Frequency and characteristics of additionally detected ipsilateral breast lesions following recall at screening mammography. (December 2018) - Lameijer, Joost RC.
Abstract: Purpose: To determine the frequency and outcome of additionally detected ipsilateral breast abnormalities following recall at screening mammography. Methods and materials: We included a consecutive series of 130, 338 screening mammograms obtained between January 1, 2014 and January 1, 2016. During 2-year follow-up, clinical data were collected of all recalls. Women with a bilateral recall (115) and women recalled for multiple lesions in one breast (165) were excluded from the analyses. Screening outcome parameters were determined for recalled women with or without evaluation of additional ipsilateral breast abnormalities following recall. Results: A total of 3995 women were recalled (recall rate, 3.1%). In 258 (6.4%) of these women, another lesion was detected in the ipsilateral breast than the one for which she had been recalled. Biopsy was more frequently performed of additionally detected ipsilateral lesions than of recalled lesions (55.8% (144/258)) versus 39.7% (1375/3457), (p < 0.001)). The proportion of malignancy in recalled lesions and additionally detected lesions was comparable (21.5% (743/3457) versus 19.0% (49/258), p = 0.34). Of all 144 biopsies of additionally detected ipsilateral lesions, 9 revealed a synchronous tumour in addition to a malignant recalled lesion, and 33 biopsies revealed multicentric or multifocal tumours. In 5 women, the recalled lesion turned out to be benign, whereas the additional lesion in a different quadrant was malignant at biopsy. A total of 97 biopsies showed benign findings. Conclusion: A substantial proportion of women are analyzed for additional ipsilateral breast lesions following recall. These lesions are more frequently biopsied than recalled lesions, but have a comparable probability of being malignant. The majority of additionally detected cancerous lesions are part of multifocal or multicentric malignancies. Highlights: 6.7% of recalled women underwent evaluation of ipsilateral, non-recalled lesions. One out of 5 ipsilateral, non-recalled lesions proved malignant. Tumour stage and surgical treatment differed between screen-detected cancers and non-recalled, ipsilateral cancers. Most non-recalled malignant lesions were considered as part of multifocal or multicentric cancers. Additional imaging of the ipsilateral breast after unilateral recall may be required as additional breast cancers may be present.