Skip to main content
SpringerLink
Log in

Predicting Biopsy Outcome After Mammography: What Is the Likelihood the Patient Has Invasive or In Situ Breast Cancer?

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

As many as 1,000,000 breast biopsies are performed annually in the United States. Although substantial effort has been devoted to estimating breast cancer risk, there have been no studies to predict outcome in women undergoing breast biopsy.

Methods

A population-based study was undertaken to develop and test models for predicting the probability of invasive breast cancer and/or ductal carcinoma-in-situ in 7670 women undergoing breast biopsy after mammography. Logistical prediction models were developed by using data from 6129 randomly selected women and tested with data from the remaining women.

Results

The overall cancer prevalence among women undergoing biopsy was 22.4%. Prevalence in women with mammograms highly suggestive of malignancy (category 5) was 84.6%, with minimal variation in individual cancer probabilities due to age. A total of 24.6% of women with suspicious mammograms (category 4) had cancer, but individual probability estimates ranged from .01 to .86, depending on age, presence of a lump, previous biopsy, menopausal status, and use of postmenopausal hormone therapy. These variables also influenced biopsy outcome in women with other mammography assessments (categories 0–3), but the overall prevalence was lower (8.6%), and estimated probabilities ranged from .01 to .45. When cancer was present, the probability of invasive disease was influenced by mammogram assessment category, absence of mammogram calcifications, and presence of a lump.

Conclusions

The probabilities of invasive cancer and ductal carcinoma-in-situ in women undergoing biopsy can be more accurately predicted by using clinical characteristics in addition to mammography findings. This information could potentially influence decisions regarding immediate biopsy or continued surveillance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Burns RP. Image-guided breast biopsyAm J Surg 1997;173:9–11

    Google Scholar 

  2. Hall JA, Murphy DC, Hall BR, Hall KA. Open surgical biopsy for nonpalpable mammographic abnormalities: still an option compared with core needle biopsy. Am J Obstet Gynecol 1998;178:1245–50

    Google Scholar 

  3. Poplack SP, Tosteson AN, Grove MR, Wells WA, Carney PA. Mammography in 53,803 women from the New Hampshire Mammography Network. Radiology 2000;217:832–40

    Google Scholar 

  4. Brett J, Austoker J, Ong G. Do women who undergo further investigation for breast screening suffer adverse psychological consequences? A multi-centre follow-up study comparing different breast screening result groups five months after their last breast screening appointment. J Public Health Med 1998;20:396–403

    Google Scholar 

  5. Gram IT, Lund E, Slenker SE. Quality of life following a false positive mammogram. Br J Cancer 1990;62:1018–22

    Google Scholar 

  6. Lerman C, Trock B, Rimer BK, Boyce A, Jepson C, Engstrom PF. Psychological and behavioral implications of abnormal mammogramsAnn Intern Med 1991;114:657–61

    Google Scholar 

  7. D’Orsi CJ, Bassett LW, Feig SA, et al. Illustrated Breast Imaging Reporting and Data System: Illustrated BI-RADS™. 3rd ed. Reston, VA: American College of Radiology, 1998

  8. Liberman L, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD. The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol 1998;171:35–40

    Google Scholar 

  9. Orel SG, Kay N, Reynolds C, Sullivan DC. BI-RADS categorization as a predictor of malignancy. Radiology 1999;211:845–50

    Google Scholar 

  10. Geller BM, Worden JK, Ashley JA, Oppenheimer RG, Weaver DL. Multipurpose statewide breast cancer surveillance system: the Vermont experience. J Registry Manage 1996;23:168–74

    Google Scholar 

  11. Hilsenbeck SG. Quality control. In: Menck H, Smart C, eds. Central Cancer Registries: Design, Management, and Use. Chur, Switzerland: Harwood Academic Publishers, 1994

  12. Osius G, Rojek D. Normal goodness-of-fit tests for multinomial models with large degrees of freedom. J Am Stat Assoc 1992;87:1145–52

    Google Scholar 

  13. Rosenberg RD, Lando JF, Hunt WC, et al. The New Mexico Mammography Project: screening mammography performance in Albuquerque, New Mexico, 1991 to 1993. Cancer 1996;78:1731–9

    Google Scholar 

  14. Fuhrman GM, Cederbom GJ, Bolton JS, et al. Image-guided core-needle biopsy is an accurate technique to evaluate patients with nonpalpable imaging abnormalities. Ann Surg 1998;227:932–9

    Google Scholar 

  15. Liberman L. Percutaneous image-guided core breast biopsy. Radiol Clin North Am 2002;40:483–500

    Google Scholar 

Download references

Acknowledgments

  Supported by a grant (UO1-CA70013) from the National Cancer Institute.

Author information

Authors and Affiliations

  1. Department of Pathology, University of Vermont College of Medicine and Vermont Cancer Center, Health Science Complex, 89 Beaumont Avenue, Burlington, Vermont, 05405-0068

    Donald L. Weaver MD

  2. Department of Biostatistics, University of Vermont College of Medicine and Vermont Cancer Center, Hills Building, Burlington, Vermont, 05405

    Pamela M. Vacek PhD & Joan M. Skelly MS

  3. Department of Health Promotion Research, University of Vermont College of Medicine and Vermont Cancer Center, South Prospect Street, Burlington, Vermont, 05405

    Berta M. Geller EdD

Authors
  1. Donald L. Weaver MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pamela M. Vacek PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joan M. Skelly MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Berta M. Geller EdD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donald L. Weaver MD.

Additional information

The views expressed in this article are solely those of the authors and do not necessarily represent the official views of the National Cancer Institute or the Federal government.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weaver, D.L., Vacek, P.M., Skelly, J.M. et al. Predicting Biopsy Outcome After Mammography: What Is the Likelihood the Patient Has Invasive or In Situ Breast Cancer?. Ann Surg Oncol 12, 660–673 (2005). https://doi.org/10.1245/ASO.2005.09.008

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2005.09.008

Key Words

Search

Navigation