E5068. A Service Review of the Outcome of Screening Recalls of Well-Defined Solitary Lesions From the NHS Breast Screening Program
Authors
Javaria Aleem;
Sandwell and West Birmingham NHS Trust
Sandeela Sattar;
Sandwell and West Birmingham NHS Trust
Edward Goble;
Sandwell and West Birmingham NHS Trust
Objective:
This study aims to (1) review the imaging features, histopathological outcomes, and management for well-defined breast lesions recalled from the NHS Breast Screening Programme (NHSBSP); (2) determine the proportion of these lesions that yield clinically significant results; and (3) determine if consistent imaging features would have allowed some lesions to safely have not been recalled (optimize recall rate).
Materials and Methods:
This was a retrospective study of 112 patients who attended the assessment clinics from October 2021–March 2022. Exclusion criteria: previous history of cancer treatment. Data collection: NBSS and images reviewed on PACS. Histology results were obtained from the hospital system (CSS). Data were analyzed using SPSS (version 25) software.
Results:
The average age of patients was 60 years. The size range of the lesions was 4–54 mm. Most lesions were observed in the upper outer quadrant (34%); 51% of lesions were found in the right breast, and 49% in the left breast. Tomomammogram was performed in 61 (55%) cases. There were 19 (17%) cases in the prevalence screening, and 93 (83%) in the incidence screening. In the assessment clinic, 72 lesions were not biopsied, and 40 lesions were biopsied. Among 72 nonbiopsied lesions, 54 (48.2%) were cysts, five (4.5 %) were intramammary lymph nodes, one (0.8%) was lipoma, eight (7.1%) were composite, and four (3.5%) were skin lesions. The histology of 42 biopsied lesions revealed B1 (5%), B2 (52.5 %), B3 (25 %), B5a (5 %), and B5b (12.5%). The imaging score (I) on mammogram and ultrasound of nonbiopsied lesion was given I1 (6.3 %), I2 (54.5%), and I3 (3.6%). Imaging scores in biopsied lesions were I2 (12.5 %), I3 (19.6%), I4 (1.8 %) and I5 (1.8 %). Among 19 prevented screen cases, 10 were biopsied, and 18 had benign outcomes. Only one case was B3 on the histology for which stereo-guided, vacuum-assisted excision was performed. In the incident screen, 29 cases were biopsied, and 15 (13.4%) had benign histology. The characterization among different age group demonstrates benign nonbiopsied lesions were more recalled than biopsied lesions.
Conclusion:
Cysts accounted for a high percentage of well-defined lesions recalled. Biopsy was performed for 40 mass lesions; out of them, 23 masses had benign histopathology (B1, B2). Most of the first screens had benign outcomes (18/19 cases), due to a lack of comparison and low threshold, particularly in dense breasts. Sometimes there is a need for confirmation of benignity to rule out any underlying malignancy and detect any potential cancerous abnormalities. Data suggests we could become more accurate by reviewing the typical features of benign lesions and endeavoring to recall fewer lesions with typically benign features.
