This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weaver, D. L. Articles by Geller, B. M. Search for Related Content PubMed PubMed Citation Articles by Weaver, D. L. Articles by Geller, B. M.

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

¹ Department of Pathology, University of Vermont College of Medicine and Vermont Cancer Center, Health Science Complex, 89 Beaumont Avenue, Burlington, Vermont 05405-0068
² Department of Biostatistics, University of Vermont College of Medicine and Vermont Cancer Center, Hills Building, Burlington, Vermont 05405
³ Department of Health Promotion Research, University of Vermont College of Medicine and Vermont Cancer Center, 1 South Prospect Street, Burlington, Vermont 05405

Correspondence: Address correspondence and reprint requests to: Donald L. Weaver, MD; E-mail: donald.weaver{at}uvm.edu

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.

Key Words: Breast neoplasm • Invasive carcinoma • Ductal carcinoma-in-situ mammography • Breast imaging • Risk prediction

This article has been cited by other articles:

				E. S. Burnside, J. Davis, J. Chhatwal, O. Alagoz, M. J. Lindstrom, B. M. Geller, B. Littenberg, K. A. Shaffer, C. E. Kahn Jr, and C. D. Page Probabilistic Computer Model Developed from Clinical Data in National Mammography Database Format to Classify Mammographic Findings Radiology, June 1, 2009; 251(3): 663 - 672. [Abstract] [Full Text] [PDF]

				W. E. Barlow, E. White, R. Ballard-Barbash, P. M. Vacek, L. Titus-Ernstoff, P. A. Carney, J. A. Tice, D. S. M. Buist, B. M. Geller, R. Rosenberg, et al. Prospective breast cancer risk prediction model for women undergoing screening mammography. J Natl Cancer Inst, September 6, 2006; 98(17): 1204 - 1214. [Abstract] [Full Text] [PDF]