Department of Surgery, Comprehensive Breast Center, The Bryn Mawr Hospital, Bryn Mawr, PA, USA.
Ann Surg Oncol. 2013 Oct;20(10):3163-8. doi: 10.1245/s10434-013-3114-3. Epub 2013 Aug 22.
Current National Comprehensive Cancer Network guidelines recommend repeat imaging 6-12 months after a benign radiologic-pathologic concordant image-guided breast biopsy. We hypothesized that interval imaging <12 months after benign concordant biopsy has a low cancer yield and increases health care costs.
An institutional review board-approved retrospective chart review identified 689 patients who underwent image-guided breast biopsy at Bryn Mawr Hospital between January and December 2010. Charts were evaluated for documentation of radiologic-pathologic concordance.
Of 689 patients, 188 (27 %) had malignant pathology, 3 (0.4 %) had nonbreast pathology, and 498 (72.3 %) had benign pathology. Of 498 patients with benign findings, 44 (8.8 %) underwent surgical excision as a result of discordance, atypia, papillary lesion, or other benign finding. Of the remaining 454 patients who did not undergo excision, 337 (74.2 %) had documented radiologic-pathologic concordance. Interval imaging <12 months after benign biopsy was obtained in 182 (54.0 %) concordant patients. Five (2.7 %) patients had suspicious [American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) 4] findings on follow-up imaging. Only one breast cancer was identified, representing 0.5 % (95 % confidence interval 0-3.4) of all benign concordant patients undergoing interval imaging. The cost of detecting a missed cancer with interval imaging after benign concordant biopsy was $41,813.77 in this cohort.
Interval imaging performed <12 months after benign concordant breast biopsy demonstrated a low yield for the detection of breast cancer and resulted in increased health care costs. Our data support the policy for discontinuation of routine interval imaging after benign concordant biopsy.
目前，美国国家综合癌症网络指南建议在良性影像学-病理学一致的影像引导乳腺活检后 6-12 个月进行重复影像学检查。我们假设，在良性一致活检后 <12 个月进行间隔成像的癌症检出率较低，且会增加医疗保健成本。
经机构审查委员会批准的回顾性图表审查，确定了 2010 年 1 月至 12 月期间在布林莫尔医院接受影像引导乳腺活检的 689 名患者。对图表进行了评估，以确定影像学-病理学一致性的记录情况。
在 689 名患者中，188 名（27%）患者的病理学检查结果为恶性，3 名（0.4%）患者的病理学检查结果为非乳腺疾病，498 名（72.3%）患者的病理学检查结果为良性。在 498 名良性发现的患者中，由于不一致、非典型、乳头状病变或其他良性发现，44 名（8.8%）患者进行了手术切除。在其余 454 名未进行切除的患者中，337 名（74.2%）患者的影像学-病理学一致性有记录。在 182 名（54.0%）良性活检结果一致的患者中，进行了 <12 个月的间隔影像学检查。在随访影像学检查中，有 5 名（2.7%）患者发现可疑（美国放射学院乳腺成像报告和数据系统（BI-RADS）4 类）表现。仅发现 1 例乳腺癌，占所有接受间隔成像的良性一致患者的 0.5%（95%置信区间 0-3.4）。在该队列中，用间隔成像检测良性一致活检后漏诊癌症的成本为 41,813.77 美元。
在良性一致的乳腺活检后 <12 个月进行间隔成像的检出率较低，乳腺癌的检出率较低，且会增加医疗保健成本。我们的数据支持在良性一致活检后停止常规间隔成像的政策。
