ACR Appropriateness Criteria Adds and Revises Topics for December 2017
News | Clinical Decision Support | December 29, 2017
December 29, 2017 — Radiologists can enhance the quality and effectiveness of care with the newest release of the ACR
Double Black Announces Gemini Series Monitors for Multimodality and Digital Breast Imaging
Technology | Flat Panel Displays | December 28, 2017
December 28, 2017 — Double Black Imaging and their Image Systems Division are releasing their Gemini Series 6MP and 8
Overlay Init